Journal of Education and Health Promotion

Abstract BACKGROUND: Despite new anticoagulants’ developments, warfarin is still one of the most
commonly used medicines, particularly in the cardiovascular system. One of the significant challenges
with warfarin is the prevalence of dangerous side effects such as bleeding and drug and food
interactions, which can negatively affect patients if not adequately controlled. As health‑care team
members, nurses have a crucial role in prescribing this medicine and educating patients. In this
regard, this study was conducted to determine the knowledge and practice of nurses working in the
cardiovascular wards regarding warfarin.
MATERIALS AND METHODS: In this cross‑sectional, descriptive study, knowledge and practice
of 239 nurses working in the cardiovascular wards of teaching hospitals affiliated to Iran University
of Medical Sciences have been investigated using European Cardiovascular Nurses Knowledge
questionnaire on anticoagulants and the checklist for high‑risk drugs safety instructions. The sampling
was performed through the stratified sampling method with proportional allocation. Data were analyzed
using the SPSS software version 16 through descriptive and inferential statistics (independent t‑test,
one‑way analysis of variance, and Pearson correlation coefficient) (Inc., Chicago, IL, USA).
RESULTS: The mean scores of knowledge (18.51 ± 3.87) and practice (10.53 ± 2.12) were
slightly higher than the median, and the lowest mean score was related to knowledge on drug
interactions (7.62). The practice had a statistically significant relationship with knowledge (P ˂ 0.001).
Regarding demographic variables, there was a statistically significant relationship between nurses’
knowledge and the education level (P = 0.009) and nurses’ practice and age (P = 0.022), work
experience (P = 0.032), and work experience in cardiovascular wards (P = 0.036).
CONCLUSIONS: Based on the findings of this study, the knowledge of nurses working in the
cardiovascular wards about warfarin was not sufficient, and their practice was of poor quality. Nurses’
lack of knowledge and improper practice can jeopardize drug safety in patients and cause serious
side effects such as bleeding. Proper training of nursing students and nurses about warfarin as a
high‑risk drug, its side effects, and drug‑food interactions, and the emphasis on patient education in
patients receiving this medicine can effectively reduce the incidence of side effects.

Abstract BACKGROUND: The coronavirus disease‑2019 (COVID‑19) crisis has changed many aspects of 
frontline nurses’ lives. Nurses caring for patients with COVID‑19 reported experiencing significant 
psychological distress and work‑related anxiety. This study aimed to assess the perceived stress 
and quality of life among frontline nurses fighting against COVID‑19.
MATERIALS AND METHODS: This web‑based cross‑sectional study was conducted on 322 
frontline nurses fighting against COVID‑19 in hospitals affiliated to Mazandaran University of Medical 
Sciences. Data were collected using the two following online questionnaires: the Perceived Stress 
Scale and World Health Organization Quality of Life-Brief. Data were compiled from October 23, 
2020, to November 25, 2020. Data were analyzed using the independent sample t‑test, Pearson’s 
correlation test, and regression analysis test in the SPSS‑21.
RESULTS: Average perceived stress scores was 30.27 (standard deviation [SD] = 7.01). Average 
quality of life subscale scores consist of physical health, psychological health, social relationships, and 
environment were 57.71 (SD = 12.74), 44.3 (SD = 15.58), 45.61 (SD = 16.99), and 47.6 (SD = 18.11), 
respectively. There was an inverse significant association between all the subscales of quality of life 
and perceived stress (P = 0.008). Based on the multiple linear regression analysis, the variables 
of age, gender, marital status, and perceived stress were the significant predictors of quality of life 
subscales.
CONCLUSIONS: Paying serious attention to addressing the concerns of frontline nurses, especially 
those who are at high risk, is necessary. It is recommended to take action as soon as possible to 
reduce the perceived stress and improve quality of life on nurses who care for patients with COVID‑19.

Abstract BACKGROUND: Since poor communication with the patient has a negative impact on the quality of 
nursing care, taking the necessary measures to strengthen the relationship with the patient seems 
necessary. This study was conducted to determine the effect of spiritual intelligence training on 
nurses’ skills for communicating with patients.
MATERIALS AND METHODS: This experimental study with the control group and the pretest‑posttest 
design was conducted on 70 nurses working in Imam Khomeini Hospital, Mahabad, in 2019. 
Randomized stratified sampling was used to recruit participants. Then, participants were randomly 
assigned to the two groups of control and intervention. The demographic information form and the 
patient‑nurse communication skill questionnaire were used to collect the data. For the intervention 
group, 7 spiritual intelligence training sessions were held as a workshop in 2 months. Two weeks 
and a month after the intervention, both groups completed the questionnaires. Data were analyzed 
with the SPSS software version 17.0.
RESULTS: The findings showed that the mean communication skill scores in the intervention group 
before training were 44.71 ± 7.62, which significantly increased to 66.22 ± 8.43 2 weeks after training. 
Bonferroni multiple comparisons showed the mean communication skill scores significantly increased 
before, 2 weeks later and in the follow‑up phase in the intervention group (P < 0.001).
CONCLUSION: Spiritual intelligence training is effective in improving the communication skills of 
nurses. It is recommended that the prepared content can be provided to in‑service training units; 
consequently, nurses can improve their communication skills by individual and group learning.

Abstract BACKGROUND: Nurses are in close contact with COVID‑19 patients and due to the high risk of 
infection, they experience fear and anxiety that can result in burnout. This study aimed to review the 
studies on burnout among nurses during the COVID‑19 epidemic.
MATERIALS AND METHODS: The study followed the guideline for Preferred Reporting Items 
for Systematic Review and Meta‑analysis (PRISMA). Using the keywords: “burnout,” “nurse,” and 
“COVID‑19” and with the help of Boolean operators, “AND” and “OR” the online databases, namely 
PubMed, Scopus, Google Scholar, Web of Science, and Science Direct were searched. Articles 
published from the first of February 2020 to 30 October, 2020 were retrieved. After the quality 
appraisal, the required data were extracted and analyzed.
RESULTS: Out of 85 articles identified in the initial search, and after removing duplicates and those 
that did not have the required data, seven articles entered the analysis. Among these articles, 
four (57.14%) reported moderate burnout and three articles (42.86) reported high level of burnout 
among nurses during the COVID‑19 pandemic.
CONCLUSIONS: A majority of the studies reported that nurses experienced a moderate level of 
burnout during the COVID‑19 pandemic. Given the prevalence of burnout in nurses and because 
nurses are the largest portion of the healthcare providers who are in close contact with patients 
infected by COVID‑19, it is necessary for health care policymakers to adopt strategies for preventing 
or reducing burnout among nurses.

Abstract BACKGROUND: The health reform plan (HRP) is a plan to improve Iran’s health systems that began 
in 2014. The three main approaches of this plan include financial protection of the people, creating 
justice in access to health services, and improving the quality of services. It predicted that the level 
of health system responsiveness would increase. Achieving this goal is possible only with the correct 
implementation. The best people to measure the correct implementation are nurses, midwives, 
and physicians. Hence, this study was conducted to assess the attitude of nurses, midwives, and 
physicians about the implementation of the HRP.
MATERIALS AND METHODS: This cross‑sectional descriptive study was conducted in educational 
hospitals of Jahrom University of Medical Sciences in 2020. By convenience sampling method, 325 
nurses, midwives, and physicians participated in this study. Sampling was done in all work shifts, and 
in all wards. A researcher‑making questionnaire was used to collect data. The scoring did by the Likert 
scale from (completely agree = 4 to completely disagree = 1). Quantitative and qualitative face and 
content validity was calculated (IS: 0.84, CVI: 0.92, CVR: 0.87), and its reliability was calculated by 
Cronbach’s alpha method (0.78). The data were analyzed by SPSS software version 16. Descriptive 
statistics, Mann–Whitney U‑test, and Kruskal–Wallis test were used for the data analysis (P ≤ 0.05).
RESULTS: In the study, 90.15% agreed with the implementation of the HRP. There was no significant 
difference between the male and female (P = 0.063). There was a significant difference between the 
educational degree (P = 0.006), married and the single participants’ attitude (P = 0.003), the nurses, 
midwives, and physicians (P = 0.001).
CONCLUSION: HRP is more successful in the field of financial protection, so policymakers should 
pay more attention to justice in access to health services and improving the quality of services fields.

Abstract BACKGROUND: Health‑care providers, including physicians and nurses, are vital resources of the
health‑care system, and their health is essential to ensure safe care and to control outbreaks in the
community. The aim of this study was to explore the experiences of physicians and nurses infected
with COVID‑19.
MATERIALS AND METHODS: This descriptive exploratory qualitative study was conducted in 2020.
To conduct this study, 19 participants (5 physicians and 14 nurses) were selected using purposive
sampling. Data were collected using semi‑structured interviews. Data analysis was performed using
conventional content analysis.
RESULTS: Eight main categories of “Fear and anxiety,” “Fighting against COVID‑19,” “Feeling
abandoned during home quarantine period,” “Denial of disease despite testing positive,” “Recovery:
the second opportunity,” “Imposition of psychological burden after returning to work,” “Promotion of the
health professional perception,” and “Promising supportive resources,” as well as 21 subcategories,
were extracted from the participants’ experiences.
CONCLUSION: The experiences of physicians and nurses with COVID‑19 revealed that their
perception of the profession and providing care had changed. This experience has highlighted the
focus and effort to promote patient‑centered care and interprofessional collaboration among them.

Abstract BACKGROUND: Professional ethics is a set of principles and standards of human behavior that
affect individual behavior and leads to improve care that provided by medical staff. The present
study examined the knowledge and attitude of medical and nursing students toward professional
ethics in Iran.
MATERIALS AND METHODS: This descriptive‑analytic study was carried out on 176 medical and
nursing students in Bam University of Medical Science, Iran in 2019. In this study, students were
selected by census sampling. Data collected using two researcher‑made questionnaires related to
knowledge and attitude toward professional ethics. Data were analyzed in SPSS software.
RESULTS: The mean scores of knowledge among nursing and medical students were 86.56 (8.76)
and 85.10 (12.19), respectively. The mean score of attitude among nursing and medical students
was 127.06 (12.45) and 129.9 (11.88), respectively. Results of the Pearson correlation test showed a
positive and significant associated between the score of knowledge and attitude nursing and medical
students’ (P < 0.001), (r = 0.76) (r = 0.66). Among the demographics characteristics, student age
was associated to their attitude and knowledge significantly (P = 0.03).
CONCLUSION: Iranian nursing and medical students have a positive attitude and a high level of
knowledge about professional ethics. A high level of knowledge was related to the most positive
attitude.

Abstract BACKGROUND: The acceptability of hospital staff in the use of hospital information management
system (HIMS) is an emerging research area it can explain the fate of any HIMS development and
implementation project in hospitals. The aim of this study was to observe the level of acceptance of
HMIS among nursing officials working at a teaching hospital.
MATERIALS AND METHODS: This cross‑sectional study was conducted for 1 year in a teaching
hospital of northern India by using a pretested questionnaire. Our study participants were nursing
officers who were not under the probation period and we used a purposive sampling (10% nurses
from each ward). Our sample size was 256.
RESULTS: We have observed that majority of 174 (67.96%) participants had good acceptability
to the HIMS system. Our study revealed that most of the participants were aware of HIMS. Among
all participants, nearly half of them had good acceptability to the HIMS system. This is may be due
to their job profiles, distribution of their working places, and their past experiences with HMIS. The
bottlenecks such as connectivity problem, error prevention, and lack of training can be addressed
by the hospital management by proper measures.
CONCLUSION: The acceptance level of HIMS among the nursing officials working in a teaching
hospital was good.

Abstract BACKGROUND: Following the global emergency of coronavirus disease 2019 (COVID‑19),
health‑care workers, especially nurses were encountered with an increasing workload. Therefore, due
to the importance of this issue, the present study aimed to examine stress, anxiety, and depression
levels among nurses during the COVID‑19 pandemic in Iran.
MATERIALS AND METHODS: This cross‑sectional study was conducted in four educational hospitals
affiliated to Kerman University of Medical Sciences in 2020. The standard Depression, Anxiety and
Stress Scale‑21 questionnaire was applied to assess the levels of stress, anxiety, and depression
in nurse personnel with a census method (n = 403). Data were analyzed using descriptive statistics
and analytic statistics such as Kolmogorov–Smirnov, Mann–Whitney, Kruskal–Wallis, and multiple
linear regression tests through the version 20, SPSS Inc., Chicago, IL, USA, Software at the level
of P < 0.05.
RESULTS: The results of the study showed that the mean scores of depressions (9.18 ± 4.45),
stress (9.62 ± 4.94), and anxiety (10.32 ± 4.85) in nurses were at moderate level. A significant
relationship was observed between stressed, anxious, and depressed participants in the gender,
marital status, level of education, and working hours per month. No statistically significant relationship
was found between other demographic variables including age, work experience, and employment
status with anxiety, depression, and stress categories.
CONCLUSION: The results of this study can increase the awareness of health system managers,
especially hospitals, about the level of stress, anxiety, and depression and can help in order to provide
psychological support programs for improving the mental health of nurses during the COVID‑19
pandemic.

Abstract BACKGROUND: Competence in providing spiritual care to patients has become an increasingly
important aspect of nursing care delivery. However, studies on nurses’ competence in spiritual care
delivery and the factors affecting it are very limited. The present study was conducted to evaluate
Iranian nurses’ competence in providing spiritual care and its relationship with their Spiritual
Well‑Being.
MATERIALS AND METHODS: The present study is descriptive‑analytical research conducted in Bam
in the south of Iran between 2016 and 2017. All nurses working in the teaching hospitals affiliated
with Bam University of Medical Sciences were invited to participate in the study. For data collection,
the Spiritual Care Competence Scale (SCCS) and the Spiritual Well‑Being Scale (SWBS) were used.
Collected data were then analyzed using descriptive statistics (mean and standard deviation), Pearson
correlation coefficient, independent t‑test, and one‑way ANOVA with SPSS software.
RESULTS: In this study, 158 nurses were participated. The result showed that the mean score
SCCS and SWBS were 101 ± 12.6, 76.92 ± 13.4, respectively. Pearson correlation test showed a
significant and direct relationship between the mean score of SCCS and SWBS (P = 0.001, r = 0.264).
The results of this test also showed a significant relationship between all the dimensions of SCCS
and SWBS (P < 0.05).
CONCLUSIONS: In this study, the nurses had a relatively appropriate competence in providing
spiritual care to patients. There was also a significant relationship between the nurses’ spiritual
care competency and their spiritual well‑being. Given the lack of adequate studies in spiritual care
delivery competencies, it is recommended that similar studies are conducted among nurses in other
parts of the country and worldwide.

Abstract BACKGROUND: The rate of reporting medication errors is lower than the actual rate. The role of
education, encouragement, and promotion of reporting culture can contribute to the increase of errors
reporting. This study was to investigate the effect of motivational program on reporting of medication
errors in the pediatric units.
MATERIALS AND METHODS: A quasi‑experimental study with pre‑ and post‑test design was done
through 60 nurses working in the pediatric wards of the selected hospital in Isfahan, Iran in 2018–2019.
Nurses participated in the study through the census sampling method. Data were collected using
a questionnaire based on eight medication principles completed by the nurses before and after the
intervention. The intervention was conducted through a motivational program in two parts of training
and positive reinforcement. Data were analyzed through the descriptive statistics (frequency, mean,
and standard deviation [SD]) as well as inferential statistics (Wilcoxon test and paired t‑test).
RESULTS: After the intervention, the most medication error reports (60%) were in the principle
of right medication (similar name). Furthermore, the total score (SD) of medication error reporting
was significantly increased from 7.35 (2.43) before the intervention to 17.04 (5.59) after the
intervention (t = 8.03, P < 0.001).
CONCLUSIONS: Motivational program increased medication error reports. Therefore, the
managers can improve medication care and the safety of children through continuous education
and encouragement in the hospitals.

Abstract BACKGROUND: Nurses have a challenging job and encounter more stressful situations. In
response to these situations, they demonstrate adaptive or maladaptive cognitive emotion regulation
strategies (CERS). As there is a lack of literature regarding the factors predicting the selection of
CERS , the present study aimed to investigate the role of age, sex, marital status, working experience,
type of ward, and education level in predicting these strategies in Iranian nurses.
MATERIALS AND METHODS: A descriptive correlational study was conducted to examine predictive
factors’ emotion regulation strategies used by 193 nurses who worked at six hospitals under the
supervision of Qazvin University of Medical Sciences in 2018. The study population were selected
by stratified random sampling method. Data were collected by two questionnaires, one demographic
questionnaire and the other was Cognitive Emotion Regulation Questionnaire conducted by
Garnefski (α = 0.8). Data analysis was performed using correlation and multiple linear regression.
RESULTS: The results showed that there is a significant relationship between the “type of ward”
and “age” with adaptive and maladaptive strategies. In the multiple linear regression model, two
variables of age (P = 0.03) and type of ward (P = 0.04) were able to predict 23% of variance CERS.
CONCLUSIONS: Based on the results of this study, health‑care providers and hospital managers
should pay attention to factors related to adaptive and maladaptive CERS.

Abstract BACKGROUND: Emotional intelligence and interpersonal sensitivity are known as important nursing
skills. They have significant role in the promotion of nurses working life and the health care which
they provide. The goal of this study was the determination of the relationship between emotional
intelligence and interpersonal sensitivity with quality of work life in nurses working in governmental
hospitals of Tehran city in 2019.
MATERIALS AND METHODS: This investigation was a descriptive‑analytical and correlation study
which was conducted among 256 nurses working in five governmental hospitals in Tehran. The studied
nurses were selected through in access sampling method. The instruments of research included
demographic, emotional intelligence, interpersonal sensitivity, and work life quality questionnaires.
The analysis of data was done by descriptive and deductive statistics (t‑test and Pearson correlation
coefficient) and also SPSS.
RESULTS: The conditions of emotional intelligence, interpersonal sensitivity, and work life quality
of nurses were, in turn, in average, severe, and weak levels. The correlation between emotional
intelligence and work life quality of nurses was significant (P ≤ 0.05) and they were positively correlated
with each other (r = 0.311). The relationship between interpersonal sensitivity and work life quality of
nurses was significant (P ≤ 0.05) and they were negatively correlated with each other (r = −0.43).
CONCLUSION: The development of emotional intelligence and sensitivity in reciprocally interpersonal
relations of nurses lead to fundamental changes in nurses’ attitude toward themselves, their
colleagues, patients and their profession and can promote their work life quality. Therefore, these
two skills are necessary for nurses and they should be taken into consideration by nursing schools,
faculty members, instructors, and nursing managers

Abstract INTRODUCTION: Cardiopulmonary resuscitation (CPR) is regarded as the most important skill of
the medical staff who is required to be aware of the latest changes to the CPR guidelines so that
they can take the most effective actions in the critical conditions of CPR. Therefore, the present
study aimed to determine the levels of CPR literacy among the personnel of universities of medical
sciences based in Kermanshah and Khuzestan provinces based on the latest 2015 CPR guidelines
in 2019.
MATERIALS AND METHODS: In this descriptive, analytical, cross‑sectional study, 525 subjects
were selected as the sample population using the two‑stage cluster sampling. For data
collection, a researcher‑made questionnaire was used, whose content validity and reliability were
confirmed (r = 0.71). The study screened the data received and analyzed valid data set through the
ttest and Spearman’s correlation coefficient by incorporating SPSS Statistics software version 23.0.
In addition, P < 0.05 was considered statistically significant.
RESULTS: The 2015 CPR literacy levels of the samples were as follows: excellent (85 subjects or
16.2%), good (404 subjects or 77%), and average (36 subjects or 6.9%). The results of Pearson’s
correlation coefficient revealed a weak and inverse relationship between the levels of CPR literacy
and the age of samples (r = −0.092) and work experience (−0.029), which were statistically significant.
In addition, the results of Mann–Whitney U‑test demonstrated that the level of CPR literacy among
the personnel of Ahwaz University of Medical Sciences exceeded that among the personnel of
Kermanshah University of Medical Sciences (P < 0.001).
CONCLUSION: It is suggested that in retraining the nursing and paramedical personnel, CPR be
carried out with more emphasis on the changes introduced in this guideline compared to that in 2010,
including esophageal tracheal airway, reasons for the cessation of CPR, intraosseous infusion, and
induced hypothermia.

Abstract BACKGROUND: The current nursing shortage is complicated because of turnover intention
among nurses. Most of the inactive nurses returned to professional nursing practice. Returned to
professional nursing practice program was low attrition rates and a more cost‑effective strategy that
prepared inactive nurses returning to practice. This study aimed to explain the process of returned
to professional nursing practice.
MATERIALS AND METHODS: This study was a grounded theory study, which lasted from about
2018 to 2020. Data were collected through semi‑structured interviews and observations with
participants after signing an informed consent form. The average interview duration was 45 min. The
study participants were selected through purposeful sampling from both public and private hospitals
affiliated to Iran University of Medical Sciences. Interviews were verbatim transcribed and analyzed
using a constant comparative analysis method.
RESULTS: In this study, 16 participants were selected, including ten nurses, two educational
supervisors, two head nurses, and two matrons. The “transformed competence” as the core concept
and the four main concepts of “feeling alienated with the new environment,” “getting prepared for
restart,” “gradual maturity in clinical practice,” and “components of organizational culture” were
extracted from the data analysis process.
CONCLUSION: The process of returned to professional nursing practice in the context of the
organizational culture of incentive learning leading to a high level of competence, and in the context
of the organizational culture of inhibiting learning, is leading to deficiency incompetence.

Abstract INTRODUCTION: Some working and organizational conditions, such as psychological stress and
shift work, are factors that threaten the health of staff working in health centers. These factors can
cause fatigue in a long time. Fatigue reduces the ability to process information and decrease to
respond to hazardous conditions and will affect the safety of the environment. Therefore, the purpose
of this study was to determine the relationship between safety climate and occupational fatigue in
nurses working in Zabol city.
METHODS: This cross‑sectional study was performed on 143 nurses working in educational hospitals
of Zabol in 2019. The proportional sampling method was used, and the Swedish Occupational
Fatigue Questionnaire and the Nurses Safety Questionnaire were used for data collection. Data
were analyzed using independent t‑test, analysis of variance, Mann–Whitney, Kruskal–Wallis tests,
and SPSS‑21 software.
RESULTS: In the present study, 57.3% were women and 42.7% were men. The mean score of
occupational fatigue was 85.09 ± 41.49, and the mean score of safety climate was 67.15 ± 12.73. There
is a significant inverse relationship between occupational fatigue and safety climate. The comparison
of safety climate and its subscales between occupational and demographic variables showed that the
score of male supervisors’ attitude was 01.36 ± 2.41 while the score of female supervisors’ attitude
was 8.88 ± 2.61, and this difference was significant. Furthermore, cumulative burnout, the attitude of
supervisors, and the safety climate were significantly different between different educational levels.
CONCLUSION: The results of this study showed that there is a relationship between occupational
fatigue and safety climate. Issues related to safety and risk factors in hospitals due to the high risk of
disease outbreak and mortality, in addition to being economical, are important in terms of the human
aspect as well. In addition, the activity of nursing staff is more important compared to other groups
because of providing health care and communicating with patients; thus, more education about the
safety climate of the workplace environment in hospitals can reduce nurses’ fatigue.

Abstract INTRODUCTION: Majority of critical care nurses do not have desirable skills in performing
endotracheal tube suctioning (ETS) despite related training taught in the curricula. This study aimed
to investigate and compare the effect of education through video and performance feedback (PF)
on nurses’ skills in performing ETS.
METHODS: This was a quasi‑experimental study. The sample size comprised of all nurses (n = 49)
working in the intensive care unit of one of the educational hospital located in one of the western
cities of Iran. Nurses were assigned to either one of educational video (EV) and PF groups. Data
were collected using a 25‑item structured best practices information sheet. Data were analyzed using
SPSS software version 20 (SPSS Inc., Chicago, IL, USA).
RESULTS: After the interventions, no significant difference was found in the total mean score of
nurses’ practice in ETS between those who received education through EV and those who received
through PF (16.3 vs. 15.1) (P > 0.05). Before and after the intervention, a significant improvement
was observed in the total mean score and other dimensions of nurses’ practice in endotracheal
suctioning (P < 0.0001).
CONCLUSIONS: The results showed that both of methods through feedback and EV are useful
in improving nurses’ ETS practice. However, further studies are required to examine the effects of
such interventions in the long term.

Abstract BACKGROUND: Mobile health has the potential to revolutionize the role of educators by empowering
nurses to take more responsibility for their own learning. Hence, this study was designed to examine
the effect of mobile health method to emergency nurses’ knowledge about Emergency Severity
Index triage.
MATERIALS AND METHODS: A two groups’ pool blind quasi‑experimental study was performed
on emergency department nurses working in hospitals affiliated with Isfahan University of Medical
Sciences. The study was conducted from September to November 2014. Sample size was calculated
as 35 participants in each group (a total of seventy participants). Participants were divided into two
groups of mobile health and workshop, randomly. Participants’ knowledge score was collected
according to researcher‑made questionnaire with twenty questions. SPSS version 11.5 was used
to conduct statistical tests such as independent t‑test and paired t‑test for analyzing the data with
the significant level <0.05.
RESULTS: The results show that there was not any significant difference between the knowledge
scores of mobile health and workshop group before intervention, but there was a significant difference
after 2‑week intervention (P = 0.012).
CONCLUSION: The electronic program was an attractive education method for emergency nurses
because in these method educators by empowering nurses to take more responsibility for their own
learning. Hence, it is suggested that mobile health is used by authorities along with routine training,
due to its less cost and spending less time.

Abstract Background: Spiritual well‑being is well‑recognized as a factor that affects cancer patients’
quality of life, quality of care, and satisfaction. There is evidence that supports the fact that
patients’ spiritual needs are associated with better quality of care, higher hospice utilization,
and less aggressive care at the end of life. However, few studies have examined the Spiritual
well‑being (SWB) in cancer patients. Less is known about spirituality; furthermore, no published
research about SWB and its relationship with demographic parameters in breast cancer
patients exists; this made us carry out this project. Materials and Methods: This cross‑sectional
study was a descriptive – analytical one, conducted on 297 breast cancer patients, with
a simple sampling methodology. The data collection instrument included a questionnaire
containing two parts (demographic information and standard SWB Scale questionnaire). The
data were analyzed with 95% confidence by SPSS18, using descriptive and analytic statistics.
Results: According to the results of the present study, SWB of most of the study subjects (52.52%)
was at a moderate level. Results showed that the average score for religious aspect of spiritual
well‑being (RWB) was 51.38 ± 8.17 for 60, average score for the existential aspect of spiritual
well‑being (EWB) was 42.47 ± 10.21 for 60, and the total score of SWB was 93.69 ± 10.04 for 120.
Based on the study findings, there was a statistically significant correlation between the SWB and
age (P = 0.03, r = 0.59), educational level (P = 0.04, r = −0.58), and marital status (P = 0.001), of
breast cancer patients. Conclusion: According to the results of the present study, the SWB of
most study subjects was at a moderate level. Furthermore, according to the results there was a
correlation between some important demographic parameters in women with breast cancer and
SWB. Hence, it is necessary for the treatment team to assess and improve the SWB of patients;
meanwhile the role of nurses is highlighted. In fact, the nurse is the first person who can recognize
the spiritual needs of a patient and even his/her family, and can be effective in meeting the spiritual
needs and improving their SWB. Therefore, it is strongly recommended that in patients with cancer,
a holistic care plan, based on spiritual care, development, and education of patients be applied, as
it is considered to improve their SWB.

Abstract Background: Effective cancer pain management requires accurate knowledge, attitudes,
and assessment skills. The purpose of this study was to obtain information about the
knowledge and attitudes of nurses concerning cancer pain management with the use Health
Belief Model (HBM) as conceptual framework. Materials and Methods: The study was a
descriptive survey and included 98 randomly selected nurses from Alzahra hospital, Isfahan,
Iran. A self‑administered questionnaire which was designed on the basis of HBM was used
to collect the data. Knowledge, attitudes, and HBM constructs regarding cancer pain were
the main research variables. The obtained data were analyzed by SPSS (version11.5) using
descriptive statistics, independent t–test, and Pearson correlation at the significant level of
α=0.05. Results: Ninety‑eight nurses aged 38.7 ± 7.04 years were studied in this survey. From
the 10 pain knowledge questions assessed, the mean number of correctly answered question
was 61.2 (SD=16.5), with a range of 30–100. There was a direct correlation between knowledge
and attitude of nurses with HBM constructs except for perceived barriers and perceived threat.
Among the HBM constructs, the highest score was related to self‑efficacy with mean score of
87.2 (SD=16.4). Conclusions: The findings support the concern of inadequate knowledge
and attitudes in relation to cancer pain management. We believe that basic and continuing
education programs may improve the knowledge level of nursing about pain management.