Journal of Education and Health Promotion

Abstract BACKGROUND: Incivility is one of the significant challenges that affect nursing education. Uncivil
behaviors have a significant upward trend compared to the past in nursing education. This study
was conducted to explore academic incivility from the perspective of nursing students and faculty.
MATERIALS AND METHODS: This study was conducted in 2021 using a descriptive qualitative
method. Fifteen baccalaureate nursing students and six faculty were selected using purposeful
sampling method. Data was collected through in‑depth semi‑structured interviews, and a qualitative
content analysis was applied for data analysis.
RESULTS: Data analysis revealed four categories, namely, ineffective teaching–learning, inapposite/
unreasonable requests, behaviors disrupting mutually respectful environment, and academic
dishonesty, and 14 subcategories.
CONCLUSION: To reduce incivility, closer attention needs to be paid to the admission of faculty as
well as training them to use effective communication techniques and interactive teaching methods.
In addition, nursing students must be provided with the training about uncivil behaviors. Furthermore,
clear and precise rules and regulations concerning incivility incidence should be developed and
implemented in the universities.

Abstract BACKGROUND: As the core of a health‑care team, nurses play a key role in promoting community
health, and their job involves witnessing human suffering and pain in health‑care settings. The present
study aimed to evaluate the correlations between resilience coping strategies, and the underlying
factors in the nurses working in COVID‑19 hospitals.
MATERIALS AND METHODS: This descriptive, cross‑sectional study was conducted on 320 nurses
working in COVID‑19 wards for a minimum of 6 months in 2021. The participants were selected
via multistage sampling. Data were collected using demographic, resilience, and coping strategy
instruments. Data analysis was performed in SPSS version 20.
RESULTS: The mean resilience score was 76.94 ± 11.33. The mean scores of emotion‑focused
and problem‑focused strategies were 59.65 ± 4.40 and 96.08 ± 5.38, respectively. The assessment
of the correlation between resilience with the emotion‑focused and problem‑focused strategies
showed a positive significant correlation (r = 0.25; P < 0.001 and r = 0.33; P < 0.001, respectively).
CONCLUSION: According to the results, the nurses working in COVID‑19 wards mostly adopted
problem‑focused strategies in difficult work conditions depending on the required care provision.
Both coping strategies significantly affected the subscales of resilience in the nurses. Therefore, it is
recommended that special attention be paid to teaching strategies to cope with anxiety and resilience
and develop problem‑solving skills in nursing personnel during the emergence and outbreak of new
diseases in order to reduce their anxiety.

Abstract BACKGROUND: The high prevalence of coronavirus disease‑2019 (COVID‑19) has a lot of stress on
medical students. This study was conducted to investigating the adaptation strategy with COVID‑19
health anxiety in nursing students
MATERIALS AND METHODS: This study was designed as a cross‑sectional study. Participants
of the study were 431 students of the Nursing and Midwifery Faculty of Shahid Beheshti University
of Medical Sciences. Inclusion criteria were studying at the time of the outbreak of COVID‑19 and
willingness to participate in the study. Data collection tools included participated in the study. Data
collection tools included a demographic questionnaire, Health Anxiety and Coping Inventory for
Stressful Situations (Short Form). Reliability of tools was assessed and confirmed with Cronbach’s
alpha coefficient. Cronbach’s alpha coefficient of health anxiety was 0.76 and Cronbach’s alpha
coefficient of Coping Inventory for Stressful Situations was 0.79. Data were collected between July
2020 and September 2020. Pearson’s correlation coefficient was used to examine the relationship
between the data. Data were analyzed with SPSS 26.
RESULTS: Findings indicated that most of the participants were female, single, 22–28 years old, and
undergraduate students. The mean of COVID‑19 health anxiety was 5.59 ± 17.04. Results showed
that 19.58 ± 5.05 of the participants used avoidance‑focused adaptation strategies, 25.12 ± 3.88
problem‑focused adaptation strategies, and 19.32 ± 5.13 emotion‑focused adaptation strategies.
CONCLUSION: The COVID‑19 health anxiety was higher in female, young, and married students.
The problem‑focused adaptation strategy should be further taught so that students can better coping
with COVID‑19 health anxiety.

Abstract BACKGROUND: Coronavirus disease 2019 (Covid‑19) pandemic has increased virtual education
use. This study aimed to determine the attitude of nursing students of Ahvaz Jundishapur University
of Medical Sciences towards virtual education and its relationship with their satisfaction during the
Covid‑19 pandemic.
MATERIALS AND METHODS: This descriptive‑analytical study was conducted during 2020–2021
with the participation of 229 nursing students (undergraduate, graduate, and doctoral) who had spent
at least one semester virtually at Ahvaz Jundishapur University of Medical Sciences. The sampling
method was convenience. The data collection tool was a questionnaire consisting of three parts.
The first part included students’ demographic information and the second and third parts included
the standard questionnaire of individual development and educational assessment to determine
students’ attitudes toward virtual education and their satisfaction with this type of education. IBM
SPSS statistics 22 software and descriptive and analytical statistical tests were used for data analysis.
RESULTS: According to the study results, the mean score of students’ attitudes toward virtual
education was 35.1 ± 11.3 and the mean score of students’ satisfaction with this educational method
was 88.3 ± 30.6, both of which are at the desired level. Also, a direct relationship was found between
students’ attitudes and satisfaction scores (P < 0.001).
CONCLUSION: In this study, the attitude of nursing students to virtual education and their satisfaction
with this educational method had been at the desired level. Therefore, the relevant authorities should
also consider the necessary planning in the field of using this educational method and improving
students’ attitudes towards it under normal conditions.

Abstract BACKGROUND: Parents play a key role in the care, monitoring, management of symptoms
experienced in children with cancer, the support, and follow‑up of treatment. However, there is a
paucity of research as how to improve the health literacy of parents with cancer. The aim of this
study was to identify the best and most important strategies to promote health literacy in parents of
children with cancer.
MATERIALS AND METHODS: A two‑step modified Delphi method was used to establish consensus
in Iran in 2021. Fourteen experts representing oncology, clinical nursing, and faculty members of
nursing were selected by purposive sampling. In round one, 90 strategies to promote health literacy
obtained in the qualitative study were distributed to the experts, which were scored from 1 to 5. In
order to discuss statements without consensus in the first round, round two was held in a face‑to‑face
meeting. Descriptive statistics such as mean, standard deviation, and percentage of response
frequency were used to calculate agreement levels between experts.
RESULTS: In round one, 57 statements reached a consensus. In round two, 21 statements reached a
consensus. Finally, 78 statements reached consensus representing four domains including functional
health literacy, interactive health literacy, critical health literacy, and care health literacy.
CONCLUSION: Delphi method helps to identify the best and most important strategies to use in
health literacy promotion programs for parents of children with cancer. Identifying these strategies
will help health officials, planners, and policymakers.

Abstract BACKGROUND: Coronavirus disease (COVID‑19) causes significant psychological distress among
nursing students. College‑bound nursing students might have preferred different types of coping
strategies to deal with psychological distress. This study aims to measure the psychological distress
and role of coping styles to mediate the stress level among the baccalaureate nursing students amid
the COVID‑19 pandemic.
MATERIAL AND METHODS: A cross‑sectional online survey was conducted in December 2020 at
a nursing college attached to a tertiary care teaching hospital, North India. Nearly 251 baccalaureate
nursing students completed the Impact of Event Scale‑Revised (IES‑R) and Coping Orientation to
Problems Experienced Inventory (Brief‑COPE) scale to report their psychological distress and coping
styles, respectively. Chi‑square test, independent sample t‑test followed by binary and multivariable
regression were used to identify the factors associated with distress in students during the pandemic.
RESULTS: Students’ mean age was 22.22 ± 1.24 years. The mean IES‑R was 19.59 ± 12.45 in
nursing students. Psychological distress found a significant association with age (P = 0.022), academic
class (P = 0.016), travel history (P = 0.034), and being positive reverse transcription–polymerase
chain reaction (RT‑PCR) for COVID‑19 status of self (P = 0.018) and family members in the medical
profession (P = 0.013). In binary logistic regression, stress level found a significant association with
first‑year academic level (OR: 3.250, 95% CI: 1.429–7.390, P = 0.005) and family members in the
medical profession (OR: 4.44, 95% CI: 1.019–19.382, P = 0.047). Adaptive coping styles were more
frequently preferred than maladaptive coping styles (54% vs 41%). Adaptive (r = 0.295, P < 0.001)
and maladaptive coping (r = 0.403, P < 0.001) shows a significant positive relationship with stress
in students, respectively.
CONCLUSIONS: Coronavirus pandemic causes significant distress among nursing students. Students
were able to manage stress using acceptance and religious/spiritual coping strategies. During the
pandemic, stress management to support mental health is highly recommended.

Abstract BACKGROUND: Nursing students have a role in the awareness of risk factors in the development
of healthy lifestyle behaviors. Nursing students’ awareness of disease risk factors plays a role in
developing healthy lifestyle behaviors. Therefore, it was aimed to determine the relationship between
the effect of nursing students’ healthy lifestyle behaviors and cardiovascular disease risk factors’
knowledge levels and obsessive–compulsive symptoms.
MATERIALS AND METHODS: This was a descriptive cross‑sectional study. Two hundred and
twenty‑four students studying in the nursing departments of two foundation universities participated
in the study between April and October 2020. Sociodemographic information form, Health Promoting
Lifestyle Profile II (HPLP‑II), Cardiovascular Disease Risk Factors Knowledge Level (CARRF‑KL),
and Maudsley Obsessive–Compulsive Inventory (MOCI) were applied to the students.
RESULTS: It was found that the nursing students’ healthy lifestyle behaviors (123.53 ± 25.78) and
cardiovascular risk factors’ knowledge level (21.08 ±± 2.70) were high. Obsessive–compulsive
symptoms (16.12 ± 6.22) were moderate. In the correlation of sociodemographic characteristics, it
was found that age correlated with the nutrition subdimension of CARRF‑KL and HPLP‑II, income
level correlated with HPLP‑II, place of residence correlated with HPLP‑II, CARRF‑KL, and MOCI, and
having a health problem correlated with health responsibility. Income status, place of residence, and
presence of health problems were found to be correlated with HPLP‑II in all subdimensions in the
regression analysis. In the regression analysis of HPLP‑II with CARRF‑KL and MOCI scales, it was
found that it was significantly related to interpersonal relations, spiritual growth, stress management,
and total score dimensions.
CONCLUSION: Healthy lifestyle behaviors of nursing students are related to cardiovascular risk
factors’ knowledge level and obsession symptoms. In addition, some demographic characteristics
affect healthy lifestyle behaviors.

Abstract BACKGROUND: Identifying and addressing the needs of Colorectal cancer (CRC) patients/survivors’ 
is important to improve patients/survivors’ quality of life (QoL) and health. The present study aimed 
to review studies that have investigated CRC patients/survivors’ needs. 
MATERIALS AND METHODS: In this narrative review, databases including PubMed, Scopus, Web 
of Science, Iranmedex, ISC, SID, and Magiran were searched during 2011–2021 using keywords 
included need, CRC, colon cancer, rectal cancer.
RESULTS: The findings of the studies showed that the needs of the CRC patients/survivors’ can 
be categorized into the 6 domains including informational, psychological, social, physical, financial, 
and spiritual needs.
CONCLUSIONS: By identifying CRC patients/survivors’ needs, healthcare providers particularly 
nurses can develop and design comprehensive care programs tailored to the needs and priorities 
of these patients/survivors to improve their QoL and health.

Abstract BACKGROUND: Patient‑centered care (PCC) is a key component of high‑quality care. Given the 
different effects of cancer on patients, patient‑centeredness is very important in oncology nursing 
care. The aim of this study was to explore nurses’ perceptions of the patient‑centered in oncology 
nursing care.
MATERIALS AND METHODS: This descriptive qualitative study was conducted in 2018–2020, Iran. 
Data collection methods included observation and semi‑structured interviews. Patient, family, and nurse 
behaviors were observed (total: 318 h). In addition, interviews were conducted with nurses and nursing 
managers (12 interviews). Data analysis was performed using Graneheim and Lundman’s approach.
RESULTS: Data analysis resulted in the emergence of four themes: “Organizational structure as 
a barrier to the PCC,” “Lack of institutionalization of PCC in nurses,” “Understanding and paying 
attention to the patient as PCC,” and “Situational PCC.” The final theme of this study is “PCC in the 
shadow of paternalism.”
CONCLUSIONS: The paternalism approach in the context of oncology nursing care has made the 
realization of PCC difficult. The first step to promote PCC is increasing nurses’ awareness of the impact 
of paternalism on patient‑centeredness. Providing patient‑centered oncology nursing care requires 
changing attitudes, values, and behaviors at individual, professional, and organizational levels.

Abstract BACKGROUND: Urinary tract infections (UTIs) are more common in females than males and 
predominantly based on their unhealthy practices in their day to day lives. This study is trying to 
assess the occurrence of UTI and strategies used by female student to prevent UTI.
MATERIALS AND METHODS: A cross‑sectional descriptive study carried out in a tertiary care 
teaching institute. A total of 338 conveniently selected B. Sc. Nursing and MBBS Medical students 
were surveyed. The data were collected by using a pretested, a self‑structured questionnaire 
related to occurrence and practices to prevent UTI along with necessary demographic details. 
Descriptive (frequency, percentage, mean and standard deviation) and inferential (Chi‑square test) 
statistics was used to compute the data.
RESULTS: The result of this study shows that 10.05% female students reported of having UTI. The 
proportion was higher in nursing students (67.6%) than medical (32.4%) but did not show a significance 
difference (P = 0.61). Age, duration of hostel life, and marital status were significantly associated 
with the status of UTI (P = 0.001). To prevent UTI, students were using commercial product with 
Tea Tree Oil, soap, drinking 3–4 l water/day, increased frequency of peri‑wash during menstruation 
period, and use of Citrus Fruits. The use of western toilet was also significantly associated with 
status of UTI (P = 0.04).
CONCLUSION: The occurrence of UTI was more among nursing students. Most of the perineal 
hygienic practices by the female students were associated with occurrence of UTI; hence, it is 
necessary to emphasize on preventive practices to minimize re‑occurrence.

Abstract BACKGROUND: One of the important challenges faced by health‑care system is to raise the level of 
knowledge of nurses about cerebrovascular accident(CVA) nursing care in the emergency department. 
Therefore, the aim of this study was comparison of two new educational techniques (noninteractive 
multimedia learning and workshop) on knowledge of nurses about CVA nursing care in the emergency 
department.
MATERIALS AND METHODS: This experimental study was conducted with a two‑group design. 
Sixty‑four eligible nurses working in the emergency department in selected hospitals affiliated to 
Isfahan University of Medical Sciences, Isfahan, Iran, were selected as the study participants. Nurses 
were randomly assigned into two groups of noninteractive multimedia (n = 32) and workshop (n = 32) 
using random number table. The data‑gathering tools including a demographic questionnaire (6 items) 
and knowledge questionnaire (24 items) were completed before and 2 weeks after the intervention in 
both the groups. Data were analyzed using SPSS 18 and descriptive (mean and standard deviation) 
and analytical statistics (ANOVA, independent t‑test, and paired t‑test). The level of statistical 
significance was P ≤ 0.05.
RESULTS: The result shows that independent t‑test showed that there was not a significant difference 
between the mean total scores of nurses’ knowledge before intervention in the two groups (P > 0/05). 
Furthermore, the results of paired t‑test showed a significant difference in the knowledge score 
2 weeks after compared to before the education in both the groups (P < 0.005). In addition, the 
results of independent t‑test showed a significant difference in the knowledge score 2 weeks after 
the intervention in the two groups (P < 0.005). The average knowledge score in the workshop group 
was significantly higher than in noninteractive multimedia learning group.
CONCLUSION: According to the result, new educational techniques such as noninteractive 
multimedia learning and workshop could improve knowledge of nurses about CVA nursing care in 
the emergency department.

Abstract BACKGROUND: Planning for the issuance of professional competency examination has been put on
the agenda of professional policymakers, but the ways of evaluating and conducting examinations and
its dimensions are the main challenges. The present study aimed to explain the essential dimensions
of professional competency examination in Iran from academic and clinical nurses’ perspective.
MATERIALS AND METHODS: The present mixed‑method study was performed at three stages,
systematic review, qualitative, and quantitative stages. At the first stage, 56 articles and texts were
collected from PubMed, CINHAL, Ovid, and ProQuest databases, by using the keywords, namely
professional competency examination and assessment. Base on the inclusion criteria and eligibility
assessment of article, six articles and one text on regulation were selected. At the second stage,
the results of the literature review were approved by 20 nursing experts. Direct content analysis was
used for data analysis. The results were prepared in the form of a questionnaire. At the last stage,
the questionnaire was given to 2209 clinical, academic, nurse managers, and nurses.
RESULTS: Based on findings of the review literature, essential dimensions of the professional
competency examination included a central theme of the client’s needs with four categories. At the
second stage, the Professional Competency Examination dimensions were approved by experts.
At the third stage, a comparison of findings indicated that clinical nurses emphasized more on
cardiopulmonary resuscitation, client safety, and implementation of procedures, while academic
nurses emphasized on the client’s needs, client education, and clients’ physiological integrity.
CONCLUSION: The client’s need is the most important dimension in the professional competency
examination. The nurses will be successful in providing care if they can identify the clients’ needs
and provide care plans based on client needs and priorities.

Abstract BACKGROUND: This study aims to use the artificial neural network as a novel approach to explore
factors that determine and predict successful performance of nursing interns in Saudi Arabia on the
Saudi Nursing Licensure Examination (SNLE).
MATERIALS AND METHODS: The study employed a cross‑sectional, analytic approach. A total of
62 nursing interns were recruited by convenience sampling from the University of Hail to participate.
Data collection was conducted from September to December 2019. Descriptive statistics were used
to describe the demographic characteristics of the nursing interns and their responses regarding
examination determinants. Neural network analysis was used to identify factors that are highly
predictive of the success of the nursing interns on the SNLE.
RESULTS: Overall, the nursing interns were undecided (3.94 ± 0.14) about the influential factors
determining their success. Their study hours (100%) and grade point average (GPA) (96.9%) were
identified as strong determinants reflective of the tenacity and vigor of the nursing interns, based on
the predictive power of the model. Meanwhile, age (45.7%), marital status (21.3%), gender (15.2%),
and the type of academic program (5.9%) were considered the least important of the sociodemographic
variables.
CONCLUSION: Exam preparation activities such as preparation programs, review classes, and
exam simulations must be promoted and enhanced to increase the passing tendencies of the nursing
interns in the SNLE. The GPA and increased study hours make the most significant contributions to
success on the SNLE as compared to other variables such as age, gender, marital status, and the
academic program. This study serves as a springboard for nursing educators and administrators in
laying tailored strategies to strengthen the nurse interns’ GPA and time management.

Abstract BACKGROUND: Pain is a common health issue and acute pain is the main problem for patients
after surgery and injury. Inadequate and inappropriate management of pain is dangerous and costly
for patients and leads to undesirable health effects. To overcome this problem, empowerment of
the health‑care team, especially nurses, is essential. Today, to improve the quality of health‑care
provision, various methods are used that e‑learning is one of them.
MATERIALS AND METHODS: Based on the studies on pain management, existing parameters
were extracted, and according to them, the educational content of the software was approved by
nursing professors and anesthesiologists. The Unified Modeling Language diagrams were designed
to provide a better understanding of the entities and the order in which the software operates. The
software was implemented in the google android studio environment using Photoshop and JQuery
mobile. Finally, the software was evaluated by using Questionnaire for User Interface Satisfaction.
The software was evaluated by experts and students in two stages. The first stage was evaluated
by eight anesthesiologists and nursing professors, and the second stage was evaluated with the
participation of 55 undergraduate students and 28 M.Sc. nursing students.
RESULTS: The software was developed with two main modules of training and testing, and sections
of the report, about us and exit, and four scenarios for the test section. In the initial evaluation of
software by experts with an average of 91.85%, and in the second assessment of students, with a
mean of 78.15%, application software was evaluated at a good level.
CONCLUSIONS: In order to teach academic and practical (clinical) materials to students, the use of
digital teaching aids and e‑learning, along with traditional methods such as lectures, increases the
students’ eagerness, and motivation to learn more and thereby enhance the level of learning and
improving the quality of education.

Abstract BACKGROUND: Adherence to the treatment plans is one of the most effective conducts to prevent
and reduce postoperative side effects. Partnership‑based education is one of the most efficient ways to
shape health behaviors. The aim of the present study was to determine the effect of partnership‑based
education on adherence to the treatment plans in open heart surgery.
MATERIALS AND METHODS: This quasi‑experimental study was conducted in 2019–2020 on
the patients undergoing open heart surgery in Tehran (Capital of Iran). Sampling was done in one
educational hospital. A total of 86 patients and their caregivers participated in the study. Sampling
was done nonrandomly by tossing a coin, and patients were allocated into the odd week in the
intervention group and the even week in the control group (n = 43 in each group), and data were
collected before and after intervention using the Treatment Adherence Questionnaire concerning
dietary, physical activity, and medication aspects. The educational intervention was carried out after
the pretest analysis in five 20–45 min sessions (two individual and three group educations). Data
were analyzed with Chi‑square, independent t‑test, and paired t‑test using SPSS 19 at a significance
level of P < 0.05.
RESULTS: Patients and caregivers in both groups did not have a significant difference in terms of
demographic variables (P > 0. 05). In addition, there was no significant difference in the mean of
dietary, physical activity, and medication plans before the intervention in both groups; however, after
the intervention, the mean of the three aspects in the intervention group was significantly higher than
that of control (P < 0.001).
CONCLUSION: Implementing partnership‑based education with participation of patients and
caregivers is influential in improving patients’ adherence to the treatment plans and it is recommended
as a clinical dynamic educational strategy.

Abstract BACKGROUND: People experience extreme anxiety in testing situations, so it considers as a
psychological condition and can actually impair learning and hurt test performance. People experience
some degree of stress and anxiety before and during examinations. This study aimed to investigate
the effect of blended aromatherapy using lavender and damask rose oils on the test anxiety of
nursing students.
MATERIALS AND METHODS: The present study was a single‑blinded clinical trial study. Seventy
nursing students were selected and randomly assigned to two experimental and sham groups. For
the experimental group, seven droplets of lavender, 10%, and three droplets of damask rose oil,
10%, and for the sham group, ten droplets of sesame oil were poured on a nonabsorbent pad which
was placed within a 20‑cm distance from the students’ noses on their chairs’ handles. The data were
collected by using a two‑part questionnaire including demographic information and State‑Trait Anxiety
Inventory 1, before, 15 min after the intervention, and immediately at the end of the test. Data were
analyzed using descriptive (frequency, mean, and standard deviation) and inferential (independent
t‑test, ANOVA with repeated measure, Fisher’s exact test, and least significant difference post hoc
test) statistics.
RESULTS: It was found that no significant difference between the two groups in terms of age, the
number of credits, Semester Grade Point Average and, gender, place of residence and marital
status and the two groups were almost identical in regard of the above variables (P > 0.05). State
anxiety mean scores of the experimental group were lower than the mean scores of the sham group,
15 min after the intervention and at the end of the test, and the difference between the groups was
statistically significant (P < 0.05).
CONCLUSIONS: Blended aromatherapy is effective in improving the test anxiety of nursing students.
Therefore, it can be used as a therapeutic approach to reduce test anxiety.

Abstract Motivation is one of the key factors in educational achievement. Like any other field of study, motivation
in nursing is highly critical. The instructor’s knowledge about the teaching methods that are effective
in academic motivation of students enables them to adopt proper measures to improve the teaching
efficiency. The present paper is a systemic review of the efficiency of instructional interventions in
improvement of academic motivation in nursing students. The published papers related to the study
from 2000 to February 2020 were searched at different databases such as PubMed, Scopus, Web
of Science, PsycInfo, and ERIC. To examine the quality of the articles, critical appraisal instrument
for reports of educational interventions was used. Totally, 18 articles entered the study for structured
review. The majority of the articles reported that educational interventions improved academic
motivation in nursing students. The effective teaching methods described in the reviewed articles
that led to an improvement in academic motivation were simulation, case‑based learning, cooperative
learning, learning contract, peer assessment, and self‑assessment using video typing. As the findings
showed, implementation of applied and participatory methods in teaching process improved the
academic motivation of nursing students. Therefore, using such methods, nursing instructors can
improve the academic motivation of their students.

Abstract BACKGROUND: Education in vulnerable communities can be a health affordable strategy to
promote patient empowerment. Recognition and understanding the problems of diabetes education
are of significance to overcome the barriers and advance the educational and care services to
control diabetes and promotion of society health. The aim of this study was to explore participants’
perspectives, experiences, and preferences, regarding diabetes education problems.
MATERIALS AND METHODS: This descriptive, qualitative study was conducted from March 2016 to
September 2017. The participants were 23 people including nine patients with diabetes and their family
members and 14 members of diabetes healthcare team (physicians, nurses, and nutritionists). The
data were collected through individual semi‑structured interviews and analyzed through conventional
content analysis approach proposed by Graneheim and Lundman. Some main categories and
subcategories emerged.
RESULTS: Three main categories showed the most prominent problems of diabetes education,
namely, inadequate infrastructure for diabetes education, insufficient defined and de facto position
for the role of diabetes nurse educator, and the failure in patient‑oriented team approach in diabetes
education.
CONCLUSION: This article addresses the most important problems of diabetes education. The
fundamental strategy to overcome these problems seems to be the planning and management of
diabetes education as a high priority in the noncommunicable disease management policies of the
Ministry of Health and Medical Education.

Abstract BACKGROUND: Management of cancer complications requires the provision of palliative care as a
comprehensive care by the main and trained members of this method of care. The aim of the present
study was to assess the compliance of educational curricula of selected disciplines with the content
standards of cancer‑related palliative care.
MATERIALS AND METHODS: In this descriptive–comparative study, the content standards of
palliative care for nurses, physicians, and social workers were identified based on the World Health
Organization guideline and Oxford Textbook of Palliative Nursing. For this purpose, a separate
checklist was prepared for the disciplines with different dimensions. Then the face and content
validity of the checklists were checked. Finally, we examined the coordination between selected
curricula available on the website of Education Deputy of the Ministry of Health, Treatment and
Medical Education with the dimensions of the checklists.
RESULTS: All three curricula in most domains were relevant with the content standards, but there
was the biggest education need in the areas related to the dimensions of “planning and educational,”
“educating physician in palliative care,” and “considering patient preferences” in these disciplines.
CONCLUSIONS: To meet the educational needs, it is suggested to change some course topics,
hold training courses, or joint workshops.

Abstract BACKGROUND: Some nursing schools in Iran with the aim of training qualified nurses have set up
master’s degrees in emergency nursing. In any case, there are challenges in the implementation
of this discipline in academic nursing centers which prevent the fulfillment of goals and missions in
the curriculum.
MATERIALS AND METHODS: In this qualitative study, four graduates of the master of emergency
nursing and 13 undergraduate students were purposively recruited from the Nursing and Midwifery
Faculty in Qom, Iran. Data were collected through semi‑structured interviews and analyzed through
conventional content analysis.
RESULTS: Emergency nursing master’s program challenges consist of two categories: nonproductive
course design and unresolved infrastructure. The extracted subcategories were unfit curriculum,
inappropriate content, nonspecialized program, unclear roles, improper course planning, unskilled
human resources, and poor educational facilities.
CONCLUSION: Based on the experiences of nursing graduates, the curriculum of master of
emergency nursing in Iran needs to be substantially revised in terms of content and structure.

Abstract BACKGROUND: Paying attention to students’ opinions and suggestions on existing evaluation
methods and new methods of evaluation is an essential and important part of clinical education, so
this study aimed at determining the effectiveness of two evaluation techniques satisfaction among
undergraduate nursing students.
MATERIALS AND METHODS: This was a quasi‑experimental study conducted on 60 undergraduate
nursing students of Isfahan University of Medical Sciences in 2019. There were 30 samples in each
group (logbook and e‑logbook) that were selected by convenience sampling method. the Android
application (e‑logbook) was used in the intervention group to evaluate the clinical skills of students.
The User Satisfaction Questionnaire was conducted by undergraduate nursing students. Data were
analyzed using SPSS software version 14 and descriptive statistical tests.
RESULTS: The results showed that the mean (standard deviation) overall score of satisfaction
from both evaluation methods including logbook and e‑logbook was 39.7 (9.4) and 47.7 (12.2),
respectively. Also satisfaction score of the evaluation method was significantly different between
the two groups (P = 0.03).
CONCLUSION: According to the results of the present study, the use of new and active methods of
evaluation, including the application of e‑logbook, can be useful in evaluating nursing students and
cause student satisfaction, so using the application is useful.

Abstract INTRODUCTION: Professional responsibility‑acquiring process among bachelor degree nursing
students is important for their current and future performance and educational and health‑care
system, but this process has not been explored in the literature. The aim of the current study is to
explore the process of acquiring professional responsibility among bachelor degree nursing students.
METHODOLOGY: The study design was based on grounded theory (Corbin and Strauss 2015).
Purposive and theoretical sampling led to the inclusion of 18 individual interviews and a focus group
interview with bachelor degree nursing students, their instructors, and key informants in a nursing
school and university, an educational hospital, and a health comprehensive service center in Tehran
in 2019–2020.
RESULTS: After data analysis, 6 categories, 17 primary categories, 64 subcategories, and 1747 initial
codes were extracted. Trying to optimal use of the educational period was the main category of this
study and its primary categories were responsible learning and performance management strategies,
there were facilitators and inhibitors categories for applying these strategies. Personal, educational,
and professional context factors were primary categories that may lead to the main concern (uncertain
productivity of the educational period) with regard to acquiring professional responsibility. Protection
of the students and others versus irresponsibility was consequence category of this process.
CONCLUSION: Knowing the process of acquiring professional responsibility among bachelor degree
nursing students can be used to facilitate the formation, promotion, and evaluation of professional
responsible behaviors. Further researches in these areas are recommended.

Abstract INTRODUCTION: Evaluation of students’ clinical performance is an essential part of nursing
education. Mobile technology is one of the new methods of evaluation that has opened a new horizon
for nursing professors. Therefore, this study aimed to design, implement, and evaluate mobile health
technology in critical care nursing department in four‑phase intervention.
METHODS: This study was a four‑stage educational intervention in which all postgraduate students
of intensive care nursing in Isfahan University of Medical Sciences participated in the study. The four
steps were designing and developing a logbook, needs assessment, designing and implementing
an Android app, and evaluating users (students) of the Android app. Subjects' satisfaction scores
were collected using a researcher-made questionnaire with 14 questions. Data were analyzed using
SPSS 14 software.
RESULTS: In this study, a clinical practice evaluation app was designed at four levels of
access (student, professor, department manager, and faculty dean). The results showed that more
than half of app users reported this technology in terms of an overall response to the tool (87.5%),
tool specificity (100%), the amount of information displayed (75%), page layout (62.5%), information
rate (75%), recall information (87.5%), and ease of doing instructions (100%) were positive.
CONCLUSION: Evaluation of clinical practice using technology was associated with increasing
students’ satisfaction with evaluation method. In addition, this application enabled the simultaneous
interaction between the professor with the higher and lower ranks, including the department manager
and student and vice versa and the simultaneous recording of this interaction.

Abstract INTRODUCTION: Recently, the night shift is included in the curriculum of nursing internship students.
However, this shift is associated with some problems and benefits for students, which have been
assessed in limited studies. This study aimed to discover and describe the problems and benefits
of the night shift for nursing internship students.
METHODOLOGY: This qualitative method was carried out with the conventional content–analysis
method. In total, 15 seventh‑semester and eighth‑semester nursing students at Sabzevar University
of Medical Sciences, Iran, were selected by purposeful sampling. Data were collected using in‑depth
semi‑structured interviews about students’ perceptions of night shift problems and benefits. In addition,
data analysis was performed applying the conventional content–analysis technique.
RESULTS: In this study, seven main categories were extracted, five of which included problems
such as exploitations, being an outsider, moral distress, learning deficits, and annoyance. The other
two categories were benefits including gaining new experiences and independence.
CONCLUSION: The problems related to the students were the nursing personnel and the educational
system of hospitals, which can be dealt with through the interaction of the educational system with
hospitals managers in order to clarifying the role of students, fair division of work, and making
educational resources available. Moreover, gaining new experiences and independence are among
the benefits of the night shift for students, the continuation of which is in favor of nursing education.

Abstract Globalization has been attracted by great literature and papers of many disciplines in recent years.
Although globalization has considerable social, political, and economic effects, it has turned to an
important challenge in health‑care systems. Nursing, as the largest part of the health system in
the world, has also been affected by globalization. The purpose of the present paper is to critique
globalization and its impacts on the nursing profession. This review article was conducted by searching
for reliable internet resources in the English language on the impact of globalization on nursing.
Published articles were searched until 2018, and related articles were extracted in three stages:
1‑selection of articles by reading abstract, 2‑selection with an overview of the text, and 3‑selection
with a full review of the article’s text. According to the literature of globalization, we categorize and
discuss the nursing areas that are affected by globalization in nine areas: global nursing development,
nurses emigration,information interchange and interactions in nursing, higher education in nursing,
professional territory, nursing specialization, professional ethics, management and supervision, and
professional independence. The intensity of globalization effects on the nursing profession has not
been the same in all societies, and factors such as compliance of society, culture, and technology
are among the most important factors that affect it. Globalization is an inevitable process and brings
with itself many prominent promotions such as global nursing development and important challenges
such as nursing emigration and ethical issues.