Journal of Education and Health Promotion

Abstract BACKGROUND: The COVID‑19 pandemic is a major health crisis that has changed the life of
millions globally. Coronaviruses are viruses’ group that can contract animals and humans and the
cause of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS),
and COVID‑19. Nurses are the primary service providers in the health care; nurses who are in close
contact with infectious patients need to get their mental health checked and supervised on a regular
basis, particularly with regard to stress, anxiety, and suicidal ideation, so that they can provide optimal
quality of life and healthy mental health to have good care for patients to assess the impact of the
pandemic on mental health status for nurses in Iraq.
MATERIALS AND METHODS: A total of sample study (1000) nurses in Iraq completed an online
questionnaire between March and May 2021. Psychological impact was assessed using the
depression anxiety stress scale (DASS21).
RESULTS: The study revealed impact COVID‑19 on mental health status (anxiety stress) and
no impact COVID‑19 on mental health status (depression) for nurses was (P value = 0.040 and
P value = 0.045, respectively).
CONCLUSION: The impact COVID‑19 on mental health status for nurses. Protecting the nursing
staff from chronic stress, anxiety, and depression, which constitutes a psychological burden on health
during the outbreak of the COVID‑19 pandemic, by clarifying the disease and how to prevent it, as
well as providing the personal protective equipment to decrease stress, anxiety, and depression
during the pandemic.

Abstract BACKGROUND: Nursing is one of the most stressful occupations. Educational intervention regarding
stress management can play an important role in reducing occupational stress among nurses The
present study aimed to determine the effectiveness of educational intervention on reducing oxidative
stress caused by occupational stress in nurses: A health promotion approach in a hospital in western
Iran.
MATERIALS AND METHODS: The present interventional study was performed in 2019 among
92 nurses working at the Kosar Hospital located in the city of Sanandaj in the country of Iran.
Occupational stress was evaluated using the Osipow Occupational Stress Questionnaire. Oxidative
stress was measured by taking blood samples and measuring the enzymatic activity of superoxide
dismutase (SOD), malondialdehyde, and catalase (CAT) using SOD, malondialdehyde (MDA), and
CAT kits. Educational intervention was carried out in the second stage. Three months after the
intervention, data were taken again.
RESULTS: The results of the present study indicated that there was a significant difference in
occupational stress between before and after the educational intervention (P < 0.05). A significant
reduction in MDA (P = 0.038) and SOD (P = 0.048) was observed after educational intervention, but
this was not the case for CAT (P = 0.592). There was no significant correlation between occupational
stress with oxidative stress parameters before and after the educational intervention (P < 0.05). No
significant difference in occupational stress was observed between men and women. Among the
oxidative stress parameters under evaluation, MDA was higher among men compared to women
and this was statistically significant.
CONCLUSIONS: Educational intervention regarding occupational stress is effective in reducing
oxidative stress among nurses. The group meetings teach stress management to the participants
and enable them to better manage their stress by utilizing their own capabilities. Thus, attention to
this issue is vital in maintaining the mental and physical health of nurses and, in turn, improves the
quality of care rendered.

Abstract BACKGROUND: Today, considering the importance of bioterrorism, it may be time to assess the
risk of bioterrorism as an important priority. Nurses, as the broadest group of therapy group, are
very influential in this regard.General aim: To determine the impact of bioterrorism education through
two methods of lectures and booklets on the knowledge and attitude of nursing staff. Practical Aim:
Minimizing the damage caused by bioterrorism attacks by empowering nursing staff.
MATERIALS AND METHODS: This two-group semiexperimental intervention study was performed as a
before and after education intervention with the participation of 80 nursing staff of Shams Al-Shomus Nezaja
Hospital affiliated to Health Administration of Islamic Republic of Iran Army Ground Forces. The study
population included all hospital nursing staff in 2021. The inclusion criteria included having a willingness
and informed consent to participate in the study and exclusion criteria included unwillingness to continue
cooperation and failure to complete more than 10% of the questionnaire by the subject. This study was
performed on 77 nurses in 2021. The nurses were divided into two groups: lecture and booklet. First,
the pretest was completed by the nurses. After the educational intervention, both groups completed the
posttest. Both groups then completed the questionnaire again after about 2 weeks. First, all the data were
measured for normal distribution by the Kolmogorov–Smirnoff test. Statistical description was expressed
for the variables with normal distribution as the ratio of geometric mean ± standard error and for abnormal
variables as mean ± standard error. To compare the means of the studied quantitative variables, t-test
and Wilcoxon matched-paired statistical tests were used. The significance level was considered <0.05.
SPSS.16 and Graph Pad Prism 8.0.1 softwares were used to analyze the statistical data.
RESULTS: Using both methods is effective in improving the level of knowledge and betterment attitude,
but according to the paired t-test in comparison of the two groups, at intervals immediately after training
and 2 weeks after training, a significant increase in the average knowledge score of the lecture group
Statistically shows (P < 0.001). However, the analysis of attitude scores was performed between the
two groups of lectures and booklets, which did not show statistically significant changes between them.
CONCLUSIONS: One of the most important issues in the performance of medical staff in bioterrorism
attacks is useful, effective, correct, and sufficient training. According to the results of the present
study,bioterrorism training leads to increasing the level of knowledge and betterment the attitude of
nurses in the field of bioterrorism. Therefore, the inclusion of training courses in medical centers,
especially military medical centers, is necessary and sensitive.

Abstract BACKGROUND: Unsafe medication administration and medication errors pose a threat to medication
safety. Safe medication is one of the most important nursing practices that plays an important role
in preventing medication errors. The aim of this study was to assess the medication administration
of nurses in cardiac wards and its relationship with some demographic characteristics.
MATERIALS AND METHODS: The present study was conducted as an observational study in 2021
with the 60 nurses who working in the medical cardiac wards of one selected hospital affiliated with
the Isfahan University of Medical Sciences. Data were collected using three‑part tools (demographic
information, medication checklist (55 items), and documentation checklist (8 items). The checklist
was completed by the observer after observing the nurses’ medication administration. Data analysis
was conducted using descriptive and inferential statistics in the SPSS software (version 16, SPSS
Inc., Chicago, IL, USA). A P < 0.05 was considered statistically significant.
RESULTS: The mean total score of the principles of injection and oral medication administration
were 82.53 ± 10.75 and 75.76 ± 9.62, respectively. The mean score of the principles of injection
and oral medication administration in the morning shift was significantly higher than the evening
and night shifts (P < 0.001). The relationship between the mean score of the principles of injection
medication (r = 0.234, P = 0.067), oral medication (r = 0.222, P = 0.083), and the nurses’ work
experience no significant. The rate of adherence to the principles of medication administration in the
premedication administration stage was higher than during and after drug administration.
CONCLUSION: Although the mean score of medication administration of nurses in the medical
cardiac wards was at the desired level, it is necessary to monitor and plan by nursing managers to
improve medication administration. Reducing the number of night shifts, adhering to accreditation
programs in the hospital, continuous monitoring of nurses in terms of compliance with the principles
of medication are among the proposed solutions to improve the safe medication in nurses.

Abstract BACKGROUND: Basic infection control measures are required in India’s health‑care setting in
Neonatal Intensive Care Units (NICUs) to lower the prevalence of hospital‑associated infections.
The aim of the present study was to assess practices followed by nurses of NICUs for nosocomial
infection prevention.
MATERIALS AND METHODS: From January to February 2020, a descriptive cross‑sectional study
was conducted. Participants in the study were chosen by total enumeration sampling technique,
i.e., 60 nurses were included in this study who working in tertiary care institutions, India. The study
respondents’ knowledge and practice for nosocomial infection control strategies were assessed by
using a 30‑item and 27‑item questionnaires, respectively. SPSS (version 23.0) was used to analyze
the data collected.
RESULTS: Results showed that all nurses (100%) were females, belongs to the age group of
26–35 years (82%), hold professional qualifications (34%) in GNM as well as post basic BSc nursing,
married (72%), had 1–5 years of professional experience (66%), and working in the NICUs for
1–3 years (74%). Most of nurses (55%) had never attended any session on nosocomial infection
prevention. Nurses of NICUs (70%) had just a moderate degree of understanding on nosocomial
infection prevention. Nurses’ practice showed good practise (60%) for nosocomial infection prevention
in NICUs.
CONCLUSIONS: The necessity to adopt health‑care policy about nosocomial infections and execution
of regular training program to upgrade and refresh nurses’ knowledge and practices regarding
for nosocomial infection control measures is indicated to fill gap among knowledge and practices
concerning nosocomial infection control and prevention.

Abstract BACKGROUND: One of the most important steps in increasing the nurses’ professional competence 
and consequently improving the quality of nursing care is to evaluate nurses’ clinical competency 
and then take effective actions to enhance it. This study aimed at exploring the clinical competence 
of Iranian nurses and factors related to it.
MATERIALS AND METHODS: In this systematic review and meta‑analysis, PubMed, Scopus, Web 
of Science, Scientific Information Database, and Iranmedex databases and Google Scholar search 
engine were searched to February 14, 2020.
RESULTS: After screening, a total of 25 articles were included. In general, the level of clinical 
competence of Iranian nurses was at a desirable level. After meta‑analysis of the mean score of nurses’ 
clinical competence, the combined mean was 161.13 (95% confidence interval [CI]: 137.78–184.48;
P < 0.001; I
2 = 99.8%; P value for heterogeneity = P < 0.001) by the Competency Inventory for 
Registered Nurses (CIRN) questionnaire. The summarized mean of clinical competency measured 
by the Nurse Competence Scale (NCS) questionnaire was 70.75 (95% CI: 60.80–80.70; P < 0.001; 
I
2 = 99.9%; P value for heterogeneity = P < 0.001). Factors affecting nurses’ clinical competence were 
age ≥33 years, nursing work experience ≥9 years, and a master’s degree in nursing. However, the 
clinical competence of nurses had a significant negative relationship with job stress.
CONCLUSION: The level of clinical competence of Iranian nurses was desirable. Studies that used 
the CIRN, reported the highest and lowest clinical competence in clinical care and professional 
development dimensions, respectively. Studies that used the NCS, reported the highest and lowest 
clinical competence in dimensions of work role and ensuring quality, respectively.

Abstract BACKGROUND: COVID‑19 is a contagious disease without any treatment, vaccine, or immunity,
which the only way out is the practice of preventive measures. This article assessed the perception
and factors influencing the practice of preventive measures to COVID‑19 among nurses in Anambra
State, Nigeria. The study objectives include to determine the perception of nurses toward COVID‑19
and to determine factors that influence the practice of preventive measures to COVID‑19 among
nurses in tertiary hospitals in Anambra State.
MATERIALS AND METHODS: The design for the study was descriptive cross‑sectional survey
conducted among 344 nurses in the two tertiary institutions.
RESULTS: Three hundred and three (88.1%) nurses had no formal training on COVID‑19 protocol.
They have a good perception of the disease as, among others, they (165 [48.0%]) see it to be highly
contagious, 207 (60.2%) can recognize symptoms easily, 168 (48.8%) believed that COVID‑19 could
be handled professionally based on their experience, 155 (45.1%) responded that there is no vaccine
yet for the disease, and 200 (58.1%) responded that patients should not hide their symptoms and travel
history to avoid infecting other people. The result on the false benefits has 323 (93.9%) who responded
that COVID‑19 preventive measures will predispose one to the disease, 319 (92.7%) who responded
that the preventive measures will not slow the spread of the disease, 288 (83.7) who responded
that it is independent of normalcy returning to areas affected, and 327 (95.1%) who responded that
COVID‑19 preventive measures are among the effective ways to mitigate the disease and enhance
life sustainability. Some work‑related/institutional and disease‑specific factors influence their practice
of preventive measures to COVID‑19. Such factors include the time to use personal protective
equipment (PPE) in an emergency (170 [49.4%]), remembering to use PPE (158 [45.9%]), insufficient
nursing staff during a shift (158 [43.0%]), and too many responsibilities during a shift (178 [51.7%]).
CONCLUSION: With the increasing death as a result of COVID‑19, of which health workers are not
immune to, it is essential to annihilate all negative factors that may impede the accurate practices
of the preventive measures and also support the nurses with the necessary tools and knowledge to
mitigate their exposure to the disease.

Abstract BACKGROUND: Patients’ satisfaction is a fundamental factor in the quality of nursing care. The
emergence of the novel Coronavirus Disease 2019 (COVID‑19) and the highly contagious virus
can affect nursing care by increasing the number of care‑seekers.This study aimed to determine
the patients’ satisfaction and related factors in patients with COVID‑19 hospitalized in Taleghani
Hospital, Urmia‑Iran, in 2020.
MATERIALS AND METHODS: This descriptive, correlational study was conducted on 196 patients
with COVID‑19 hospitalized in Taleghani Hospital, Urmia. Purposive convenient sampling was used
to recruit participants. Study participants completed Patient Satisfaction Instrument and demographics
questionnaires. Data were analyzed with the SPSS software version 25.0.
RESULTS: The majority of patients (68.9%) were moderately satisfied with nursing care. Based
on Pearson Correlation Analysis, only residential status had a significant inverse relationship with
satisfaction level in patients with COVID‑19 (r = −0.0238, P = 0.001).
CONCLUSIONS: The patients’ satisfaction with nursing care was mostly at a moderate level. Thus,
there is a need to educate health personnel and nurses in particular and motivate them to have
active participation in achieving patients’ satisfaction with COVID‑19. Notably, only the institutes that
take patients’ satisfaction as a top priority can succeed in a competitive market of health services.

Abstract INTRODUCTION: In the COVID‑19 crisis, nurses are directly involved in patient care, so they face
many challenges. This study was performed to determine the challenges faced by nurses while
caring for COVID‑19 patients in Iran in 2020.
MATERIALS AND METHODS: This qualitative, content analysis was conducted in Iran on ten nurses
directly involved in the fight against the corona epidemic, selected through a purposeful sampling
strategy. Data were collected through deep interviews consisting of open questions. All the interviews
were recorded, and immediately after each interview, it was transcribed into written form. The data
were analyzed using MAXQDA software.
RESULTS: All the challenges could be classified into three main categories and 17 subcategories.
The main categories were miss‑management in controlling corona conditions, mental and physical
complications and challenges in corona work conditions, and lack of sufficient workforce.
CONCLUSION: Hospital managers and authorities play a significant role in meeting the financial
needs and requirements of nurses, and can minimize the job discrimination prevalent at medical
centers through providing financial and nonfinancial incentives for nurses. Moreover, the findings
of the present study can help hospital managers and authorities to gain a better understanding of
the experiences of nurses, and to take the necessary measures to obviate the challenges faced by
nurses in public health emergencies.

Abstract BACKGROUND: The COVID‑19 epidemic is a global health crisis that, in addition to physical health,
has affected the mental health of all individuals, especially health‑care workers, including nurses
and family members. In this regard, the present study aimed to investigate the effect of COVID‑19
epidemic on mental health of nurses’ family members.
MATERIALS AND METHODS: The present descriptive‑analytic and cross‑sectional study was
conducted in 2020 year on family members of nurses working in Hajar Hospital for admission and
hospitalization of patients with COVID‑19, after obtaining the necessary permits and coordination. To
prevent the spread of COVID‑19 through respiratory or contact droplets, a blog was designed to collect
data using software. Participation in this study was voluntary. Data collection tools included consent,
demographic questionnaire, and mental health questionnaire (Patient Health Questionnaire‑9). Data
were analyzed by SPSS version 22.
RESULTS: Findings of this study showed that out of 208 family members of nurses participating
in this study, 96 were male and 112 were female and their mean age was 35.78 years, and 55.3%
of the participants had university education. Their mean mental health score was 12.91 ± 3.75, so
that 22.6% of people had mild depression, 71.4% of people had moderate depression, and 1.8%
of people had severe depression. Independent t‑test showed that there is a statistically significant
relationship between mental health and gender and marital status (P < 0.001). Furthermore, one‑way
analysis of variance test showed that there is a significant relationship between mental health and
age (P < 0.001); this test also showed that there is no relationship between education and mental
health (P = 0.75).
CONCLUSION: The results indicate that the mental health of nurses’ family members is affected
by the challenges of COVID‑19 epidemic time, so that many of them suffer from some degree of
depression. Therefore, supporting this population requires urgent action.

Abstract BACKGROUND: Absenteeism is a situation whereby students absence themselves from clinical
posting without good reason, this incidence among student nurses contributed a significant problem
that if not addressed will adversely affect the quality of nursing care; therefore, motivation of student
during clinical posting found to be an important ingredient needed in eradicating absenteeism.
Consequently, this study aims to determine the reasons why student nurses absenting themselves
from clinical posting, its effect and how clinical instructor can motivate student nurses since they are
the first role models and have a significant impact in their skill development.
MATERIALS AND METHODS: A descriptive, quantitative design was used to elicit the information
from a sample of 80 nurses and 80 students’ nurses. Nurses: 25 medical surgical ward, 23 surgical
ward, 17 obstetrics and gynecology ward, 15 theaters, and 80 student nurses, statistically drawn
through a stratified sampling technique across the wards and school of nursing. Data collected were
analyzed using tables, percentages, means, and standard deviation at 0.05 level of significance
through the Statistical Package for the Social Sciences software.
RESULTS: The student participants reported that non conducive working environment, working
in infectious ward without adequate protection, noncooperation from clinical instructor, excessive
number of clinical hours, embarrassment faced in front of patients and other medical personnel, lack
of prompt medical treatment and care when sick, too much workload, and other number of clinical
assignments as a major reason why they absenting themselves from clinical posting. The effect of
student absenteeism and how students can be motivated is identified in this study.
CONCLUSION: Reported factors leading to absenteeism among nursing students and identified
motivating care should be handled carefully by the hospital managers to produce better health-care
delivery’ nurses in future.

Abstract BACKGROUND: Quality of working life (QWL) refers to aspects of life quality, which are related to
work settings. This study was designed to evaluate the QWL and its effective factors among nurses
of Tehran University of Medical Sciences Hospitals.
MATERIALS AND METHODS: In this cross‑sectional descriptive–analytical study, the demographic
questionnaire and work‑related quality of life questionnaire were used to collect data among 435
nurses working in hospitals, affiliated to Tehran University of Medical Sciences. This article has been
adapted from the approved project of Medical Ethics Committee of Tehran University of Medical
Sciences (with the identification code 8911215132).
RESULTS: The average QWL of nurses in the study was 50.56. There was a significant statistical
relationship between gender, frequency of overtime, and working ward with QWL (P < 0.05). In a
multivariate analysis, working ward had the only meaningful relationship.
CONCLUSION: Due to low QWL of nurses in the emergency department, the need of interventions
to improve conditions and ultimately to increase QWL of nurses working in the emergency room is
being reminded.

Abstract BACKGROUND: Ethical decision‑making and behavior of nurses are major factors, which can effect
on the quality of nursing care. It seems that there is a correlation between demographic variables
and ethical decision‑making and moral behaviors of nurses. Promoting patients’ health is one of
the issues related to nurses’ ethical behaviors. The aim of this study was to determine the role of
judgment in promoting nurses’ decisions and ethical behavior.
MATERIALS AND METHODS: This was a descriptive, cross‑sectional study in which 260 nurses were
selected based on the inclusion criteria. Sampling method was available. The data collection tool was
the Hospital Ethics Committee Survey Questionnaire. Data were analyzed by SPSS software version 20.
RESULTS: In this study, judgments and ethical behaviors of nurses were evaluated at the moderate
and good level. Gender, marriage status, education level, and nursing position were effective in
judgments and ethical behavior of nurses. Age, job experience, and participation in the ethics
workshop had no significant effect on ethical behavior and moral judgment. The mean score of moral
belief of nurses participating in this study was 181.56 ± 17.60, and their mean moral practice in the
real environment was 168.5 ± 17.77.
CONCLUSION: The judgment competencies in ethical situation of nurses should be promoted to
a higher level. It seems that more advanced educational methods are needed to achieve this goal.
The findings from this study show the necessity of nurses’ ability to improve their behavior and moral
judgment. It also shows that nurses need more reinforcement based on the demographic variables.

Abstract BACKGROUND: The improvement of the knowledge, skill, and attitude of nurses working at the
intensive care unit (ICU) through implementing training need assessment and holding continuous
in‑service training courses are of main requisites for providing better health services to the community.
Based on this, in the present work, we are looking for the identification and prioritization of the training
need of intensive care nurses in the Zabol University of Medical Sciences’ hospitals.
MATERIALS AND METHODS: As a cross‑sectional, descriptive study, including two phases of
identification and prioritization of training needs of ICU nurses, it was conducted by a close‑ended
researcher‑made questionnaire for collecting the data on training needs from the viewpoint nursing
officials, supervisors, and head nurses of the ICU wards in the first phase and a multiple‑choice
scientific test plus a checklist for measuring the knowledge and skill of the nurses in the ICU in the
second phase. In both phases, census method was used for collecting the data. The validity and
reliability of data‑gathering tools, mentioned above, were tested and verified before gathering data.
Data were analyzed with the descriptive statistics.
RESULTS: The results indicated that ventilator setting according to arterial blood gas sampling
and interpretation (77.81), cardiac monitoring, detecting dysrhythmia and taking immediate
intervention (73.04), ventilator setting according to patient’s respiratory status (68.61), airway
management, oxygenation and intubation (64.39), and adults cardiopulmonary resuscitation (61.77)
were the high‑priority training needs of the nurses successively.
CONCLUSION: To improve the quality of training programs and upgrading the knowledge, skill,
and attitude of nurses working at ICU, the significance and the weight of each training titles should
be determined according to the standards and the continuous in‑service training plan along with
nurses’ training needs and duties.

Abstract BACKGROUND: Although using time management skills is a major component of nursing professional
practice, they have not received much attention. Time management training can improve the
psychological and communication aspects of nursing care quality. Therefore, this study aimed to
evaluate the effect of time management skills training on the psychosocial and communication
aspects of nursing care quality.
MATERIALS AND METHODS: This semi‑experimental study was conducted at Valiasr Hospital of
Shahr Babak City, Kerman Province, in the Southeast of Iran, during 2018. The study population
consisted of 100 nurses who were randomly assigned to one of the two groups: an intervention
group or a control group. To identify and measure the outcomes, nurses’ perceptions of the
psychosocial and communication aspects of care quality were first assessed by the Quality Patient
Care Scale (Qualpacs) at pretest. Then, the intervention group received the 2 days of training on
time management skills for 12 h. The posttest outcome data were collected from both the groups 1
month after the intervention.
RESULTS: No statistically significant differences were observed between the two groups with respect
to the total mean scores of nursing care quality and its psychosocial and communication aspects
before the intervention (t = 1.96, P = 0.09). However, there was a statistically significant difference
between the two groups in this regard after the intervention, and the mean nursing care quality scores
and its related aspects were improved in the intervention group (t = 5.76, P < 0.0001).
CONCLUSIONS: The time management skills training could significantly improve psychosocial and
communication aspects of nursing care quality. Health‑care managers should allocate facilities to
clinical training programs so that health‑care professionals can acquire the time management skills.
The higher effectiveness of time management training can be determined by its application in diverse
domains of health care.

Abstract INTRODUCTION: Adequate knowledge about the presence of postexposure prophylaxis (PEP)
against human immuno‑deficiency virus (HIV) is imperative for health‑care workers. This study
focuses on the evaluation of the present knowledge and practice of nurses and paramedical workers
on the post exposure prophylaxis against HIV.
AIM: The aim of this study is to assess and compare the knowledge and practice of PEP against
HIV among Staff Nurses and Paramedical workers.
SUBJECTS AND METHODS: A descriptive cross‑sectional questionnaire study about the knowledge
and practice of PEP against HIV among Staff nurses and Paramedical workers done at a tertiary care
hospital in South India. The analysis of the data was performed using SPSS software version 24.
The statistical tests used to compare the knowledge between nurses and paramedical workers was
Chi‑square test. P < 0.05 was considered statistically significant.
RESULTS: About 339 nurses and 66 paramedical workers participated in the study. An overall
of 65.4% of the study participants had a good level of knowledge, higher (P = 0.000) among
nurses (71.1%) compared to paramedical workers (36.3%). However, only 23% of nurses and 14.3%
of paramedical workers received PEP after a needle prick injury.
CONCLUSION: This study revealed a low‑level practice of HIV PEP among staff nurses and
paramedical workers despite their good knowledge. This can be improved by providing formal training
sessions to the health care workers.

Abstract BACKGROUND: Nurses in their workplace, for a variety of reasons, always face moral distress that
is an underlying issue in the nursing profession, which can lead to problems such as reduced quality
and quantity of care and sleep disorder. Besides, given the increased privatization of hospitals, this
study aimed to explore the association between nurses’ moral distress and sleep quality and its
comparison among nurses in private and public hospitals.
MATERIALS AND METHODS: This was a descriptive‑analytical study involving 150 nurses working
in Ilam Province hospitals. Sampling conducted using a multistage random sampling method. Data
were collected through the questionnaire of sociodemographic characteristics, the Corley’s Moral
Distress Scale, and the Pittsburgh Sleep Quality Index. Data were analyzed using SPSS software
version 22. Descriptive statistics such as frequency, mean, ANOVA, independent t‑test, multiple linear
regression, and Pearson correlation coefficient at the significant level of P < 0.05 were calculated.
RESULTS: The analysis revealed that moral distress was positively associated with sleep quality.
Furthermore, the scores of nurses’ moral distress and sleep quality were different in private and
public hospitals, so that the level of moral distress in the public hospital and sleep quality in the
private hospital was higher and lower, respectively, but the difference was not statistically significant.
Moreover, sleep quality, and the type of employment was the most important predicting variables of
moral stress (B = 1.86) and sleep quality (B = 2.39), respectively.
CONCLUSION: According to the study results, a positive and significant association was found
between moral distress and nurses’ sleep quality. It is recommended that appropriate strategies
and training program be formulated by the health‑care system to increase nurses’ ability to combat
moral distress adverse effects.

Abstract BACKGROUND: Assessing how programs are implemented from the perspective of the learners
themselves is one of the most effective ways to improve the quality of continuing education. The aim
was to evaluate the implementation of in‑person continuing education programs from the perspective
of nurses.
METHODOLOGY: Setting of the study was the selected hospital of Isfahan University of Medical
Sciences (Al‑zahra hospital). This study is a descriptive cross‑sectional one. Using a researcher‑made
questionnaire, the implementation of continuing education programs in four areas of the aim,
educational techniques, educational content, and educational field was evaluated. The sample
consisted of 236 nurses working in these hospitals who participated in the study through convenience
sampling. Data were analyzed by SPSS software version 19 using descriptive statistics.
RESULTS: Based on the results, “the need for new content learning” was mentioned as the first
priority in continuing education programs. The majority of participants scored each of the following
domains (aim, educational techniques, educational content, and education field) as well as all items
related to the continuing education program evaluation as “moderate.”
CONCLUSION: Most nurses assessed the implementation of in‑person continuing education
programs implemented in Isfahan University of Medical Sciences in general and in each of the
domains as “moderate.” Therefore, in order to improve the quality of programs, it is necessary to
take steps to match the goals with the needs of learners, improve teaching techniques, improve the
quality of program contents, and optimize the scope of the programs.

Abstract BACKGROUND: Iran has experienced an increasing number of earthquake disasters in the past
three decades. Due to nurses’ unique role as professional and volunteer responders in times of
disaster, more information is required regarding the capabilities they need to provide more effective
care during the crisis. The aim of this study was to identify professional capabilities needed by nurses
to provide care to the injured of earthquake.
MATERIALS AND METHODS: The present study was conducted as a qualitative conventional content
analysis, and data collection was carried out through 16 semi‑structured and in‑depth interviews with
the nurses involved in providing care to the injured in the Kermanshah earthquake. The data were
analyzed following Graneheim and Lundman’s approach.
RESULTS: Data analysis led to the emergence of 427 primary codes, 10 subcategories, and four
categories. The four categories included clinical competence (professional knowledge and clinical
skills), personal competences (communication skills, resiliency, and creativity and innovation
in providing care), ethical competence (commitment to ethics and professional responsibility),
and essential skills in caring for the injured (skills in triage, psychological care skills, and skills in
observation and monitoring)
CONCLUSION: The present study identified a wide range of professional capabilities required by
nurses in disasters. Given that nurses do not acquire some of these specialized and technical skills
during their education, it is recommended to enhance the professional capacity of nurses in disasters.
In addition, special training programs in this field can be incorporated into the curriculum of nursing
programs and in-service nursing education.

Abstract INTRODUCTION: Nurse educators need to develop the level of scientific and practical of the students
with the goal of becoming expert nurses. However, the use of modern educational methods to raise
the motivation and satisfaction of learners can help individuals achieve this goal. Therefore, the aim
of this study was to investigate the effect of health education in emergency nurses about triage.
METHODS: A two‑group pool‑blind experimental study was performed on seventy emergency nurses.
Samples were randomly assigned into two groups: e‑learning group (35 individuals = electronic
education) and traditional group (35 = workshop education). The demographic questionnaire and the
satisfaction questionnaire before and 2 weeks after the intervention in both groups were completed.
RESULTS: Independent t‑test showed that the satisfaction scores before intervention in both
e‑learning and traditional groups were not statistically significant, whereas there was a significant
difference between two groups after 2 weeks after the intervention (P = 0/015).
CONCLUSION: Using nursing professors’ electronic education programs can increase the level of
satisfaction and motivation in the nursing mothers. Therefore, the use of this new educational method
is recommended by managers and educational planners as an effective teaching.

Abstract BACKGROUND: University health coverage gives everyone accesses to health services focused
on the most important causes of illness and death and ensures that the quality of services is high
enough to improve the health of those receiving services. Nurses as the largest group of staff in the
health system play an important role in achieving UHC. This study aimed to determine the training
needs of nursing managers in universities of medical sciences of Iran in achieving UHC.
MATERIALS AND METHODS: This study was a qualitative study conducted in 2019 using the
framework method. There were 15 experts in nursing management, health management, and nursing
authorities at the national level using the purposive random sampling. Data were collected from the
expert panel. We used the Atlas.ti software version 7.2 and using the framework method for the
analysis of qualitative data. A set of codes organized into categories that were jointly developed by
the researchers involved in the analysis. The UHC framework used to summarize data in a way that
could support answering research questions.
RESULTS: This study showed that three educational modules leadership and strategic thinking,
management, and decision‑making, achieving excellence in nursing management to capacity building
of nursing managers in the country.
CONCLUSION: Training leadership skills and strategic thinking in the nursing empowerment modules
illuminate global and national health roadmaps and policies and change attitudes to the model of
nursing service delivery. Since nurses are the largest group of professionals in the health system, it
facilitated by changes in the role and functions of the hospital and nurses to reach UHC.

Abstract BACKGROUND: The use of physical restraint in health‑care settings is common and complex practice
as it has physical, psychological, judicial, ethical, and moral issues. Nurses are the key persons
regarding physical restraint use in hospitals as they are managing the whole process beginning with
decision‑making, application, caring the restrained patients. Lack of understanding and negative
attitude of nurses in the use of physical restraints will hamper patient safety.
MATERIALS AND METHODS: A descriptive cross‑sectional survey was carried out among 110
rando  mly  selected nurses working in various departments at a tertiary care center Uttarakhand,
India, in 2019. The data were collected using self‑reported questionnaires consisting of three parts:
demographic information, knowledge assessment questionnaire, and attitude rating scale regarding
the use of restraints. Data were   analyzed using  the SPSS version  23 descriptive  (frequency,
percentage, mean, mean percentage, and standard deviation) and inferential statistics (Mann–Whitney
and independent t‑test).
RESULTS: The findings indicated that the mean knowledge and attitude of the nurses for physical
restraints were 13.9 ± 1.9 (0–20 points), 35.2 ± 4.7 (28–55 points), respectively. The study revealed
that there was no relationship found between knowledge and attitude of nurses regarding the use
of physical restraints (r = 0.084).
CONCLUSION: The knowledge and attitude regarding the use of restraints among nurses were found
to be moderate. In‑service training is highly recommended for nurses to improve the knowledge and
practices related to the use of physical restraint.

Abstract INTRODUCTION: The hospitals are a stressful environment for employees, especially nurses. Stress
and other health problems may lead to occupational burnout and reduction of nurses’ efficiency.
The aim of the current study is to investigate the effect of emotional intelligence training on health
promotion of nurses in Sabzevar Hospitals.
METHODOLOGY: The current study is a field trial with a random control group. The sample
group was 135 nurses of Sabzevar Hospitals. They were then divided randomly into experimental
and control groups. First, all of the samples answered the questionnaire of personal information,
Bar‑On Emotional Intelligence, and General Health Questionnaire. The first group (intervention)
was trained by giving the speech, and the second group (control) did not receive any intervention
about the subject of the study. The experimental group was then trained for the components
of emotional intelligence and answered the questionnaire again. The significance level was
considered as P < 0.05.
RESULTS: The results showed that the distribution of qualitative variables in the study was similar
and also the scores of emotional intelligence and the dependent variables after intervention in the
intervention group had a significant and inverse relationship, meaning that the score of emotional
intelligence decreased with the score of general health score. This could be significant in comparison
to the two groups. Findings showed that emotional intelligence at the beginning of the study in
the intervention and control groups were 35.03 ± 32 and 30.89 ± 33, respectively, and after the
intervention, it was 29.68 ± 35 and 42.89 ± 34, respectively. Total general health was 19.76 ± 84 and
18.77 ± 77 in the case group before intervention and 14.55 ± 56 in the case group and 17.68 ± 52
in the control group, respectively (P < 0.001).
CONCLUSION: Findings indicated the significant mutual effect of emotional intelligence changes
and general health variables. It means as the score of emotional intelligence gets more, health score
decreases and the rate of general health increases.

Abstract BACKGROUND: The patient handover process is in fact a valuable and essential part of the care
processes in the hospitals. This can be a factor in increasing the quality and effectiveness of medical
care. Incorrect and incomplete handover can increase the percentage of errors and cause serious
problems for patients. The aim of this study was to identify the handover challenges concerning
safety and quality of health services.
MATERIALS AND METHODS: A systematic review was conducted according to the Preferred
Reporting Item for Systematic Reviews and Meta‑analyses guideline. The key words “challenges
of patient handover” or “challenges of patient handoff” were used in combination with the Boolean
operators OR and AND. The ProQuest, Ovid, Doaj, Magiran, SID, Scopus, Science Direct, PubMed,
and ISI were searched.
RESULTS: A total of 263 articles were extracted, and 20 articles were selected for final review.
The results of selected articles indicated that there are various challenges such as communication,
noncoordination, nonuse of checklist, poor management, time management, and other things. These
studies reported that communication was the main challenge of handover process.
CONCLUSIONS: Hospitals try to provide a lot of services to the patients and other customers in a
safe and healthy environment. Lack of communication among the incoming and outgoing nurses in
handover process is one of the main causes of reduced safety and quality of services and patient
dissatisfaction.

Abstract BACKGROUND: Structural empowerment (SE) is an effective method of advancing work
environments and has previously been widely discussed in Western countries. Due to the lack of
culturally and academically accepted scales in Iran for measuring SE, localization of a foreign scale
in this field is necessary.
OBJECTIVES: This study aimed at investigating the validity and reliability of the Persian Version of
the Conditions of Work Effectiveness Questionnaire‑II (CWEQ‑II‑PV) among Iranian nurses.
METHODS: The present cross‑sectional methodological research was conducted during 2017–2018.
Participants were 230 nurses working in four teaching hospitals affiliated to Kashan University of
Medical Sciences in Kashan, Iran, who were selected using quota sampling. A standard forward–
backward translation procedure according to Wild et al. (2005) was used to translate the English
Version of the CWEQ‑II to Persian. The psychometric evaluation processes were achieved by face,
content, and construct validity (confirmatory factor analysis [CFA]). Reliability was examined using
test–retest and Cronbach’s alpha for internal consistency reliability.
RESULTS: The CWEQ‑II‑PV showed good content validity (the mean content validity scores for
relevancy, clarity, and simplicity were 94%, 96%, and 94%, respectively). In the CFA, the original
six‑factor version with 19 items was confirmed. The original model was presented and incorporated in
the CFA, indicating an acceptable fit for the model (root mean square error of approximation = 0.06,
comparative fit index = 0.92, goodness of fit index (GFI) = 0.94, and adjusted GFI = 0.91). Cronbach’s
alpha coefficient for the total scale was 0.84 and for each component ranged from 0.71 to 0.87,
indicating good internal consistency, and the test–retest Spearman and intraclass correlation
coefficients were 0.93 and 0.87, respectively, showing good test–retest reliability.
CONCLUSIONS: Evidence was found to support the reliability and validity of the CWEQ‑II‑PV scale
that measures the quality of the work environment for nurses from a SE perspective.