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Background and purpose: Caring as the core concept of nursing, have been defined in different ways since the past, yet it remains an abstract concept in nursing practice. There are many discussions and challenges between scientists in nursing and so far few researches were carried out on this concept. The purpose of this study was to identify how nursing care is conceptualized by nurses in Iran, and to develop guidelines for clinical practice. Materials and methods: This study employed the hybrid model to define the concept of care through 3 phases. For the theoretical phase attributes of care were identified through a review of the literature (until 2011), and in depth interviews were conducted for the fieldwork to develop attributes from the data and to verify those identified from the literature review. In third phase attributes and final analysis of care were extracted from the first and second phase. Purposive sampling was done for 20 participants (16 nurses and 4 faculty members. Results: Core attributes of care include assessing patients' needs, altruism, duty responsibility, routine and participating in religious activities. However, core attributes of a good nurse who cares a patient includes creativity, responsibility, being decisive, capable of establishing effective relationship, and skillful in practice. Conclusion: It seems that the result of this study somewhat assisted in clearing the concept of care. This may result in providing the patients with care based on their needs, their satisfaction, professional development and reduction of health costs. Moreover, by identifying the facilitating and preventive factors, and the concept of care, nursing managers and instructors will be able to design and run their management and educational activities based on scientific findings which could provide the necessary conditions for learning and proper implementation of nursing care.

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Background and purpose: This study aimed to determine the origin and distribution of lead, copper, zinc, nickel, chromium and vanadium in surface sediments of Mazandaran coastline (southeastern coast of the Caspian Sea). Materials and methods: Surface sediment samples were collected from four transects in Tonekabon, Noshahr, Babolsar and Amir abad port, at three different depths of 5, 15 and 30 m in July 2012. Metals concentration were determined by ICP - OES. Results: The metals in the studied areas were found to be from natural sources, probably due to weathering of rock and soils erosion transported by rivers into the sea. Significant difference was seen in the mean total concentration of metals along the four transect when the distance from the shore increased. The mean concentration of metals along the coast from east to west showed a significant increase. Among the metals, the highest concentrations was found for zinc (104 μg/g) at 30 m depth in Babolsar transect and the lowest concentration was found for copper (8.72 μg/g) at 5 m depth in Amir abad port transect. Conclusion: Total concentrations of metals were lower than standard levels (SQGs and NOAA). Moreover, the risk assessment code (the presence of metals in the exchangeable fraction) did not show any risk from copper, zinc, nickel, chromium and vanadium, but it showed only a low risk for lead. This study found that the studied metals have low-risk for local environment.

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Background and purpose: To know about the outcomes of self- learning education as compared to lecture is highly influential in training and increasing nurses, competency. The aim of this study was to compare the effect of the lecture and self-learning modules on the nurses’ teaching competency to cardiac patient education. Material and Methods: In this randomized controlled trial study 60 nurses in were selected using the convenience sampling and through blocking-random allocation method and divided them inot two groups of learning module and lecture. In the lecture group, the intervention consisted of a 2h-4 sessions. The other group received learning module. A week after the intervention, post-test was performed. Data were collected by written-test and Observation and Self Assessment. Data were analyzed by SPSS version 16 and descriptive and inferential statistics (independent t-test, paired t-tests, Chi-Square). Results: Both the self-learning modules (P<0.001) and lecture (P<0.001) were effective on the promotion of nurses’ teaching competency, and the effect of the two methods in teaching competency was not statistically meaningful (P= 0.11). The difference of Written-Test in Lecture and Learning Module Group Were Repeating 3.87±1 and 4.63±1.43 (P= 0.02). The difference of self -assessment in the Lecture and Learning Module Group Were Repeating 0.25±0.42 and 0.02±0.21 (P=0.03). The difference of observation in the Lecture and Learning Module Group Were Repeating 1.21±1.07 and 1.41±1.05 (P=0.46). Conclusion: Self-learning modules seem to be as effective as the lecture in the competency of nurses and in providing useful training programs.

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Background and purpose: Cancer is one of the most common growing diseases. According to statistics, its incidence in East Mediterranean region and Iran is increasingly growing. Considering the rise in the number of patients with cancer and threatening nature of this disease as well as problems of the patients and their families, the necessity to know and to understand the patients’ needs and problems, especially after revealing cancer diagnosis is imperative. Recognizing patients’ needs will help in resolving their problems. The aim of this study was to understand patients’ needs when confronted with cancer diagnosis. Materials and methods: Using qualitative approach, the present study was done with content analysis method application. Nineteen participants including patients, physicians, nurses and patients’ close relatives were chosen amongst the clients of an oncology unit, a cancer clinic, and a cancer patients support center. Purposeful sampling method was applied at the beginning and continued until data saturation was achieved. Face to face interview and taking field notes were used to collect the data. All the interviews were recorded and transcribed verbatim. Results: Five hundred and sixty five primary codes in four categories were obtained which consisted of 'supports of family and friends', 'effective interaction of medical staffs with patients', 'services offered by supportive organizations' and 'necessity to inform and prepare the patients'. The main common theme of categories was 'support' which was the major need of patients with cancer. Conclusion: The findings of this study showed that when the diagnosis of cancer is made, patients will have a lot of needs. Recognizing these demands by health authorities and clinical staffs could improve their interaction with patients.

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Background and purpose: Bipolar disorder (BD) is a severe illness that has serious impacts on the lives of such patients and their families. Today families of individuals with BD are actively involved in providing care to their loved ones. Therefore, successful management of these patients relies significantly on the health of caregivers. The aim of this study was to explore the meaning of health according to family members who care for adult patients with BD. Materials and methods: A phenomenological qualitative research was carried out in the family members caregiving to BD patients in Farshian Psychiatric Hospital, Hamedan, 2010. The subjects were selected using purposive sampling. By reaching data saturation the number of participants was 12. In order to collect the data in-depth interviews were conducted and then analyzed by Van Manen method. Results: Six main themes with 14 subthemes were identified in this study including ‘living in hell’, ‘mental-emotional exhaustion’, ‘self-neglect’, ‘the need to receive support’, ‘condemned to isolation’ and ‘feelings of shame’. Conclusion: This study underlines the necessity for comprehensive support among family caregivers of BD patients. Hence, support and interventions regarding such families’ health have to be considered by all mental health treatment providers.

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Background and purpose: Cognitive models refer to the effect of early maladaptive schemas in formation of psychology pathologies in establishing psychological problems. This study aimed at determining the relation between early maladaptive schemas with procrastination and mental health of medical and non-medical students of Shahid Beheshti University of medical sciences. Materials and methods: This correlational descriptive study was done using procrastination questionnaire (GP), early maladaptive schema of Yang (YSQ-SF) and General Health Questionnaire (GHQ-28) were applied to collect the data. The data was analyzed using SPSS. Results: The subjects included 462 students including 232 medical students and 230 non-medical students who were recruited according to accessibility features. There results showed a significant correlation between early maladaptive schema and procrastination and mental health in medical and non-medical students. Conclusion: This study verified the role of early maladaptive schema in psychological pathology and procrastination. However, further studies should be carried out to define and clarify the cognitive content of any psychological malfunction.

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Introduction: Nurses are the largest group of professionals in the health care systems whose the most important aim is enhancing patients’ quality of life, but nurses’ own quality of life and health promoting behaviors are the issues that have not been dealt with sufficiently. The present study was performed to measure the amount of health promoting behaviors of nurses working in educational hospitals of Sari affiliated to Mazandaran University of Medical sciences 2013. Material & Methods: The present research is a descriptive cross- sectional study which was done through using stratified random sampling in 226 working nurses in four educational hospitals in Sari city in 2013.Data were gathered using a two-section questionnaire including demographic characteristics and 52 likert-type (from 0 to 4 score) questions which was based on Health Promoting Lifestyle Profile-HPLP- II and its validity and reliability were confirmed. Data analysis was performed using T-test and One-way ANOVA tests. Results: The mean score of HPLP- II was 135.33±18.55 (the total score is 208). The highest score was in the area of nutrition (25.53±4.37) and the least score was in the area of physical activity (16.85±5.05).The total score of HPLP- II and all its area except nutrition were higher in the male nurses than that of female nurses, but the significant difference was observed in the area of physical activity (p=0.001). Conclusion: Nurses should obey health promoting behaviors in a high level and this study is a beginning of increasing researchers and hospital managers’ knowledge to implement health promoting plans among the working nurses in the hospitals to achieve a desirable level of health promoting behaviors especially in the physical activity domain.

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Background and purpose: One of the main goals of nursing education is training appropriate and efficient nurses. The purpose of this study was to discover the perceptions of nursing students and their teachers about professional competency of academic staff. Materials and methods: In this qualitative content-analysis approach study, the data were collected through unstructured in-depth interviews [30 individual and 1 focusing (Focus Group) interviews]. The participants were chosen using purposeful sampling from Mazandaran University of Medical Sciences, Iran, during July 2012 to June 2013. Formal or conventional qualitative content analysis was performed. Results: 11 categories and 4 themes were achieved. The themes included making the theoretical training efficient and useful (with 4 subthemes), gaining qualificative nursing science and skills (with 4 subthemes), making the clinical education efficient and effective for students (with 8 subthemes), and making the evaluation logical and objective (with 3 subthemes). Conclusion: This study found four basic themes of professional competency of academic staff and the indicators related to these features according to nursing students and their teachers' viewpoints. These findings can be used for designing evaluation and assessment tools for professional competency of academic staff.

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Background and purpose: The need for privacy is a basic human right. Nurses are expected to respect the patients’ privacy. This study investigated the viewpoints of patients and nurses regarding keeping the patients’ privacy during nursing care. Materials and Methods: In this cross sectional study 127 nurses and 384 patients meeting the criteria for study were selected through randomized sampling. Data was collected by a questionnaire designed by Heydari (2000) and analyzed using t-test and ANOVA in SPSS ver.18. Results: The results showed a significant difference on average score of the realm of human between nurses and patients (P<0.05). According to the studied population the levels of paying respect to human realm and private space in hospital were moderate. Significant relationships were seen in viewpoints of nurses’ considering their gender and educational level. We also found a significant correlation between the patients’ viewpoints and their level of education and place of residence. Conclusion: To enhance the quality of services provided by nurses they should consider patients’ right to privacy and care for them while respecting their privacy.

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Background and purpose: The success of organ donation process is closely related to the knowledge, attitude and practice of nurses toward this issue. Therefore, the nurses involved with this process should be aware of their roles. This study was conducted to determine the effect of training program based on nursing model of dynamism and continuous improvement in seeking assurance and getting approve on nurse's knowledge, attitude and practice about their role in organ donation process Material and methods: In this experimental study, Ghaem and Imam Reza Hospitals in Mashhad were assigned into either experimental or control groups. Then through stratified random sampling allocation, 60 ICU Nurse's (n=30 per group( were selected. In intervention group training program was conducted in two stages based on the model and in the control group traditional training program on organ donation process was performed. Each stage continued for 3 hours with a one week interval. Both groups completed a researcher made questionnaire assessing nurse's knowledge, attitude and practice toward nurses role in organ donation process before and one month after the intervention. Data Analysis was done using t-test, Paired test and Chi-Square in SPSS V.11.5. Results: There was no significant difference in nurse's knowledge (P=0.36), attitude (P=0.27), and practice (P=0.59) between the two groups before the intervention but significant differences were seen in both groups after the intervention (knowledge P<0.001, attitude P<0.00, and practice P<0.001). Conclusion: The results showed that training program based on proposed model was found to be more effective in increasing the nurses’ level of knowledge, attitude and practice in organ donation process. Nursing model of dynamism and continuous improvement in seeking assurance and getting approve could be applied in nursing education to enhance the level of training provided for nurses involved in organ donation process.

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Background and purpose: Suitable workload of nurses is one of the main factors in patient care safety and quality assurance. Thus, measuring nurses' workload in ICUs is really important. The aim of this study was to determine the degree of nursing workload in ICU and associated factors using Nursing Activity Scale (NAS). Materials and methods: A descriptive-analytical study was performed in 285 ICU inpatients in educational Hospitals affiliated to Mazandaran University of Medical Sciences. The patients' demographic data and medical data were collected through a checklist during three months. NAS was applied to evaluate the nursing workload. Results: The sample consisted of 162 (56.8%) male and 123(43.2%) female. The mean age of patients was 42 ± 4.2. Among the subjects 164 (57.5%) had medication and 121(42.5%) were on surgical treatments. Most of the patients (48.4%) were admitted from operating rooms. The mean scores of NAS were 121.56 ± 40.49, 105.95 ± 34.98, and 99.57 ± 26.07, in morning, afternoon and evening shifts, respectively. Conclusion: The study showed a high degree of nursing workload in ICU in three working shifts. Using NAS is recommended for determining the ratio of the nurses' activities to their numbers in order to provide high quality patient care in ICUs via allocating adequate number of nursing staff.

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Background and purpose: Human dignity is amongst the main human rights and violence in workplace is a worrying issue for every person. The prevalence of violence in medical staff led the authors to study about violence in nurses and related factors in critical care units in educational hospitals affiliated to Mazandaran University of Medical Sciences. Materials and methods: A descriptive-analytical study was carried out in 2014 in which 481 nurses were recruited using stratified random sampling. Data was collected through Dumont Horizontal Violence Questionnaire (including 49 questions) and analyzed in SPSS v.21. Results: Among the participants 16.6% had shown violent behavior towards their colleagues. It was also found that 34.9% of nurses have been exposed to violence at least once a month. The findings showed that head nurses were exposed to violent behaviors from hospital managers and physicians more than others. Data analysis indicated that peer violence was more prevalent in hemodialysis unit, while in CCU and ICUOH nurses were involved in violence from hospital managers and physicians. Conclusion: This study demonstrated that many nurses are exposed to violence, therefore, educating and training hospital personnel on anger management could reduce the rate of violent behavior.

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Background and purpose: Kidney transplant is the most cost-effective strategy in treatment of patients with kidney failure. But allograft dysfunction is still discussed as one of the main problems in these patients. The aim of this study was to identify the factors associated with the development of complications after kidney transplant. Materials and methods: This correlation- descriptive study was performed in kidney transplant recipients (2002-2006) in Mashhad Imam Reza Hospital. Data was recorded in a researcher-made check list including type of dialysis, history of dialysis, cause of kidney disorder, donor kidney anatomy, parathormone hormone level, and complications after kidney transplant including length of hospitalization, urinary infection, and post-renal transplant diuresis. Results: The results showed relationships between age of recipients and wound infection, donor kidney anatomy with lynfocel, deceased or live donor with length of hospitalization, and post-renal transplant diuresis with acute tubular necrosis. We found relationships between history of transplant with length of hospitalization, lynfocel, and acute tubular necrosis. Also, a significant correlation was found between history of dialysis with length of hospitalization (B=0.153, P=0.002) and acute tubular necrosis (B=-0.137, P=0.002). Moreover, there was a significant association between parathormone hormone level with length of hospitalization and post-renal transplant diuresis (B=0.473, P= 0.004 and B=0.398, P=0.011, respectively). Conclusion: Old age recipients, high frequency of dialysis, low level of parathormone hormone, deceased or live donor, and donation of right kidney were amongst the main factors in development of post-transplant complications.

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Background and purpose: Moral distress is a common phenomenon in nursing professional and burn nurses are constantly faced with making different moral decisions for patients who are in terrible conditions. Therefore, nurses in burn units experience moral distress as mental tension. This study was conducted to determine the severity of moral distress and the factors associated with that in burn nurses. Materials and methods: A descriptive- analytical study was conducted using census sampling on 172 nurses working in Mazandaran burn center, 2014. Data was collected through identifying demographic and occupational characteristics of the nurses (using relevant questionnaires) and Corley’s Moral Distress Scale. Data analysis was performed applying Mann-Whitney and Kruskal-Wallis test. Results: The mean score for moral distress was 105.65±52.39 which indicates a moderate level experienced by nurses. Kruskal-Wallis test showed a significant positive correlation between educational level and level of moral distress (P=0.011). There was no significant association between moral distress and other individual and professional characteristics (P>0.05). Conclusion: Moral distress is accompanied by many complications that have direct effects on nurses’ professional practice. Therefore, nurse managers should consider this issue and plan for programs on appropriate coping strategies.

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Background and purpose: Anxiety is a normal reaction to stress influencing behavioral, physical and mental aspects of human life. This study aimed to apply Neuman Systems Model in reducing the patient's anxiety level before surgery. Materials and methods: In a randomized controlled trail, 104 patients undergoing orthopedic surgery in Imam Ali Hospital, Bojnourd were studied. Data was collected using a demographic questionnaire and the Spielberger State-Trait Anxiety Inventory (STAI). Intervention was performed according to Neuman Systems Model that includes assessing the actual and potential stressors, identifying the objectives and strategies for action, and strengthening the defense and the natural flexibility. Assessment of anxiety was done in two groups (the experimental group according to Neuman Systems Model and the control group without any intervention) before and after the intervention. Data was analyzed by Chi-square test, t-test, and paired t-test using SPSS V. 16. Results: The results showed no significant difference in the level of anxiety before the intervention between the two groups. But after the intervention the anxiety level reduced significantly in experimental group (-18.94±16.1, P<0.001). A significant increase in anxiety was seen in control group (+12.73±9.98, P<0.001). Conclusion: The Neuman Systems Model was found to be efficient in reducing the level of anxiety before orthopedic surgical procedures. This study supports the role of Neuman Systems Model in reducing anxiety before orthopedic surgery, so, this model could be applied in both educational and clinical settings.

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Schwannomas are benign tumors of the nerve sheath and are usually single encapsulated and slow growing in peripheral or sympathetic nervous system. In this report a 49 year-old man is presented with one year complain of abdominal pain and intermittent hematospermia. The CT scan of the abdomen showed a 60 × 65 × 60 mm mass in anterior pelvic cavity with deviation to the sacral bone, originated from nerve. Several examinations revealed neurofibroma. Due to the large size of the tumor and it's position to the pelvic nerves, to remove the mass the patient only underwent laparotomy with partial resection. Pathology tests confirmed Ancient Schwannoma with degenerative changes. Radiotherapy was done with the aim of reducing the size of the rest of tumor. In our case, schwannoma was diagnosed incidentally. The size of the tumor indicated a relatively long period from the time that tumor was generated until the time of diagnosis. Despite using paraclinical findings, a definite diagnosis of the disease was made by histopathological tests.

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Abstract Background and purpose: Methotrexate as a chemotherapy drug causes chronic liver damage, infiltration of neutrophils, oxidative stress, and direct renal tubular damage. Quercetin is a flavonoid with antioxidant and anti-inflammatory properties. Therefore, the aim of this study was to investigate the effect of quercetin on eliminating the liver and kidney toxicity of methotrexate. Materials and methods: In this experimental study, 32 rats were divided into 4 groups. Group I (control) was given regular diet. Group II received single-dose methotrexate. Group III received methotrexate + a single dose quercetin and the last group (positive control) received methotrexate + a single dose silymarin. After five days, blood samples were taken and the serum GOT, GPT, ALP, Cr, urea and antioxidant capacity of plasma were measured. Some parts of liver and kidney were removed to measure the liver and kidney SOD, MDA, catalase activity and histopathological studies. Results: Serum GOT, GPT, ALP, Cr, and liver and kidney MDA were significantly higher (P<0.05) in group II, compared with those of the control group. These parameters significantly decreased (P<0.05) in group III. Compared to the control group, antioxidant capacity of plasma, activity of the liver and kidney SOD, catalase and serum urea decreased significantly in group II (P<0.05). Administration of quercetin significantly increased these parameters (P<0.05) and decreased hepatic and renal lymphocyte infiltration. Conclusion: According to the results, administration of quercetin could have a protective role in preventing liver and renal toxicity induced by methotrexate which could be due to its antioxidant property.

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Background and purpose: Palliative care is an important concept in nursing practice and in literature several definitions are suggested for this concept. This study aimed at analyzing the concept of palliative care and identifying its features, antecedents and consequences within Iran’s cultural context.

Materials and methods: Hybrid model of concept analysis was used to clarify the meaning of palliative care. The three phases of a hybrid concept analysis included theoretical, fieldwork, and final analysis. In theoretical phase different databases including PubMed, CINAHL, Science direct, Google scholar, SID and Magiran were searched for related articles (published in 2003-2013). The search keywords were palliative care and nursing care in the titles and abstracts. In the fieldwork phase semi-structured in-depth interviews were conducted through purposive sampling in eight nurses. In next step, by combining the two previous stages the final analysis was performed.

Results: In final analytical phase, main themes were extracted including pain management, holistic care, spirituality based care and religious based care. 

Conclusion: The findings showed that palliative care is an important aspect of clinical practice. It is a holistic, humanistic and corporative care for promoting the quality of life of patients and their families that support them while considering physical, psychological, spiritual, religious, cultural and social aspects. This type of care is beneficial throughout life and also in difficult situations such as famine and it should not be used just for end-stage patients.

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Background and purpose: There is a high incidence of urinary tract infection (UTI) and the resistance rate of infectious organisms to antibiotics is increasing. In this study we aimed to investigate the frequency and pattern of antibiotic resistance of pathogens in urinary tract infections in hospitalized patients.

Materials and methods: This cross-sectional study was conducted using 107 urine samples with positive urine cultures form patients with urinary tract infections admitted to the department of infectious diseases in Razi Hospital (an educational hospital in Quemshar), 2011. Then the minimal inhibitory concentration (MIC) of antibiotics was determined by E-Test. Data was analyzed in SPSS (V. 18).

Results: The mean age of the samples was 61.63 ± 18.38 years (age range 10-91 years) and there were 27% male and 73% female. E. coli was found as the most common gram-negative organism (68.2%) that showed a high sensitivity to nitrofurantoin (90.4%) and imipenem (79.5%) and a high resistance against ampicillin (93.2%) and cotrimoxazole (76.7%). Among all infections, the highest antibiotic susceptibility was to nitrofurantoin (81.3%), imipenem (78.5%) and the highest resistance was observed against ampicillin (94.4%).

Conclusion: Antimicrobial therapy should be performed according to the results of urine culture and antimicrobial susceptibility testing.