Background: Caring for brain dead patient is one of the most troublous duties of an Intensive Care Unit (ICU) nurse. This study aimed to determine nursing challenges based on recent literature and identify the strategies to overcome these challenges. Materials and Methods: In this systematic review, the standard systematic review guideline of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used with articles published in PubMed, Science Direct, Scientific Information Database (SID), and Google Scholar databases during 2000–2018 on the keywords “brain dead OR brain death” and “nurses OR nursing.” After the primary search, 212 articles were found. Eventually, 21 articles were selected for the final evaluation. Results: According to the results, the challenges included the concept and diagnosis of brain death, religious, and cultural beliefs opposing organ donation, lack of knowledge about the care process, interactions with the families. The proposed strategies were providing medical and nursing interventions to maintain a brain dead patient for organ donation, providing working conditions that maintain nurses' health, and increase the quality of care. Conclusions: Nurses play an important role in the care process of brain dead patients; therefore, recognizing their challenges can be the first step in increasing holistic care and maintaining organ vitality for transplantation. It is suggested that nursing authorities commence special educational programs with the aim to increase the knowledge of nurses about the care process of brain dead patients.

Background: Autonomy is the main element of professional practice in nursing. However, despite the many studies conducted on nursing autonomy, this concept is not fully understood and a comprehensive explanation of this concept in nursing is necessary. Meta-synthesis offers a way to increase the understanding of this concept using existing research findings. Thus, the present study aimed to explain the concept of professional nursing autonomy. Materials and Methods: This qualitative meta-synthesis was conducted based on a modified version of Noblit and Hare's meta-ethnography approach and qualitative studies on the concept of nursing autonomy published in databases such as PubMed, Scopus, Web of Science, Cochrane, SID, IranMedex, Magiran, and ScienceDirect in the past 15 years (2003–2018). Results: Thirteen articles that reported the experiences of nurses regarding professional autonomy were included in the research. Based on the meta-synthesis of findings, the final interpretation of the professional autonomy of clinical nurses was presented in the three themes of professional competence, professional decision making, and professional interactions. Conclusions: According to the results, the concept of professional autonomy is a developmental achievement based on patient-based professional competence along with self-reliance to provide the best care plan for the promotion of patients' health through the professional decision making and professional interactions with other professional team members.

Background: Nipple fissure is a common problem among breastfeeding women, which can lead to early cessation of breastfeeding. Because of the lack of effective treatment and given the approved efficacy of honey and yarrow on sore healing, this study was conducted to evaluate and compare the effects of yarrow, honey, and breast milk on the treatment of nipple fissure. Materials and Methods: This study was a three-group clinical trial, and sampling was conducted at Sina breastfeeding counseling center from September 2016 to March 2018 in Sirjan, Iran, using a target-based method. The sample size consisted of 150 individuals who were randomly assigned into three groups as topical use of yarrow, the mountain honey, and breast milk after obtaining the written informed consent. The correct method of breastfeeding and using materials were instructed to these three groups on the 1^st, 3^rd, and 7^th days, where the Storr scale was completed by the researcher. Results: Friedman test showed that, in these three groups of yarrow (χ² = 92.19, df = 2, p < 0.001), honey (χ² = 93.29, df = 2, p < 0.001), and breast milk (χ² = 90.51, df = 2, p < 0.001)); severity of fissure had a significant reduction. Nevertheless, Kruskal–Wallis test revealed no significant difference among the severity of fissure scores in these three groups (p > 0.05). Conclusions: Use of honey, yarrow, and breast milk can be recommended to women in breastfeeding counseling and pharmaceutical companies can be advised to use honey and yarrow in the preparation of anti-fissure creams.

Background: Patients with cancer deal with physical, psychosocial, spiritual, and existential problems that impact on their quality of life. This study aimed to assess the effect of dignity therapy on the quality of life of mentioned patients. Materials and Methods: In this quasi-experimental study, 50 patients with cancer hospitalized in a palliative care center in Tehran, Iran, in 2017-18 who fulfilled inclusion criteria were selected through convenience sampling. The European Organization for Research and Treatment of Cancer Quality of Life-C15-Palliative (EORTC-QLQ-C15-PAl) questionnaire was filled by patients before and 2 weeks after dignity therapy. Data were analyzed using descriptive statistics such as frequency, mean, and standard deviation, as well as inferential statistics, including independent t-test and Chi-square test. Results: Results showed that dignity-therapy led to more improvement in the quality of life of the intervention group (t_35,18= 4.82, p = 0.001). There was also a significant difference between the two groups in terms of the physical functioning scale (t_32,96= -2.60,p = 0.01) and emotional functioning (t _45,69= 6.54, p < 0.001). We also found that dignity-therapy led to more improvement in nausea and vomiting (χ² = 5.71, p = 0.02), insomnia (χ² = 15.78, p < 0.001), appetite (χ² = 5.09, p = 0.02), and constipation (χ² = 12.50, p < 0.001). Conclusions: The application of new approaches like-dignity therapy could benefit patients with cancer in terms of reducing their distress, improving symptom severity, physical and emotional functioning, and total quality of life.

Background: Buerger-Allen Exercise (BAE) promote Lower Extremity Perfusion (LEP) via the wound healing process and reduce Peripheral Neuropathy Symptoms (PNS) among Diabetes Mellitus (DM) patients. We study the efficacy of BAE on LEP and PNS among patients with DM. Materials and Methods: This quasi-experimental study was conducted prospectively from July to October 2017. Fifty DM patients between the ages of 30 and 75 from both genders were selected using a purposive sampling technique and were assessed for LEP with a manual Ankle-Brachial Index (ABI) scale and assessed for PNS with Michigan Neuropathy Screening Instrument (MNSI). The BAE was demonstrated for 4 consecutive days. The intervention was repeated five times per day for each patient and the posttest was conducted 5^th day using the same tools. Results: The majority (n = 75, 75%) were 60–69 age group and 98% had education till primary school. 62% had diabetes and 20% of them had a history of peripheral arterial disease. 50% of participants had mildly impaired perfusion during pretest whereas abnormal neuropathy was seen in more than 70% cases which decreased posttest. A significant difference in PNS was seen after the implementation of BAE in both right LEP (t₄₈ =6.81, p < 0.001) and left LEP t₄₈ =5.21, p < 0.001). Conclusions: BAE has to be taught to the patients with DM in improving the level of LEP and can be encouraged to practice in the hospital and home care setup.

Background: It is well-known that clinical practice could never be free from medical errors. Respectively, in the case of a large number of students with a huge diversity of disciplines, the breach of patients' safety is not uncommon. Thus, this study aimed to assess students' evaluation of patients' safety education in their curriculum. Materials and Methods: A cross-sectional study was conducted among 338 students at the University of Gondar. A descriptive analysis was done by using Stata version 13 software and data were presented in tables and text. Results: As stated by 33.40% of medical interns and 51.10% of nursing students, patients' safety education was given as a chapter of a course. On the contrary, 48.20% of midwifery and 32.10% of health officer students stated that it was given as a small portion in a chapter in their curriculum. Almost 60% of students of all professional categories self-reported that their average level of knowledge on the patients' safety rested between “fair” and “poor.” Likewise, more than half of students of all professional categories had a “neutral” to “disagree” level of attitude for attitude items. Concerning teaching methods, most students preferred real-life examples and problem-based learning approaches as helpful in patients' safety education. Conclusions: Patients' safety education has been given less emphasis. Students also self-reported that their average level of knowledge was low. Real-life examples and problem-based learning approaches were preferred learning methods among most of the students.

Background: A review of the literature shows that there is little consensus on the practical definition of maternal role attainment in the field of neonatal nursing care. The initial interaction between mother and neonate most often begins in the hospital and can be influenced by neonatal nurses, so it is necessary to clarify this concept in nursing. The purpose of this study was to show the basic characteristics and practical definition of maternal role attainment in mothers with term neonate in a new context. Materials and Methods: This study used a hybrid model three-step concept analysis: theoretical, fieldwork, and final analysis phases. At theoretical phase, articles indexed in credential databases were searched using keywords. Totally, 33 articles were analyzed. At fieldwork phase, 12 participants were interviewed. At final phase, the findings of the two earlier phases were analyzed. The study lasted from August to November 2018. After determining the attributes, antecedents, and consequences, a final definition of maternal role attainment was introduced. Results: The concept of maternal role attainment was defined as “a developmentally, interactive, adaptive, and committed multi-dimensional process based on the discovery of pregnancy, characteristics of the mother, receiving social support, which leads to maternal identity, formation of maternal skills, resiliency, development of newborn, improvement of mother-newborn interactions and increased well-being of the mother”. Conclusions: This study identifies the concept of maternal role attainment in nursing, providng a good basis for evaluating and applying this concept.

Background: Regarding the importance of mentoring in nursing and lack of attention to this issue, as well as the lack of a suitable questionnaire to assess mentoring, this study was carried out to design and analyze psychometric properties of mentoring among bachelor's degree students in nursing. Materials and Methods: In a mixed method study, the validity and reliability of the Mentoring Questionnaire were measured after designing it. The study sample included all undergraduate nursing students of one of the nursing schools in Tehran, Iran. In the qualitative phase, item generation, face, and content validity were performed. In the quantitative phase, construct validity and reliability were performed. The Cronbach's alpha coefficient and Interclass Correlation Coefficient (ICC) test were exploited for data analysis and reliability assessment, respectively. Results: The number of items designed for the Mentoring questionnaire was twenty. Finally, the Mentoring Questionnaire was designed with 16 items. The Cronbach's alpha coefficient of the Mentoring Questionnaire was 0.96. In addition, the results of the ICC showed the high reliability of the Mentoring Questionnaire (ICC = 0.99). The indices derived from Exploratory Factor Analysis (EFA) revealed that the Mentoring Questionnaire had appropriate construct validity. Conclusions: Given the results of this study, as well as the importance of mentoring measurement among nursing students and the lack of access to a valid questionnaire, it can be concluded that the Mentoring Questionnaire is a useful tool for bachelor's degree nursing students.

Background: Nurses in nursing homes are constantly faced with various moral decisions in terms of elderly care, which in turn causes moral distress. This study aimed to evaluate the moral distress status and its influential factors in the nursing homes in Khorasan provinces, Iran. Materials and Methods: This descriptive-correlational study was conducted on 227 nurses engaged in the nursing homes of Khorasan provinces in 2019. The subjects were selected via census sampling. Data were collected using demographic, occupational, and care center characteristics questionnaire and a moral distress questionnaire. Data analysis was performed in SPSS version 16 using the Mann–Whitney U and Kruskal–Wallis test. Results: The mean (SD) score of moral distress was 28.68 (19.19), and 93.83% of the subjects reported low levels of moral distress. Significant correlations were observed between moral distress and age, work experience, workplace, nurse–physician relations, motivation of the nurses, care facilities, and medical equipment. Furthermore, the highest mean (SD) score of moral distress belonged to the items regarding the lack of work experience 12.19 (3.12). Conclusions: According to the results, moral distress in the nurses of the studied nursing home was relatively low. Despite the favorable outcome of the study, the age discrimination of nurses by nursing homes should not be overlooked.

Background: The present study aimed to develop an instrument for assessing nursing students' satisfaction with First Clinical Practical Education (SFCPE), and then to test the validity and reliability of the instrument. Materials and Methods: In this methodological research, the views of a panel of 15 clinical professors, in terms of the clinical nursing principles and skills training, were used to develop the instrument. The content validity of the instrument was evaluated quantitatively and qualitatively based on the panel's views. The data was collected from the questionnaire completed by 380 second- and third-semester nursing students in 15 medical universities of Iran. The Exploratory Factor Analysis (EFA) was later performed to determine the construct validity of the instrument. The reliability of the instrument and stability analysis were evaluated using the internal consistency test by calculating Cronbach's alpha and by the test-retest method, respectively. Results: Throughout the development phase, 16 items were added to the SFCPE instrument, and a 42-item instrument was later developed. During the qualitative and quantitative content validity reviews, the number of added items decreased to 38 items. Finally, a 37-item instrument consisting of seven factors was developed. The Cronbach's alpha coefficients of 0.95 and 0.75–0.9 were obtained for the whole instrument and the factors, respectively. Pearson's correlation coefficient was within the normal range (0.71–1). Conclusions: The developed SFCPE is a valid and reliable instrument that can be used for assessing the satisfaction of nursing students in terms of clinical nursing principles and skills.

Background: Social recovery during the postnatal period in women with perineal trauma is a little-known concept. Therefore, this study was designed to explore the experiences of social recovery in women with childbirth-related perineal trauma. Materials and Methods: A qualitative approach using content analysis was adopted to study a purposive sample of 22 postnatal women with perineal trauma during birth at Omol-banin Hospital, Mashhad, Iran from April 20^th to December 25^th, 2017. The participants were selected between 10 days to one year after childbirth. Data were collected through semi-structured interviews. Conventional content analysis approach was performed, concurrently, with data collection. To organize data, the MAXQDA 10 was used. Results: Social recovery after perineal trauma was conceptualized as 'shifting from personal ill-health to interactional empowerment'. Two generic categories emerged from data analysis including 1) impaired individual and social function, which was recognized by social isolation and lack of ability to manage daily life and 2) empowering social interactions, which was characterized by rebuilding social partnerships and returning to an interactive lifestyle. Conclusions: Social isolation as the result of neglecting social recovery of women with severe perineal trauma endangers the mental health of mothers. Understanding the concept of social recovery for women with perineal trauma, especially in severe cases, will help health professionals to provide quality postpartum care for women with perineal trauma in a longer period after childbirth.

Background: Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders in the women of reproductive age. In addition to multiple physical problems, this syndrome has many psychological manifestations. Thus, the present research was conducted aimed at investigating the psychological experiences of the adolescent girls with PCOS. Materials and Methods: This research was conducted using the qualitative content analysis method. A total of 18 adolescent girls with PCOS and 15 healthcare providers were selected by the purposive sampling method. The data were collected through in-depth interviews, focus group discussions, and field notes, which were analyzed using the conventional content analysis method. Results: After analyzing, three main categories and seven subcategories were extracted. First, the psychological experiences related to the disease symptoms had three subcategories: “psychological experiences related to hirsutism, alopecia, and acne,” “psychological experiences related to obesity,” and “psychological experiences related to menstrual disorders.” Second, the psychological experiences related to disease complications had two subcategories: “psychological experiences related to infertility” and “psychological experiences related to disease progression.” Third, the psychological experiences related to treatment of the disease had two subcategories: “psychological experiences related to prolongation of the treatment and uncertain fate of the disease” and “psychological experiences related to the complications of the medical treatment.” Conclusions: Results of the study showed that adolescent girls with PCOS were exposed to multiple concerns endangering their psychological health. Therefore, it is recommended to provide adequate and appropriate information about the disease and its consequences, as well as psychosocial supports and regular assessment of psychological state by the team of healthcare providers in the adolescent girls with PCOS.

Background: Adolescence is a period of rapid physical, social, emotional, cognitive, and sexual development. The widening gap between biological maturity and social transition to adulthood highlights the importance of adolescents' need for education, especially in sexual health. The main objective of this study was to explore the facilitators of Sexual Health Education (SHE) for male adolescents in Iran. Materials and Methods: In this qualitative content analysis, a total number of 45 participants were investigated from June 2018 to July 2019 through individual, semi-structured, in-depth interviews in the city of Mashhad, Iran, until data saturated. The participants were selected using a purposive sampling method. The data were analyzed using a conventional content analysis method based on the approach developed by Graneheim and Lundman (2004) using MAXQDA software. Results: In data analysis, 2 main categories and 9 subcategories emerged. The main categories included extrapersonal facilitators and intrapersonal facilitators. The category of extrapersonal facilitators included the 7 subcategories of appropriate policy-making, use of religious capacities, consideration of native culture, supportive family environment, school empowerment, inter-sectoral integration and collaboration, and reinforcement of parent-teacher interaction. The category of intrapersonal facilitators comprised of the 2 subcategories of supporting adolescent socialization and using distraction techniques in adolescents. Conclusions: The study revealed that having an action plan with a scientific, ethical, legal, religious, and cultural background, establishing a suitable home, school, and community environment, strengthening inter-sectoral integration, collaboration, and interpersonal coordination, and utilizing the capabilities and potentials of adolescents can provide an appropriate SHE for adolescent boys.

Background: This study aimed to design and execute a reliable checklist for evaluating midwifery students' clinical skills. Materials and Methods: In this cross-sectional study, 8 checklists were designed and validated for midwifery procedures. The students' performances were compared using this method and two other evaluation methods. Results: The face and content validity of all questions were approved (content validity ratio and content validity index >0.80, inter-rater reliability >0.50, and Cronbach's alpha >0.70). The rate of the students' satisfaction was 19%, 14%, and 76% with the nonchecklist method, the general checklist, and the designed checklist, respectively. Furthermore, both students (F_2,60= 107.07, p < 0.004) and evaluators (F_2,9 =152.23, p < 0.001) gained significantly higher attitude scores towards the new checklist compared to the two other methods. Conclusions: The designed checklist was quite reliable and valid for evaluating the midwifery students' clinical skills.