Background: Nurses' influence on health policy protects the quality of care by access to required recourses and opportunities. This is a new and important concept for nursing; however, research studies on policy influence of nurses in health care sector are lacking a basic conceptual understanding of what this concept represents. The aim of this paper is to clarify the concept of nurses' policy influence and to propose the definition of this concept, considering the context of Iran. Materials and Methods: The eight stages of Walker and Avant approach was used to guide this concept analysis. Various databases and internet engines were searched to find all related information about the concept. Textbooks were also searched manually. English language literature reports published between 1990 and 2012 were reviewed. Results: Based on the analysis undertaken, nurses' policy influence is nurses' ability in influencing decisions and affairs related to health through political knowledge, effective communication, and collaboration with other members of the health team, which results in the improvement of nurses' job environment and increases patient outcomes. This is a dynamic process situated on a spectrum and is accompanied with nurses' knowledge, competency, power, and advocacy, and also their ability to change. Conclusions: Nurses have individual views on health care issues and influence health care policies in different ways. With a common understanding of nurses' policy influence as a concept, nurses will recognize the importance of policy making in the health sector and their influence on this process and also on patients' outcomes.

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Introduction: Admission of a family member to hospital would cause stress on other family members also. One of the most stressful treatment interventions imposing high level of anxiety to the families of patients is when the patients are undergoing a surgery, especially a cardiac surgery. So, we decided to investigate whether recommended Azkar could reduce stress, anxiety, and depression in families of the patients. Materials and Methods: This study is a quasi-experimental study conducted on 120 immediate relatives of patients undergoing a cardiac surgery. Families of patients undergoing open heart surgery were randomly divided into two groups of study and control. The Depression, Anxiety, and Stress Scales (DASS 21) questionnaires were completed by both groups. Then, some explanations about how to use recommended prayers were given to the study group, and an hour later, the questionnaires were completed again. The data were analyzed by SPSS. P < 0.05 were considered significant. Results: Stress, anxiety, and depression showed a significant difference in the study group before and after intervention. Similarly, there was a significant difference in the mean scores of anxiety, stress, and depression in the study and control groups after intervention. Conclusions: Findings of the present study showed that recommended religious prayers can significantly reduce anxiety, depression, and stress of families of the patients undergoing open heart surgery. Introduction: Admission of a family member to hospital would cause stress on other family members also. One of the most stressful treatment interventions imposing high level of anxiety to the families of patients is when the patients are undergoing a surgery, especially a cardiac surgery. So, we decided to investigate whether recommended Azkar could reduce stress, anxiety, and depression in families of the patients. Materials and Methods: This study is a quasi-experimental study conducted on 120 immediate relatives of patients undergoing a cardiac surgery. Families of patients undergoing open heart surgery were randomly divided into two groups of study and control. The Depression, Anxiety, and Stress Scales (DASS 21) questionnaires were completed by both groups. Then, some explanations about how to use recommended prayers were given to the study group, and an hour later, the questionnaires were completed again. The data were analyzed by SPSS. P < 0.05 were considered significant. Results: Stress, anxiety, and depression showed a significant difference in the study group before and after intervention. Similarly, there was a significant difference in the mean scores of anxiety, stress, and depression in the study and control groups after intervention. Conclusions: Findings of the present study showed that recommended religious prayers can significantly reduce anxiety, depression, and stress of families of the patients undergoing open heart surgery.

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Background: During the menopausal period, sexual desire may decrease. Therefore, restoring the sexual desire may help to improve sexual functioning in this group of women. The aim of this study was to examine the effect of Ginkgo biloba extract (GBE) on sexual desire in postmenopausal women. Materials and Methods: In this triple-blind, randomized, placebo-controlled trial, 80 healthy female volunteers attending three healthcare centers of Tehran University of Medical Sciences (TUMS) were enrolled. The instrument of this study had two main parts. The first part covered the personal characteristics of the volunteers and the second part used the Sabbatsberg Sexual Rating Scale (SSRS) to subjectively evaluate sexual desire before and after intervention. The participants received GBE at a dose of 120-240 mg (n = 40) or received placebo (n = 40) daily for 30 days. The results were analyzed using Mann-Whitney test. All analyses were performed using SPSS software. Results: The sexual desire was significantly improved in the GBE group compared to the placebo group (P = 0.02). Conclusions: In this study, we found that GBE had a positive effect on sexual desire of menopausal women; thus, these findings support the positive effect of GBE on the sexual function of menopausal women.

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Background: Living with heart failure patients is a complex situation for family caregivers. Few studies have been conducted to examine the effects of interventional programs to ease this condition. The purpose of this study was to determine the effectiveness of a supportive educative group intervention in reducing family caregivers' burden of caregiving. Materials and Methods: This randomized clinical trail was conducted at a selective teaching hospital in Isfahan, Iran in 2012. The intervention consisted of four weekly multimedia training sessions of 2 h that included education and family support for 50 family caregivers. Caregiver burden was measured using the Zarit Burden Interview (ZBI). Paired t-test, Student's t-tests, and repeated measures analysis of variance (ANOVA) were used to test for significant differences of the mean scores of burden between the intervention and control groups over a 3-month period. Results: The intervention was successful in reducing caregiver burden over time both at the end of the intervention period (P = 0.000) and 3 months after the intervention (P = 0.000). Conclusions: Nurses and other healthcare providers can use the findings of this study in order to implement effective programs to reduce family caregivers' challenges and to provide them more support.

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Background: Patients with multiple sclerosis experience hospitalization several times in their lives. Certainly, providing efficient and high-quality care by healthcare professionals is not possible unless the experiences of patients' hospitalization are taken into consideration. This qualitative study was aimed to identify experiences of patients with multiple sclerosis in their hospitalization. Materials and Methods: A qualitative content analysis method was used to conduct this study. The study participants were 25 patients with multiple sclerosis, who were chosen by purposeful sampling. Data were collected through non-structured interviews. Results: The analysis resulted in the emergence of 4 themes and 11 subthemes. The main themes were: Religiosity, emotional reactions, seeking support, and feeling of being in a cage. Conclusions: Awareness of families and healthcare providers of the reactions of patients with multiple sclerosis to hospitalization will help them to deal effectively with patients and to improve relationships with them. However, by understanding the patients' experiences, the practitioners gain expertise and can join in the patients' health journey in a therapeutic way during the hospitalization period. In addition, the findings can serve to create a framework for developing nursing care processes including informational and supporting programs for multiple sclerosis patients during hospitalization while taking into consideration patients' needs and cultural backgrounds.

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Background: Spiritual care should be considered an important part of holistic and multidisciplinary care and it has not been given much importance so far. We should begin with student nurses, who will soon be clinicians, to find out about potentiality of the nursing profession to put spiritual care into practice. Little has been known about spiritual well-being, spirituality, and spiritual care perspectives among nursing students. In this study, a comparison has been made in spiritual well-being, spirituality, and spiritual care perspectives between the first and fourth year baccalaureate nursing students. Materials and Methods: This is a descriptive-comparative study that was carried out among 283 nursing students. All the students were Iranians studying in the universities of Iran, Tehran, and Shahid Beheshti medical sciences. They volunteered to participate in the study. There were 105 first year students and 178 fourth year students. The questionnaires used were on Spiritual Well-being (SWB) Scale, Spiritual Perspective Scale (SPS), and Nursing Spiritual Care Perspective Scale (NSCPS). The statistical analysis was performed using the SPSS software, version 10. The data were analyzed using descriptive statistics (distribution frequency, mean, and standard deviation). Mann-Whitney test was to compare each item and independent t-test to compare the mean values of two groups. Results: Regarding spiritual well-being, there were no significant differences between the two groups. 98.8% of the first year students and 100% of the fourth year students were in the category of moderate spiritual well-being. Neither were there any significant differences between the two groups in spiritual perspective and spiritual care perspectives. Conclusions: The scores of fourth year nursing students were similar to those of first year students in spiritual well-being, spirituality, and spiritual care perspectives, though the fourth year students had already undergone 4-year nursing course. Including spiritual care in the curriculum of nursing students' courses will add to their understanding and provision of spiritual care. This will fill the present gap evident in the system in Iran. At present, the educational system here does not make use of spiritual care as part of its comprehensive curriculum.

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Background: One of the key strategies in students' learning is the influence of models on them. Understanding the factors affecting the implementation of role-modeling process in education will help to make greater use of this training strategy. This study aimed to understand the experiences of role model instructors and nursing students about the facilitator factors in the role-modeling process. Material and Methods: This qualitative study was carried out by using thematic analysis method and purposeful sampling. Data were collected until saturation by using three focus group discussions (n = 20) and two individual interviews with nursing instructors, as well as six semi-structured face-to-face interviews with role model instructors from five nursing faculties of Tehran universities in 2011. Results: Six themes, "effort for humanistic and professional growth of students," "individual and managerial empowerment of instructor," "instructor and student's modeling," "motivation and effort of student," "strategies governing the education system," and "appropriate facilities and equipment," were extracted as the facilitating factors. Conclusions: For development of role-modeling process in nursing education, paying attention to personal and environmental factors, especially effort for professional and humanistic growth of nursing students is necessary.

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Background: Continuation of delivery care by a midwife, and establishing a relationship between the midwife and the delivering woman, is so important for women, and preserving such relationship increases woman's calmness and self-confidence. The current research aims at studying the effect of midwifery continuing care during delivery on delivery outcomes. Materials and Methods: This study was a quasi-experimental research conducted on childbearing women referring to Tabriz 29 Bahman Hospital. One hundred women were randomly assigned to either experimental (n = 50) or control (n = 50) group. In the experimental group, the women were cared exclusively with a midwife from the active phase continuously, while in the control group, women were cared with several midwifes conventionally. The birth outcomes were recorded in both valid and reliable groups (checklists). Data were analyzed using SPSS version 13.0. Results: Type of delivery was the same in both the groups (P = 0.051). In the experimental group, grade of the perineal lacerations was lower (P = 0.001); also, in this group, less oxytocin was used in the labor stage (P = 0.001). Conclusions: The results showed that providing one-to-one delivery care and continuous attendance of the midwife on the bedside of delivering woman had positive effect on improvement of birth outcomes. So, providing the choice of one-to-one care for women in delivery rooms must be considered where it is logistically possible.

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Background: Some health problems are more prevalent in shift workers than day workers. Musculoskeletal disorders are considered as one of the most common health-related problems that can cause disability among health care workers. The aim of this study was to assess the associations between shift working and the prevalence of musculoskeletal symptoms (MSs) among nursing personnel. Materials and Methods: This study was conducted among 454 health care workers including nurses and nurses' aides in a general hospital in Iran. A Nordic musculoskeletal questionnaire was used to evaluate the prevalence of MSs. Logistic regression analysis with adjusting for confounding factors was performed to evaluate the associations between shift working and the prevalence of MSs. Results: Lower back, knees, and upper back symptoms with the prevalence of 57.4%, 48.4%, and 47%, respectively, were the most common MSs. The prevalence of MSs in eight regions of the body (lower back, neck, knees, upper back, shoulder, wrist, buttock, and ankle) was higher among shift workers than day workers. The differences were statistically significant only in the lower back and ankle regions (P < 0.05). Odds Ratio for lower back symptoms in shift workers was 1.94 compared to day workers (P = 0.003). Conclusion: Findings of this study suggested that shift working could be associated with increased prevalence of lower back disorders among nursing personnel. This study emphasizes on the importance of proper work planning and regulating working hours for nursing personnel.

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Background: There are a few studies about commissioning mothers' understanding from the surrogacy during 9 months of waiting for delivery in Iran and other countries. This study was conducted with an aim to explore and explain the nature of concerns (experiences) of commissioning mothers. Materials and Methods: A qualitative design with a conventional content analysis approach was used to gather and analyze the experiences of commissioning mothers. They were selected from Royan Research Centre and other infertility centers in Iran. After purposive sampling for the selection of the participants, unstructured interviews were held for data collection. Twenty-four unstructured interviews were conducted with 12 commissioning mothers, 2 surrogate mothers, and 2 infertility center social workers who directly and continuously dealt with these mothers. Results: Two main themes emerged from the data analysis: 1. cultural dilemma (consisting of three subthemes: Social taboo, concerns about disclosure to others and the child, concerns about altering maternal and child's identity, and 2. uncertain waiting (consisting of three subthemes: Concerns about health of fetus and surrogate, concerns about an unfamiliar surrogate, and concerns about lack of preparation for maternal role). Conclusions: The study reveals the importance of maternal emotional care in this group and introduces a new arena for nurses' activity. These findings help the mothers by nurses' activities in health care clinics and anywhere they deliver nursing care.

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Background: Health professionals and their medical equipment have long been known to act as vectors of infectious diseases. The aim of the present study was to evaluate the role of pens used by nursing students working in clinics in relation to transmission of bacteria. Materials and Methods: The study was conducted in Sakarya University School of Health Sciences in March 2012, with the voluntary participation of 40 third-grade nursing students during their clinical practice. In total, 40 writing items were surveyed. Results: Twenty-two (55%) of the students were doing their clinical practice at pediatrics department and 18 (45%) were at obstetrics and gynecology department. All the samples consisted of pens and bacterial contamination was observed in 5 (12.5%) of them. The microorganisms identified were: 1 (2.5%) sample was Staphylococcus hominis, 2 (5%) were Staphylococcus epidermidis, 1 (2.5%) was Staphylococcus haemolyticus, and 1 (2.5%) was Staphylococcus warneri. Conclusion: This study highlights the risks of nosocomial infections, especially in pediatric units, if not enough attention is paid to the cleanliness of the pens used in the clinics.

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Background: The improvement of patient safety conditions in the framework of clinical service governance is one of the most important concerns worldwide. The importance of this issue and its effects on the health of patients encouraged the researcher to conduct this study to evaluate patient safety management in the framework of clinical governance according to the nurses working in the intensive care units (ICUs) of the hospitals of the east of Tehran, Iran in 2012. Materials and Methods: This descriptive study, which was based on census method, was conducted on 250 nurses sampled from the hospitals located in the east of Tehran. For the collection of data, a researcher-made questionnaire in five categories, including culture, leadership, training, environment, and technology, as well as on safety items was used. To test the validity of the questionnaire, content validity test was conducted, and the reliability of the questionnaire was assessed by retest method, in which the value of alpha was equal to 91%. Results: The results showed that safety culture was at a high level in 55% of cases, safety leadership was at a high level in 40% cases and at a low level in 2.04% cases, safety training was at a high level in 64.8% cases and at a low level in 4% cases, safety of environment and technology was at a high level in 56.8% cases and at a low level in 1.6% cases, and safety items of the patients in their reports were at a high level in approximately 44% cases and at a low level in 6.5% cases. The results of Student's t-test ( P < 0.001) showed that the average score of all safety categories of the patients was significantly higher than the average points. Conclusions: Diligence of the management and personnel of the hospital is necessary for the improvement of safety management. For this purpose, the management of hospitals can show interest in safety, develop an events reporting system, enhance teamwork, and implement clinical governance plans.

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Background: Quality of life (QOL) is a multidimensional concept which has nowadays turned to a supportive interventional goal in chronic diseases like cancer. Numerous interventions have been carried out to improve the QOL in patients with cancer, but the effect of indirect interventions on the patients' QOL has not been investigated yet. This study aimed to compare the efficacy of group meaning centered hope therapy of cancer patients and their families on the patients' QOL. Materials and Methods: This is a clinical trial conducted in three groups with a pre-test post-test design in which the effect of independent variable of meaning centered hope therapy on the dependent variable of QOL was investigated. The subjects were selected from the cancer patients who were aware of their diagnosis, were in primary stages of the disease, and had passed one period of chemotherapy. In this study, 42 patients (16 in control group, 14 in patients' group therapy, and 12 in patients' families' group therapy) were studied, and WHOQOL was adopted to investigate their QOL. Data were analyzed in two forms of descriptive and inferential statistical tests. Results: The results obtained showed that group meaning centered hope therapy of cancer patients and their families had a positive effect on patients' QOL compared to the control group. The notable finding of the present study was that holding group sessions either for the patients or for their families equally improved patients' QOL. Conclusion: QOL of the cancer patients can be improved by either group meaning centered hope therapy for patients or group meaning centered hope therapy for their families. This finding is important for therapists, as when the patients cannot attend group therapy sessions due to complications of chemotherapy, these sessions can be held for their families to improve patients' QOL. This conclusion is very helpful in nurses' interaction with the patients and their families.

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Background: Mechanical ventilation is one of the major supportive interventions in intensive care units. Weaning the patients from mechanical ventilation and its related criteria are of great importance due to the related complications. As there is no comprehensive standard to allocate the time of weaning and due to lack of local research in this field, development of a comprehensive tool to measure patients' readiness for weaning from mechanical ventilation is essential. Therefore, the present study was conducted with an aim to develop a readiness assessment tool for weaning patients from mechanical ventilation. Materials and Methods: This was a qualitative study with Delphi multi-triangulation design. In the first stage, the related items were extracted from the textbook and through searching the databases. In the second stage, after primary development of the items and based on supervisors' indications, a questionnaire was made and used for assessment through Delphi methods. Twenty individuals, meeting the inclusion criteria, were selected through purposive sampling and their viewpoints concerning acceptability of the items were collected. In the third stage, the items with appropriateness over 70% were selected, and in the fourth stage, the final questionnaire was developed after a session with a panel of experts and supervisors. In the present study, in the first stage, the needed items were collected from various articles and books to provide items extraction. In stages two to four, manual calculation and investigation made by a panel of experts and the research team were adopted. Results: In the first stage, 100 articles and 51 related books were selected. In the second stage, 87 items were extracted from the articles and books and were sent as semi-open questions of assessment. In the third stage, 28 items with consensus >70% were extracted, and in the fourth stage, 26 items were selected by a panel of experts and the finalized questionnaire with the title "Persian Weaning Tool" (PWT) was developed in three domains: Respiration with 9 items, cardiovascular with 4 items, and other related factors with 13 items. Conclusions: A three-domain questionnaire is the product of experts' consensus in the present study, which can be used to reduce the length of connection to mechanical ventilation and its complications.

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Background: One of the acutely fatal and prevalent crises in all societies is acute spinal cord injury. Individuals with a spinal cord injury are prone to numerous challenges, perturbation, and acute mental distresses. One of their concerns, often expressed generally and in the form of a complaint, is how people deal with them. The present study aims to analyze the experiences and interactions of the disabled with the society and to achieve a deep clarification of their internal attitudes and realistic approaches in various social classes (from common people to elite). Materials and Methods: The present study is a part of a greater research with a classical grounded theory approach conducted on 12 successful and nationally and internationally popular disabled people. Sampling was firstly purposive and then continued with snowball sampling. The data were collected by open deep interviews which were recorded and transcribed verbatim. The obtained data were analyzed by Graneheim content analysis method. Results: The findings obtained through analysis of the interviews yielded the theme of a socially suppressing attitude which contained four subthemes of compassionate attitude, disability attitude, inhuman attitude, and atonement attitude. Conclusions: The results showed that both groups of common, and educated and elite classes of Iranian society have identically suppressing attitudes and interactions toward spinal cord injury victims. It seems that traditional attitudes yet preponderate academic and scientific knowledge in Iranian society. This gap needs notable attention of all the Iranians, especially policy makers and social personalities.

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Background: Nurses are at risk for symptoms of compassion fatigue (CF) and burnout (BO). Social support plays an important role in predicting CF and BO. This study was performed to determine the prevalence of the symptoms of CF and BO and the role of perceived social support in predicting these symptoms in Iranian nurses. Materials and Methods: Using a correlational descriptive survey research design, we selected 173 participants among the nurses working in public hospitals of Malayer, Iran. Professional Quality of Life (CF and BO subscales) and Multidimensional Scale of Perceived Social Support (MSPSS) were used for collecting the data. Results: The obtained results indicated that the prevalence of CF and BO symptoms was 45.3% and 15.03%, respectively, in Iranian nurses. Social support (significant other, family, and friends) was negatively correlated to BO (P < 0.01). Also, there was a negative correlation between social support from family and CF (P < 0.01). According to hierarchical multiple regressions, social support from family was the significant predictor to CF (P < 0.005) and BO (P < 0.001) in nurses. Conclusions: Based on the obtained results, some nurses (especially emergency nurses) are at risk for CF and BO and social support negatively correlated to CF and BO in Iranian nurses. It is necessary to develop support systems for nurses who are at risk for CF and BO.

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Background: In recent years, the lack of organ for transplantation has resulted in health planners and authorities in all countries, including Iran, paying serious attention to the issue. Despite the above-mentioned fact, families with a member affected by brain death are not interested in organ donation. Objective: This study is aimed at making an investigation into the decision-making process of organ donation in families with brain death. Also, the research is aimed at investigating how the deterrent and facilitating factors in the process of organ donation can be made. Materials and Methods: The current research is a qualitative study with descriptive exploratory approach. Data were collected through unstructured interviews with 10 family members who gave consent to organ donation of their family members in 2012. Purposeful sampling processes began in March 2012 and lasted up to June 2012. Simultaneously, thematic approach was used in analyzing the data. Results: Data analysis led to finding 24 categories and 11 themes, which fell into two categories: facilitating and deterrent factors. The five main deterrent themes included the five themes of prohibiting factors that were shock, hope for recovery, unknown process, and conflict of opinions, and worrying association. The six main facilitating themes included humanistic desires, immortality, culture making, satisfaction of the deceased, assurance, and eternal honor. Conclusion: The findings indicated that there is ambiguity and different interpretations on brain death. The research also showed that using the experiences of donator families can provide practical and applied solutions to facilitate the process of organ donation and solve the problems faced by the health care system.

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Background: In patients undergoing mechanical ventilation, mucus production and secretion is high as a result of the endotracheal tube. Because endotracheal suction in these patients is essential, chest physiotherapy techniques such as expiratory rib cage compression before endotracheal suctioning can be used as a means to facilitate mobilizing and removing airway secretion and improving alveolar ventilation. As one of the complications of mechanical ventilation and endotracheal suctioning is decrease of cardiac output, this study was carried out to determine the effect of expiratory rib cage compression before endotracheal suctioning on the vital signs in patients under mechanical ventilation. Materials and Methods: This study was a randomized clinical trial with a crossover design. The study subjects included 50 mechanically ventilated patients, hospitalized in intensive care wards of Valiasr and Mousavi hospitals in Zanjan, Iran. Subjects were selected by consecutive sampling and randomly allocated to groups 1 and 2. The patients received endotracheal suctioning with or without rib cage compression, with a minimum of 3 h interval between the two interventions. Expiratory rib cage compression was performed for 5 min before endotracheal suctioning. Vital signs were measured 5 min before and 15 and 25 min after endotracheal suctioning. Data were recorded on a data recording sheet. Data were analyzed using paired t-tests. Results: There were statistically significant differences in the means of vital signs measured 5 min before with 15 and 25 min after endotracheal suctioning with rib cage compression (P < 0. 01). There was no significant difference in the means of diastolic pressure measured 25 min after with baseline in this stage). But on the reverse mode, there was a significant difference between the means of pulse and respiratory rate 15 min after endotracheal suctioning and the baseline values (P < 0.002). This effect continued up to 25 min after endotracheal suctioning just for respiratory rate (P = 0.016). Moreover, there were statistically significant differences in the means of vital signs measured 5 min before and 15 min after endotracheal suctioning between the two methods (P ≤ 0001). Conclusions: Findings showed that expiratory rib cage compression before endotracheal suctioning improves the vital signs to normal range in patients under mechanical ventilation. More studies are suggested on performing expiratory rib cage compression before endotracheal suctioning in patients undergoing mechanical ventilation.

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Background: Dissatisfaction and tending to leave are some of the major nursing problems around the world. Professional commitment is a key factor in attracting and keeping the nurses in their profession. Commitment is a cultural dependent variable. Some organizational and socio-cultural factors are counted as the drivers of professional commitment. This study aimed to explore factors influencing the professional commitment in Iranian nurses. Materials and Methods: A qualitative content analysis was used to obtain rich data. We performed 21 in-depth face-to-face semi-structured interviews. The sampling was based on the maximum variation with the staff nurses and managers in 5 university affiliated hospitals. Constant comparative method used for data analysis Results: Two main categories were emerged: "Challenging with different feelings" and "Managers' role". Challenging with different feelings had two subcategories: "Burnout" and "sense of valuing". The other theme was composed of three subcategories: "Gratitude or punishment climate", "manager's view of caring" and "knowledge-based vs. routine-based nursing". Conclusions: Findings revealed the burnout as a common sense in nurses. They also sensed being valued because of having a chance to help others. Impediments in the health care system such as work overload and having more concern in the benefits of organization rather than patient's care and wellbeing lead to a sense of humiliation and frustration. Congruence between the managers and nurses' perceived values of the profession would be a main driver to the professional commitment. Making a sense of support and gratitude, valuing the care and promoting the knowledge-based practice were among the other important factors for making the professional commitment.

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