Background: Many articles have studied workplace incivility and its influence on outcomes, but very few have been conducted to assess how to prevent this issue. In this study, we aimed to determine how to prevent workplace incivility from the nurses' perspective. Materials and Methods: This was a qualitative study which was based on a conventional content analysis approach. Thirty four nurses (25 to 52 years old) from seven training hospitals in Tabriz, Iran were selected through purposive sampling. Thirty six semi-structured interviews and eight field notes were analyzed. Results: The data analysis revealed 417 codes, ten categories, three subthemes and one theme, that is, A Need for a Comprehensive Attempt. Attempt of organization, nurses, and public as subthemes are needed to prevent workplace incivility. Conclusions: The findings of the study indicated that a comprehensive and systematic attempt was needed to prevent incivility. Nurses should try to improve their skills; officials should try to show the real image and position of nurses and hospitals to the community.

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Background: Performance appraisal is an essential component of health care organizations for the improvement in quality of patients' care. Awareness of managers' and employees' perception of performance appraisal can lead to improved performance appraisal quality. The purpose of this study was to compare the perception of performance appraisal among managers and nursing staff of hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Materials and Methods: This descriptive-analytical and cross-sectional study was conducted among 75 managers and 313 nurses in 2014. The participants were selected through a two-stage quota-random sampling. Data were collected using two researcher-made questionnaires (nursing managers and nurses' questionnaires). Data were analyzed using descriptive and statistical tests using the Software Package for the Social Sciences software. Results: The mean score of managers' and nurses' perception of the current performance appraisal was 56.8 (14.2) and 51.4 (14.5), respectively. A significant difference was observed between managers' and nurses' perception of performance appraisal (P = 0.004). The participants' perception was examined in terms of performance appraisal method, the consequences of performance appraisal, and the necessity of performance appraisal. In general, perception of managers was more positive than employees. Conclusions: The evaluation of the perception of nurses revealed deficiencies in the process of performance appraisal. Moreover, managers had a more positive perception than employees toward the current pattern of performance appraisal. The results of this study can be effective on the decisions of authorities in this field.

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Background: Compassion is an important part of nursing. It fosters better relationships between nurses and their patients. Moreover, it gives patients more confidence in the care they receive. Determining facilitators of compassion are essential to holistic care. The purpose of this study was to explore these facilitators. Materials and Methods: This ethnographic study was conducted in 2014–2015 with 20 nurses, 12 patients, and 4 family members in the medical and surgical wards. Data collection was done through observations and in-depth semi-structured interviews with purposive sampling. The study was carried out in 15 months. Data analysis was performed using constant comparison based on Strauss and Corbin. Results: Data analysis defined three main themes and eight subthemes as the fundamentals of compassion-based care. Nurses' personal factors with subcategories of personality, attitudes, and values and holistic view; and socio-cultural factors with subcategories of kindness role model, religious, and cultural values are needed to elicit compassionate behaviors. Initiator factors, with subcategories of patient suffering, patient communication demands, and patient emotional and psychological necessity are also needed to start compassionate behaviors. Conclusions: The findings of this study showed that nurses' communication with patients is nurse's duty in order to understand and respect the needs of patients. Attention should be paid to issues relating to compassion in nursing and practice educational programs. Indeed, creating a care environment with compassion, regardless of any shortcomings in the work condition, would help in the development of effective nursing.

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Background: In the nursing profession, it is apparent that the definition of caring differs between various perspectives. This article compares the difference of caring in Islamic with the Parse and Watson theories. Materials and Methods: In this study, we use concept analyses of Walker–Avants and compare research methods. Material used is all Islamic documents. Results: According to Islamic documents, there are four major types of caring, namely, (1) God taking care of humans, (2) Humans taking care of themselves, (3) Other humans taking care of humans, and (4) The universe taking care of humans and vice versa. God caring for humans affects the three other types of caring. All three definitions of caring have humanistic and holistic view. According to Watson's and Parse's definition, the development of the caring theory is based on the person's experiences that result from human interactions with, and experiences of, their environment. In Islamic definition, although the caring process is affected by environmental experiences and interactions, human not developed only base the effect of environment; rather, it is developed on the basis of human nature and divine commands. God taking care of humans is specific to Islamic perspective and is not found in other definitions. Islamic perspective maintains that God is the creator of humanity and is in charge of guiding humans. A superior form of human can always be discovered. Conclusions: Thus, nursing implementation in Muslims must be done based on Islamic commands, and Islamic commands are superior to human experiences. However, Islamic commands interpreted with human wisdom and thought can be striving toward excellence.

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Background: Postmenopausal women experience a variety of symptoms, among which sleep disorder is one of the most common problems. Acupressure and Pilates exercise programs are effective nonpharmaceutical treatments which can improve sleep quality. In the present study, we aimed to compare the effects of acupressure and Pilates-based exercises on the sleep quality of postmenopausal women referred to medical clinics. Materials and Methods: In this single-blinded randomized controlled clinical trial, we recruited 108 women aged 40–60 years who were randomly assigned into one control and two intervention groups using balanced block randomization method (three groups of 36 each). The patients in the Pilates exercise group participated in an exercise training program of three 1-hour sessions per week for 6 consecutive weeks. The participants of acupressure group received acupressure intervention three times a week for 6 weeks. The sleep quality of all participants was assessed and recorded using the Pittsburgh Sleep Quality Index (PSQI) once before and once after the intervention. Results: The results showed no statistically significant difference among the three groups on the total scores of sleep quality after the intervention. The intragroup comparison revealed that the changes in the mean total scores were significant in both the intervention groups (P < 0.001) but not in the control group (P = 0.76). Conclusions: Pilates-based exercises and acupressure can effectively improve women's sleep quality. Both techniques can be applied as effective alternative and complementary methods for improving sleep quality during the postmenopausal period.

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Background: Psychological and social health of children with cancer may be severely affected by the disease and its treatment. Successive drawing by children can help them over time in terms of psychological and social adaptation. This study aimed to investigate the effects of drawing on depression in children with cancer undergoing chemotherapy. Materials and Methods: This quasi-experimental study was conducted on 7–12-year-old children with cancer undergoing chemotherapy. After completing Maria Kovacs' Children's Depression Inventory (CDI), 65 children who had obtained scores higher than 12 were chosen as study participants and were randomly divided into two experimental and control groups. The children in the experimental group were engaged in open painting sessions for 6 weeks. After the intervention, the CDI was completed again in both the groups. The obtained data were analyzed using descriptive and inferential statistical methods, such as independent t-test, paired t-test, and Chi-square and Mann–Whitney tests. Results: There was a significant difference between the children's depression scores before and after the intervention in both the two groups (P < 0.001). Conclusions: The results showed that painting was effective in reducing depression in children with cancer undergoing chemotherapy. Therefore, painting can be used as an easy, cheap, and effective intervention by nurses to help children with cancer undergoing chemotherapy.

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Background: Burnout has its focus on exhaustion and it includes persistent response to long-lasting job-related stressful events. It has a special relevance in health care area in which staff is under constant psychological, emotional, and physical stress. The results of several studies on burnout prevalence among Iranian nurses indicate its high incidence. Therefore, more accurate researches are required for better preventive interventions, and to do so, a reliable validated scale is required. One of the suitable and new tools for the measurement of burnout is Copenhagen Burnout Inventory (CBI). This study aimed to translate and investigate psychometric properties of CBI in Iranian nurses. Materials and Methods: In this methodological study, after the translation process, face and content validities via qualitative and quantitative methods was done. Content validation ratio, scale-level content validated index, item-level content validity index were measured. Then, construct validity was determined through factor analysis. Furthermore, internal consistency reliability and stability were assessed. The questionnaire was sent to 450 nurses who were randomly selected via quota sampling. Results: Face and content validity were acceptable. After translation and cultural adaptation process, exploratory factor analysis suggested a new model based on four factors and fit indices validated this model via confirmatory factor analysis. Internal consistency and stability of CBI were affirmed for each subscale separately. Conclusions: The four-factor Persian version of the CBI proved to enjoy acceptable psychometric properties. It can be applied to evaluate burnout in Iranian nurses or other health care providers.

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Background: The practice environment pivotal role in patients and nurses better outcomes is evident. Practice Environment Scale of Nursing Work Index (PES-NWI) is widely utilized to assess nursing work environments. The present study was conducted to demonstrate the validity and reliability of the Persian version of PES-NWI. Materials and Methods: The instrument was translated and its psychometrics were investigated by content, construct validity (factor analysis), and homogeneity (internal consistency and intraclass correlation) on a sample of 350 nurses at educational hospitals in East Azerbaijan, Iran. Results: The 30 items loaded onto 4 factors explained 34.95–50.06% of the variance. The items across the factors differed slightly from those reported by the original author of the PES-NWI. Cronbach's alpha and Pearson coefficient for the entire instrument and also for extracted factors was 0.70–0.96. Conclusions: The Persian version of PES-NWI has an appropriate level of validity and reliability in the Iranian setting for nurses. The subscale of Nursing Foundations for quality care needs modification.

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Background: Kidney transplantation is the renal replacement therapy of choice for most patients with end-stage renal disease (ESRD), however, adherence to the recommended lifestyle is critical for a positive prognosis. The purpose of this study was to assess adherence to immunosuppressive therapy and lifestyle recommendations along with some related factors among kidney transplant patients. Materials and Methods: In this descriptive analytical study, all patients completed a questionnaire regarding medication intake and lifestyle recommendations (preventing of infection, self-monitoring, prevention of cardiovascular disease (CVD), and sun protection). The participants were divided into 4 groups according to the level of adherence (good, partial, poor, and nonadherent) indicated in their responses. Results: Most kidney recipients were adherent to their drug prescriptions, but were partial, poor, or nonadherent regarding lifestyle recommendations. Increased passage of time since transplantation and low family support and educational level resulted in nonadherence. Men showed greater adherence to medication intake than women. Patients with lower number of drugs and reported drug side-effects illustrated better adherence to medication intake. Women adhered to infection protection recommendations more than men, and older and married patients adhered to cardiovascular prevention recommendations more than others. However, younger patients showed greater adherence to self-monitoring recommendations, and singles, young individuals, and women were adherent to sun protection recommendations. Conclusions: Nonadherence is common among kidney transplant recipients. Thus, it is necessary to determine patients who are at risk of nonadherence and to introduce more educational programs to improve their adherence and their quality of life (QOL).

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Background: The rate of mothers undergoing cesarean section in the absence of medical indication is increasing in the world. Women attitude have an essential role in the request or selecting a birth mode. This study aimed to develop a scale for measuring attitude toward birth method selection. Materials and Methods: The study was conducted in two qualitative and quantitative parts. Data collection was conducted from June to December 2012 in Ahvaz, Iran. In the qualitative part of the study, 21 interviews were conducted with pregnant or parturient women and key informants. Consequently, content and face validity were performed to provide a pre-final version of the questionnaire. Then, in the quantitative part of the study, validity, exploratory factor analysis, and reliability were performed to assess the psychometric properties of the scale. Results: A 130-item questionnaire was developed through the qualitative phase. It was reduced to an 82-item questionnaire after content and face validity. Exploratory factor analysis loaded a 68-item with an 8-factor solution (“beliefs and attitudes,” “sexual and physical attitudes,” “fear of childbirth,” “preference of convenience, health, and supporting,” “socio- cultural norms,” “confidence to the birth practitioner,” “personal and practical choice,” and “sources of motivations,” which jointly accounted for 42.97% of the observed variance. Cronbach's alpha coefficient showed excellent internal consistency (α = 0.87), and test–retest of the scale with 2-week intervals indicated an appropriate stability for the scale (0.89). Conclusions: The findings showed that the designed questionnaire was a valid and reliable instrument for indicating the pregnant womens' attitudes to their birth method selection. Also, ATBMS is an easy use questionnaire and contains the most significant factors persuading women to choose vaginal delivery or cesarean section.

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Background: Increased level of blood lipids is one of the risk factors for cardiovascular diseases. Considerable research has done to assess the effects of physical exercises on lipid profile, of which aerobic exercises are the main part of evidence. However, in recent years, resistance exercise has been less investigated. Thus, the present study investigates the effect of resistance exercise on lipid profile in coronary artery disease patients. Materials and Methods: This study was a randomized clinical trial. Forty eligible participants were selected through selective sampling and were assigned randomly to either intervention or control groups (20 participants in each group). Fasting blood sample was taken for measurement of lipid profile before, after, and after 4 weeks of the end of intervention. The intervention period lasted 8 weeks and included two exercise sessions of 45–60 minutes per week. Resistance exercise was performed by use of light weights in the range of motion of the elbow, shoulder, and knee joints. The number of repetitions was initially 10 and was gradually increased to 15. Then, the weight was increased by 3–5% and the number of sets too. Data were analyzed on significant level of P < 0.05. Results: In both the groups, the mean and mean changes of lipid profile, before, after. and 4 weeks after the end of the intervention were not significantly different (P < 0.05). Conclusions: The 8-week of resistance exercise did not lead to a significant decrease in the mean lipid profile.

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Background: Children with cleft lip and/or palate frequently experience feeding difficulties that may place them at risk of malnutrition. Parents' negative response to these problems is associated with development of problematic behaviors in the child. This study aimed to investigate feeding behavior in children with cleft lip and/or palate and parental responses to these problems. Materials and Methods: A total of 120 parents of children (aged 6 months to 6 years) with cleft lip and/or palate were recruited from the Cleft Lip and Palate Clinic in Isfahan University of Medical Sciences, Isfahan, Iran, who gave consent and completed a two-part questionnaire through interviews. Part A of the questionnaire consisted of 25 items that evaluate children's feeding behavior during mealtimes and part B consists of 18 items that assess parental response (strategies, feelings, and anxiety) to these problems. Results: Independent t-test showed a significant difference in the mean score of feeding behavior in mothers (P = 0.020) and parental responses in fathers (P = 0.030). The Pearson correlation coefficient showed an inverse correlation between behavioral feeding score and children's interval (P = 0.008, r = −0.381) and direct correlation between parental response and feeding behavioral difficulties (P = 0.003, r = 0.428). Conclusions: With regards to the results representing appropriate feeding behaviors in children with cleft lip and/or palate, it is suggested that feeding be avioral assessment is an essential nursing and nonmedical intervention for all children.

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Background: Gender role attitude pertains to individuals' attitude toward proper role activities for men and women. Most of the factors relevant to family and society may affect individuals' attitudes toward their role. Meanwhile, parents' behaviors can act as an important factor in formation of different dimensions of children's personality. Accordingly, the present study was aimed to investigate the relationship between maltreatment and girls' attitudes toward parental and marital roles. Materials and Methods: This cross-sectional correlational study was conducted in Isfahan University of Medical Sciences in 2013 with 190 female students as the sample. Participants were selected using the random-proportional sampling method. A demographic questionnaire, researcher-made maltreatment questionnaire, and Homami's gender role attitudes questionnaire were used as the data collection instruments. Data were analyzed using Chi-square, Kruskal–Wallis, and Mann–Whitney tests. Results: Results indicated that the feminine attitude was the dominant attitude in gender roles. Findings also revealed no significant correlation between the type of gender role attitude in parental role and maltreatment. However, the correlation was meaningful in marital role of sexual and fertility affairs (P = 0.02). Conclusions: Results revealed that participants had traditional female attitudes toward their gender roles in two aspects. First, taking the cultural domination on attitudes into account, that type of attitude is appreciated in which the individual feels relaxed and has an acceptable performance in the society. Furthermore, to promote certain types of attitudes, the entire socio-cultural and economic dimensions of the society must be taken into account. Family and social policy makings are regarded as starting points for different attitudes toward maltreatment.

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Background: Attention deficit-hyperactive disorder (ADHD) is the most common behavioral disorders during childhood whose treatment is greatly dependent on families; therefore, families of such children should improve their relation with them so that they could enjoy their lives. Hence, this study was conducted to evaluate the effect of Barkley's family-oriented program on the burden of care on such families. Materials and Methods: This clinical trial was conducted among 64 family care givers for children with ADHD. By simple sampling, samples passing the inclusion criteria were selected and randomly allocated into two groups of control and intervention. The intervention group received Barkley's family education program through 9 sessions; the control group participated in 3 group sessions and expressed their problems and experiences. Data were collected and analyzed using the Zarit Burden Interview. Results: Burden of care was gradually reduced through the study in the intervention group, however, the mean score of burden of care did not have a significant reduction in the control group. Conclusions: Because Barkley's family-oriented program was able to reduce the burden of care in families of children with ADHD, it is recommended to develop similar programs and evaluate them through various studies.

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