Background: Given the nature of critical care settings, nurses working in intensive care units (ICUs) experience high levels of stress, anxiety, depression, and moral distress. Objectives: This study investigated the mediating role of self-compassion in the relationship between moral distress and mental health symptoms among ICU nurses. Methods: In this cross-sectional descriptive-analytical study using structural equation modeling (SEM), 220 ICU nurses from hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran, were selected through stratified random sampling with proportional allocation and were studied between April and September 2025. Data were collected during on-site visits using a demographic form and validated self-report questionnaires: the Short Form of the Self-Compassion Scale (SCS-SF), the Moral Distress Scale-Revised (MDS-R), and the 21-item Depression, Anxiety, and Stress Scale (DASS-21). Data were analyzed using SPSS version 24 and LISREL version 8.8. Results: Among ICU nurses, scores for depression (7.60 ± 7.84), anxiety (8.11 ± 6.66), and stress (13.42 ± 7.03) were within the normal-to-mild range. Moral distress was substantial (90.14 ± 61.32), whereas self-compassion was moderate (37.26 ± 7.46). Mental health symptoms were positively correlated with moral distress and negatively correlated with self-compassion (r = -0.456 to 0.604; all P < 0.001). Self-compassion significantly mediated the association between moral distress and anxiety (standardized indirect effect = 0.18; 95% CI, 0.12 to 0.24); however, its mediating role was not statistically significant for depression (95% CI, -0.05 to 0.10) or stress (95% CI, -0.04 to 0.13). Conclusions: Moral distress is positively associated with mental health symptoms among ICU nurses. Self-compassion significantly mediates the association between moral distress and anxiety, but not the associations between moral distress and depression or stress. These findings support targeted self-compassion interventions for anxiety, along with organizational strategies. Longitudinal studies are needed to confirm directionality.

BACKGROUND:Trauma patients recovering from coma face significant physical, psychological, and social challenges after returning home, which may adversely affect their daily lives and well-being. Exploring these experiences can inform care needs and guide tailored post-discharge support. Accordingly, this study aimed to explore post-discharge life experiences in trauma patients recovered from coma. METHODS:This qualitative study was conducted using conventional content analysis. A total of 17 trauma patients who had recovered from coma and had been discharged at least three months prior were selected through purposive sampling. For data collection, 20 face-to-face, semi-structured interviews were conducted until data saturation was achieved. Data analysis followed the Graneheim and Lundman approach. The rigor of the study was ensured using Guba and Lincoln's criteria. RESULTS:The findings revealed that the main theme of post-discharge life experience was characterized as "pleasant freedom with suffering wounds," encompassing three categories: "freedom from captivity of alienation and despair," "dubious pleasure," and "integration of real and imagined disability and helplessness." CONCLUSIONS:The initial perception of post-discharge life among trauma patients who recovered from coma is profoundly shaped by the unpleasant experiences endured during ICU hospitalization. The sufferings experienced at home reflect a combination of real complications and imagined concerns arising from the severity of trauma, often accompanied by a false sense of disability and helplessness. These findings underscore the necessity of softening the ICU environment, implementing comprehensive discharge preparation, and providing effective post-discharge follow-up that addresses not only actual physical and psychological problems but also perceived or imagined sufferings.

Introduction: Coronary artery bypass graft (CABG) is a very important intervention to relieve angina, improve quality of life, or increase life expectancy. This study aimed to determine the effect of implementing a nursing care program based on Johnson's model on the behavioral systems of patients undergoing CABG in Ahvaz teaching hospitals in 2022. Materials and methods: The present study was a clinical trial on 128 patients undergoing CABG admitted to the cardiac ICU and cardiac surgery department of teaching hospitals in Ahvaz city. The patients were selected based on the inclusion criteria, and they were assigned into intervention and control groups using permutation blocks. In the intervention group, a nursing care program based on Johnson's model was implemented for three weeks. The data collection tool was a researcher-made questionnaire developed based on Johnson's theory. Results: Before the intervention, the mean scores of the intervention group in terms of the seven subsystems of Johnson's model were as follows: achievement (-98.98 ± 75.77), affiliative (-87.34 ± 28.23), eliminative (-25.46 ± 33.27), ingestive (-135.67 ± 89.20), dependency (-122.26 ± 45.85), aggressive-protective (-62.18 ± 46.58), and restorative (-163.59 ± 62.03). After the intervention, the mean scores in the intervention group were as follows: achievement (-2.50 ± 71.55), affiliative (-66.33 ± 59.68), eliminative (19.29 ± 35.61), ingestive (152.75 ± 113.58, dependency (104.60 ± 53.42), aggressive-protective (52.18 ± 53.54), and restorative (198.43 ± 72.28), which shows the positive impact of the intervention (P > 0.05). No significant changes were observed in the sexual subsystem. Conclusion: The implementation of a nursing care plan based on Johnson's model positively affected the behavioral systems of patients undergoing CABG. Therefore, this model is recommended to be used as a framework for nursing care. Date of registration -05-12-2022 Trial registration number- IRCT20220831055838N1

Illness perception may influence self-efficacy in chronic disease management. This study examined the relationship between illness perception and general self-efficacy in hemodialysis patients in Ahvaz, Iran. This descriptive-analytical cross-sectional study was conducted in 2023 and included 266 hemodialysis patients selected through proportionate stratified random sampling from hemodialysis units affiliated with Ahvaz Jundishapur University of Medical Sciences. Data were collected through interviews (using the Chronic Kidney Disease Self-Efficacy (CKD-SE) and the Brief Illness Perception Questionnaires (B-IPQ)), medical records (for clinical variables), and a demographic information form. Data analysis was performed using SPSS version 22, applying descriptive statistics, Pearson correlation, and multiple regression analysis. The mean age of the participants was 57.16 ± 12.38 years, and 57.1

Background and aims: Breast cancer (BC) is the most common type of cancer among women, with an increasing incidence. Given the importance of early diagnosis in the control and treatment of BC, as well as the simplicity and low cost of breast self-examination (BSE) as a screening method, this study was conducted to determine the knowledge, attitudes, and practices of female students at Shahid Chamran University of Ahvaz regarding BSE. Methods: This descriptive cross-sectional study included 400 female students aged>20 years selected through cluster random sampling from Shahid Chamran University of Ahvaz. The required data were collected using a researcher-made questionnaire consisting of demographic information and scales assessing knowledge, practices, and attitudes. Results: The mean age of the participants was 22.75 (±3.029) years. The majority of participants had low knowledge, poor practice, and negative attitudes toward BSE. Only 10% of participants had received formal training in BSE. Moreover, a significant negative correlation was found between practice and knowledge among individuals with a history of breast disease in first-degree relatives (r=-0.586, P=0.001). Conclusion: Our findings revealed low levels of knowledge, attitudes, and practices regarding BSE. Therefore, planning and implementing educational programs about BC and its screening methods are necessary.

Background & Aim: The most common problems in patients undergoing hemodialysis are sleep disturbances and fatigue, which affect their quality of life. Auricular acupressure, as a non-pharmacological method, can be effective in controlling these issues. The aim of this study was to evaluate the impact of auricular acupressure on sleep disturbances and the severity of fatigue in hemodialysis patients in Ahvaz. Methods & Materials: In this clinical trial, 40 hemodialysis patients visiting the hemodialysis centers of Imam Khomeini and Golestan hospitals, affiliated with Jundishapur University of Medical Sciences in Ahvaz in 2021, were randomly assigned to two groups: the test group and the control group. The test group received auricular acupressure at true acupressure points, while the control group received acupressure at false points over a two-week period. Data collection tools included the Pittsburgh Sleep Quality Index and the Numeric Rating Scale to assess fatigue severity. Data analysis was performed using SPSS version 17 with descriptive and inferential statistical tests at a significance level of 0.05. Results: In the intervention group, the mean sleep quality score before the intervention were 11.75±1.51, and 6.20±1.43 which decreased to 8.60±1.04 and 5.00±1.21 after the intervention, and this difference was statistically significant (P<0.0001). Conclusion: The findings showed that auricular acupressure improves sleep quality and reduces sleep disturbances and fatigue severity in hemodialysis patients. Therefore, auricular acupressure can be used as an easy, safe, and inexpensive method alongside routine care for hemodialysis patients to reduce fatigue and sleep disturbances. Clinical trial registry: IRCT20201021049102N1

Objective This study aimed to investigate the relationship between perceived comfort level with moral distress and moral sensitivity among oncology nurses Methods This is a descriptive-correlational study on 210 oncology nurses. The samples were selected through the convenience method from September 2020 to February 2022 in the oncology centers of Ahvaz, Iran. Data were collected via a demographic form, Lutzen's Modified Moral Sensitivity Questionnaire, Corley's Moral Distress Scale, and Kolcaba's Nurses Comfort Questionnaire (NCQ). Data were analyzed using SPSS V24, descriptive statistics, Independent t, Mann-Whitney-U, Kruskal-Wallis, Pearson's correlation coefficient, ANOVA, and linear regression tests. Results Nurses experienced a moderate level of perceived comfort (67.91 ± 8.75), moral sensitivity (58.4 ± 13.3), and moral distress (57.54.8 ± 8.9). Moral sensitivity was significantly inversely related to the intensity of moral distress (P < .001). A statistically significant relationship was found between nurses' perceived comfort level with frequency of distress (P < .001) and moral sensitivity (P = .046). Moral distress explained 13.8% of changes in perceived comfort level (R2 = 0.138, F = 6.51, sig < 0.001, R = 0.371). Conclusion Nurses’ perceived comfort level, moral sensitivity, and moral distress were at a moderate level and intercorrelated. It is suggested that factors contributing to moral distress should be eliminated. Also, moral sensitivity should be refined as a decisive factor. Implication for Nursing Practice Oncology nurses are exposed to morally distressing situations that may be a source of discomfort. This study guides nurses, managers, planners, and policymakers to identify the contributing factors and use strategies and solutions to enhance nurses' perceived comfort level.

Background: Updating the knowledge and having the best performance of nurses in the ICUs, due to their heavy work shifts, requires choosing the appropriate educational method. Objectives: This study was conducted with the aim of determining the effect of e-learning through social media on the knowledge and performance of ICU nurses regarding tube feeding. Methods: This quasi-experimental study was conducted on 76 ICU nurses who were eligible to enter the study and were divided into two intervention and control groups using the random allocation method. The data collection tools included demographic, knowledge level questionnaires, and nurses' performance checklist regarding tube feeding. The intervention group was given 8 sessions of group training using PowerPoint and Online questions and answers through WhatsApp social media. Before and two weeks after the training, the questionnaire and checklist of nurses' knowledge and performance were completed. Finally, the data was analyzed with SPSS 22 software. Results: The two groups were homogeneous in terms of demographic variables (P > 0.05), except for gender. To compare the knowledge score after the intervention, by controlling the confounding effects and the possible effects of the knowledge score before the intervention, analysis of covariance was used. There was a significant difference between the knowledge score of the intervention and control groups after training on WhatsApp (P = 0.001). There was no significant difference between the two groups in the mean performance scores before the intervention (P = 0.833). This difference was significant after the intervention (P < 0.001), so that the performance scores of the intervention group were higher than the control group. Conclusions: Due to nurses' heavy work shifts, the possibility of face-to-face education program is less; learning using social media can lead to an increase in the knowledge and performance of nurses in ICU in the field of tube feeding.

Background:As an epidemic, COVID-19 has brought a new shock to the world's healthcare system. The crisis caused by this disease and the prolonged involvement of communities and healthcare systems have intensified the duties and psychological burden of nurses. The current study aimed to explain the experience of ICU nurses during the COVID-19 crisis. Materials and Methods:The present study was conducted using conventional content analysis in 2021. Twenty nurses of the COVID-19 ICU of Ahvaz hospitals were selected by purposive sampling. The main method of data collection was semistructured interview. The process of data analysis was done based on Granheim and Lundman's approach using MAXQDA-2020. For the scientific rigor of the findings, Guba and Lincoln's four criteria were abided by. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was used to ensure the study met the recommended standards of qualitative data reporting. Results:After data analysis, 22 subcategories, eight categories, and one theme (growth under pressure) were extracted. The eight main categories included (psychological crisis, physical exhaustion, family conflicts, complex care, professional development, expertise, life enrichment, and full support). Conclusions:Despite the pressures that ICU nurses faced during the COVID-19 pandemic, they were able to grow by benefiting from positive experiences. These findings can lead to the development and implementation of effective interventions to improve adaptation strategies of nurses, especially those working in the intensive care unit, during the COVID-19 and other future crises.

Background: Post-traumatic stress disorder (PTSD) is a disorder that arises from experiencing traumatic events such as traffic accidents, war, natural disorders, and job incidents. This study focused on determining the epidemiology of PTSD in the Iranian population from 2019 to 2024. Methods: In this systematic review and meta-analysis, we explored databases such as PubMed, Embase, Web of Knowledge, Scopus, and Magiran to achieve a maximum variety of screened articles. The quality of the included articles was evaluated using the STROBE checklist. For data analysis, due to the variation in reporting the PTSD prevalence across the reviewed articles, heterogeneity was assessed using the I2 index, and a random effect model was applied to account for this variation. Results: Out of 800 articles found in the initial review, only 15 articles were entered in the final analysis based on inclusion and exclusion criteria, with a total of 9868 participants. The overall PTSD prevalence in the Iranian population was 31.87% (95% confidence interval [CI]=17.87- 45.87, I2=95.29%, P<0.001). Additionally, PTSD prevalence in men (36.64%) was higher than in women (35.52%). Conclusion: The prevalence of PTSD in young Iranian men is relatively high, and there was no statistically significant decrease in PTSD prevalence between 2019 and 2024.

Background: Stomatitis, or oral inflammation, is one of the common complications in patients undergoing chemotherapy, causing pain, discomfort, infection, and prolonged hospitalization. Objectives: The purpose of this study is to investigate the effect of Cordia myxa mouthwash on preventing stomatitis in patients undergoing chemotherapy. Methods and Result: This study will be a double-blind, single-center, randomized controlled clinical trial focusing on 60 patients undergoing chemotherapy. The samples will be randomly divided into intervention and control groups. In addition to receiving the routine Betadine mouthwash, participants in the intervention group will receive a solution of 30 drops of 5% C. myxa formulation in 20 cc of water, and they will be asked to put the solution in their mouth, swirl it for a minute, and then spit it out. In the control group, in addition to Betadine mouthwash, a sterile water placebo (with the same taste and smell) will be used. The data will be analyzed based on statistical tests using SPSS version 22. Conclusions: If this intervention proves effective in improving access and adherence to treatment, it would represent a step forward in addressing a chronic health problem common among leukemia patients undergoing chemotherapy. Given its natural essence and the fact that it is not associated with any complications, C. myxa mouthwash can be used safely alongside the main treatment to prevent and reduce the severity of mouth ulcers caused by chemotherapy.

Nurses, as the largest part of human resources in the field of health, have many roles. Prescribing nurseis one of the professional roles that has been noticed in recent decades.1 This role was first performedin the United Kingdom (UK) in 1986 by community health nurses.2

Background: Considering the importance of using Non-Invasive Ventilation (NIV) in COVID-19-related hypoxemia, the present study was conducted to determine the effective factors on Continuous Positive Airway Pressure (CPAP) failure rate in COVID-19-related hypoxemia. Materials and Methods: This research was a retrospective cross-sectional study (2021) investigating the records of 200 adult patients with the medical diagnosis of acute respiratory failure (ARF) of COVID-19, admitted to the Intensive Care Unit (ICU) in Shoushtar (southwestern Iran) who underwent CPAP therapy. The Heart rate, Acidosis, Consciousness, Oxygenation, and Respiratory rate (HACOR) scores were measured before the treatment and 1 h after undergoing CPAP treatment. Moreover, patients’ demographic and clinical data were recorded. Data were analyzed using the Mann–Whitney, Chi-square, Wilcoxon, and logistic regression tests. The significance level was set at p ≤ 0.05. Results: The mean standard deviation [SD]) age of patients was 63.96 (16.23) years. Among all 200 patients, 78.50% (n = 157) experienced CPAP failure and the remaining 21.50% (n = 43) underwent successful CPAP therapy. Failure chance was 7.10% higher in patients with higher HACOR scores undergoing 1 h CPAP treatment than others. It was also 14.92% higher among patients with diabetes mellitus (DM) than non-DM patients. Additionally, old age (z = 2591.50, p value = 0.02), obesity (z = 2433.00, p value = 0.024), and elevated Blood Urea Nitrogen (BUN) (z = 2620.00, p value = 0.0) impacted CPAP failure rates among patients. Conclusions: The HACOR score 1 h after CPAP, DM, old age, obesity, and elevated BUN favor increased CPAP failure rates among patients.

Background: Metabolic and nutritional status influences the condition of patients under mechanical ventilation (MV) and determines if they can be disconnected from the ventilator. Objectives: This study was conducted to determine the effect of the planned Entera Meal solution on the duration of weaning patients and the length of intensive care unit (ICU) stay. Methods: In this clinical trial with a pre-test/post-test design, 42 patients admitted to the ICUs of Golestan and Imam Khomeini hospitals of Ahvaz, Iran, who were under MV, were randomly assigned to the two groups of control and intervention. In the intervention group, the Entera Meal solution was used for energy supply. The administration of the solution was started from 50 mL every 3 hours and was scaled up to 30 mL to reach the calculated energy within 48 - 72 hours. For the control group, routine homemade hospital solutions were used. Data were collected by demographic and medical information questionnaires and a checklist for recording outcomes. The data were analyzed using SPSS software version 23. Results: The results showed that the length of ICU stay was significantly affected after the administration of the planned Entera Meal solution (P = 0.004). Although we observed that the duration of weaning patients from MV was shorter in the intervention group than in the control group, this difference was not statistically significant (5.23 ± 4.77 vs. 7.71 ± 6.14 days, P = 0.15). Conclusions: The planned Entera Meal solution reduced the length of ICU hospitalization but did not have a statistically significant effect on the duration of patients weaning from the ventilator.

Aim: This study aimed to explore the barriers to the implementation of patient-centred care (PCC) in the cardiac care unit (CCU) from the perspectives of patients, nurses, physicians and nursing managers. Design: This study was performed with a descriptive qualitative study approach. Methods: In this study, the data were collected through face-to-face in-depth semi-structured interviews with 10 cardiac care nurses, one assistant nurse, two cardiologists, seven patients admitted to the CCU and nine nursing managers and analysed by Graneheim and Lundman content analysis method. Results: After analysing the data, eight subcategories and three main categories were extracted. The main categories included challenges related to: organization, healthcare providers and patients. This study demonstrated the barriers to the implementation of PCC in the CCU. Insights into these barriers can guide interventions aimed at improving the quality of PCC in the CCU, which in turn can lead to improved disease outcomes.

Background: Non-pharmacological interventions in clinical practice, such as Nature-Based Sounds (N-BS), can be an efficient way to reduce stress in patients with Myocardial Infarction (MI). This study was an attempt to investigate the effect of N-BS on stress and physiological parameters in patients with MI. Materials and Methods: This double-blind, randomized clinical trial was conducted on 80 patients with MI from two selected hospitals. Using headphones, the subjects in the intervention group listened to 30 minutes of N-BS twice a day for 3 days. The control group, on the other hand, wore headphones playing no sound. The data were collected using the Persian version of the Depression, Anxiety, and Stress Scale. The significance level was set at 0.05. Results: The repeated measure analysis showed that the within group effect is statistically significant for Systolic Blood Pressure (SBP) (F = 113.32, P < 0.001), Diastolic Blood Pressure (DBP) (F = 67.22, P < 0.001), Heart Rate (HR) (F = 28.52, P < 0.001), respiration rate (F = 36.41, P < 0.001), and stress (F = 102.82, P < 0.001). The reciprocal effect was statistically significant for SBP (F = 11.76, P < 0.001) and stress (F = 5.31, P < 0.001). Conclusions: N-BS can provide an effective, inexpensive, and non-invasive method of reducing stress in patients with MI. Nurses can incorporate N-BS intervention into the daily care of patients with MI in order to reduce their stress and lower their SBP and HR.

INVESTIGATION OF THE PREVALENCE OF MUSCULOSKELETAL DISORDERS AND SOME RELATED FACTORS AMONG THE NURSING POPULATION OF EDUCATIONAL HOSPITALS IN AHVAZ CITY, IRAN

Background and aim Standard airway care can reduce the incidence of ventilator-associated pneumonia (VAP). This study aimed to determine the effect of implementing infection control guidelines on the incidence of VAP in patients admitted to the intensive care unit (ICU). Materials and Methods In this clinical trial, 121 patients admitted to the intensive care units of Golestan and Imam Khomeini hospitals of Ahvaz, Iran who were under mechanical ventilation were assigned to two groups of control and intervention in non-randomly allocation. The study was conducted in two consecutive periods. In the intervention group, infection control guidelines were performed to prevent VAP and in the control group, routine care was performed. Data collection is done by used a three-part instrument. The first part included questions on the patients’ demographics and clinical information. The second part was the modified clinical pulmonary infection scale (MCPIS) for the early detection of VAP. The third part of the data collection instrument was a developed checklist through literature review. The MCPIS was completed for all patients on admission and the 5th day of the study. Results The two groups were homogenous respecting their baseline characteristics (P > 0.05) including the mean MCPIS score (P > 0.05). However, the intervention group had lower body temperature (P < 0.001), lower white blood cell counts (P < 0.038), lower MCPIS score (P < 0.001), and higher PaO2/FIO2 (P < 0.013) at the end of the study. The incidence of VAP was significantly lower in the intervention group when compared to the control group (i.e. 30% vs. 65.6%, P < 0.001). Conclusions The implementation of infection control guidelines could significantly reduce the incidence of VAP and its diagnostic indicators in patients admitted to the ICU. Nurses are advised to use these guidelines to prevent VAP in patients admitted to ICU.