Background and Purpose: The competence of clinical instructors is regarded as the most significant factor in achieving training goals. Competence is not a single, uniform concept, and different definitions have been proposed by educational organizers including instructors and students. Therefore, this study was performed to review the experiences of nursing students and clinical trainers regarding the characteristics of a competent clinical instructor and explore the concept of clinical competence. Methods: This qualitative study was performed on 22 participants including 12 nursing students and 10 clinical instructors. For data collection, open interviews were conducted and field notes were taken. The obtained data were assessed via content analysis. Results: Based on the analysis of interviews, five major themes related to the competence of clinical instructors emerged. These themes were as follows: “the ability to establish effective communication”, “instructor's academic status”, “scholarly knowledge”, “clinical competence” and “educational qualifications”. Therefore, a competent clinical instructor should have a combination of these characteristics, which work hand in hand and affect each other. Conclusion: Participants' experiences suggested that clinical instructors' competence is a multi-dimensional concept. Overall, a competent clinical instructor should have a “comprehensive perspective”. As the results indicated, the emerging themes were not similar to those reported in previous studies.

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Background and Purpose: Hemodialysis patients face several physical and mental tension factors including depression, anxiety and stress, which could decrease their quality of life. This study aimed to identify the relationship between quality of life (QOL), depression, anxiety and stress in patients undergoing hemodialysis. Methods: This descriptive, analytical study was conducted on 160 hemodialysis patients (80 male and 80 female) using convenience sampling at three hemodialysis centers in Sari, Mazandaran, Iran. Data collection was performed during three months using three questionnaires of demographic characteristics, DASS-21 and quality of life (SF-36). Collected data were analyzed using descriptive and inferential statistics. Results: In this study, the mean age of patients was 50.8±12.81 years, and 88.8%, 92.5% and 85.6% of the subjects had severe depression, anxiety and stress, respectively. Spearman's correlation coefficient showed a significant inverse correlation between the physical and mental domains of SF-36 questionnaire with depression (r=-0.38, r=-0.29), anxiety (r=-0.48, r=-0.45) and stress (r=-0.5, r=-0.57), respectively (P<0.001). Conclusion: According to the results of this study, increased depression, anxiety and stress could reduce QOL in hemodialysis patients. Therefore, nurses and health care staff play a pivotal role in the identification and alleviation of these factors by using coping and support strategies to improve QOL in these patients.

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Background and Purpose: Based on a holistic model of health care, human beings have biological, psychological, social and spiritual dimensions, which should be considered in the provision of comprehensive care. Given the fact that spiritual health coordinates different aspects of human life, we aimed to explore the viewpoints of nurses working in intensive care units about the concept of spiritual well-being. Methods: This cross-sectional study was conducted on a random sample of nurses (n=62), working in the intensive care unit during 2014-2015. Data were collected, using a questionnaire consisting of demographic characteristics and statements evaluating nurses' attitudes towards spiritual health. Face and content validity of the questionnaire were confirmed, and its reliability was assessed by Cronbach's alpha. Descriptive and inferential statistics were calculated, using tests such as Chi-square, t-test and ANOVA. For data analysis, SPSS version 17 was used. P-value less than 0.05 was considered statistically significant. Results: The mean age and work experience of nurses were 32.5±9.21 and 12.1±1.9 years, respectively. The obtained results showed that 33 (53.2%), 17 (27.4%) and 12 (19.3%) nurses had good, moderate and poor attitudes towards spiritual well-being, respectively. According to ANOVA test results, spiritual care was significantly correlated with nurses' age and work experience (P<0.05). Conclusion: Considering the positive attitude of our participants towards spiritual well-being and the importance of spiritual dimension in nursing care, besides physical and mental aspects, continuous educational workshops on spiritual care are recommended for promoting nursing skills.

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Background and Purpose: Nurses constitute the largest group of human resources in healthcare systems of almost all countries; they also play a significant role in community health promotion. Nurses' job satisfaction is of great importance in the promotion of healthcare quality. Therefore, the present study aimed to analyze the relationship between personality type (type A & B) and job satisfaction in nurses. Methods: In this correlational study, personality type and job satisfaction were evaluated, using Friedman & Rosenman questionnaire and Varo questionnaire, respectively. Overall, 142 nurses were selected via stratified random sampling from Bu-Ali Sina Treatment and Educational Center of Sari, Iran. For data analysis, t-test, Pearson's correlation test and ANOVA were performed, using SPSS version 14. Results: As the results indicated, the majority of samples were female (90.1%) and staff nurses (81.7%); also, 92.3% of the participants had bachelor's degrees. Overall, the mean score of job satisfaction was estimated at 48±10. The findings suggested a significant relationship between personality type and job satisfaction (P=0.032). Also, subjects with type B personality were more satisfied with their careers, compared to those with type A personality; the observed difference was statistically significant (P=0.035). Additionally, nurses' job satisfaction was significantly associated with their educational level (P=0.025). Conclusion: A Considering the characteristics of nurses with type B personality, they were more satisfied with their careers, compared to others. In order to increase nurses' job satisfaction, practitioners are recommended to conduct interviews and psychological tests to identify nurses' personality type and accordingly, provide them with systematic, regular psychological consultation.

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Background and Purpose: Coping strategies play a key role in the management of different diseases. Resilience and positive emotions in patients could enhance coping strategies and reduce disease complications. This study aimed to determine the level of resilience and the associated factors in patients with coronary artery disease (CAD). Methods: This descriptive cross-sectional study was conducted on 186 CAD patients referring to Dr. Heshmat Hospital of Rasht in 2013. Data were collected using the Connor-Davidson Resilience Scale (CD-RISC), and data analysis was performed using descriptive and inferential statistics in SPSS. Results: In this study, mean score of resilience was 65.50±1.58 (out of 100), and 53.2% of the subjects had lower scores than the mean. Significant associations were observed between the resilience level and age, gender, education status, employment status and history of hypertension (P<0.05). According to the logistic regression, employment status was the only significant predictor of resilience. Conclusion: According to the results of this study, since the majority of the subjects had lower scores than the mean of resilience, it is recommended that these patients be monitored for mental and psychological health. Furthermore, they should be trained on coping skills depending on their socio-demographic features.

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Background and Purpose: One of the most reliable methods to evaluate the scientific status of nursing is the assessment of the trend and quality of related articles. This study aimed to determine the publication status and general quality of articles published by Iranian nursing scholars engaged in different nursing and midwifery schools in well-known international journals during 2000-2011. Methods: This descriptive, cross-sectional study was conducted using scientometric methods and data obtained from Scopus database. The search for articles was performed using keywords such as Iran and nursing, and 886 articles were found dating from 2000 to 2011, 697 of which were authored by Iranian nursing scholars. Data collection was performed using checklists, and the validity of the checklists was determined using content validity. Data analysis was performed using descriptive statistics (frequency and mean) and Spearman's rank correlation coefficient in SPSS V.16. Results: Publication of international articles written by Iranian nursing scholars has been on a rising trend, increasing from only 3 articles in 2000 to 238 articles in 2011. Mean of Scopus article citation counts was 2.9±5.1, while the mean of related journal impact factor was 0.97±0.62. Regarding the number of articles, as well as the citation counts, the highest-ranking nursing and midwifery schools were Tehran University of Medical Sciences, Tarbiat Modares University and Isfahan University of Medical Sciences, respectively. Based on citation index, Kashan University of Medical Sciences, Tehran University of Medical Sciences and Tarbiat Modares University were the leading nursing schools in terms of article publication. Conclusion: Despite the increasing publication rate of articles by Iranian nursing scholars in popular international journals in recent years, there has been no significant improvements in the quality of these articles. According to the findings of this study, there is a noticeable gap in the quantity and quality of the scientific products by Iranian nursing community. Therefore, new policies are required as to enhance the quality and quantity of the articles published in the field of nursing and midwifery.

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Background and Purpose: Patients with non-transfusion-dependent beta thalassemia major (NTDTM) could reach old age, marry and have children with appropriate care. This study aimed to review the marital status and maternal-fetal outcomes of NTDTM patients at Thalassemia Research Center (TRC) of Sari, Iran. Methods: In this study, medical records of patients with β-thalassemia major were reviewed from July 2014 to December 2014. All the patients were interviewed, and a questionnaire was designated by research methodology experts. Reliability of the questionnaires was measured through a pilot study on 12 patients using the test-retest method (r=0.9). In addition, epidemiological characteristics and pregnancy outcomes of the patients were recorded. Data analysis was performed using descriptive statistics in SPSS. Results: In total, 419 records were reviewed, and 74 cases (17.6%) had NTDTM. During a 25-year marriage period, 23 pregnancies were reported with 18 childbirths. Low birth weight was observed in three neonates (23.1%), and there was one assisted pregnancy. In addition, one female NTDTM patient was married to a β-thalassemia carrier and had two abortions (one after prenatal diagnosis). In this study, 24 (32.4%) and 14 (58.3%) male NTDTM patients were married, and only one case had a child. Mean age of marriage in male NTDTM patients was 25.3±4.2 years. Conclusion: According to the results of this study, proper management of NTDTM patients will help them reach the reproductive age. It also seems that fertility is higher among female NTDTM patients.

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Background and Purpose: One of the most important elements of nursing ethics is patient advocacy, which instills patients' sense of independence and autonomy. Nurses' perceptions of this concept can significantly influence their advocacy role. Therefore, in this study, we aimed to assess nurses' perceptions about this phenomenon. Methods: In this cross-sectional study, 385 nurses were selected via quota sampling from three hospitals, affiliated to Golestan University of Medical Sciences, Iran in 2012. Data were collected, using a self-administered questionnaire for assessing nurses' perceptions of patient advocacy (with a score range of -1 to 1). The obtained data were analyzed, using descriptive and inferential statistical tests. Results: As the results indicated, nurses' perceptions about patient advocacy were relatively positive (0.73%). Moreover, there was a statistically significant relationship between patient advocacy and nurses' educational level (P=0.01), working in different hospital wards (P<0.001), participation in workshops on patient rights (P<0.001) and working in different hospitals (P=0.01). Conclusion: In this study, nurses were highly responsible regarding patient advocacy, despite the fact that patient advocacy is not considered as a professional nursing role in Iran. However, further studies are required to confirm the obtained findings.

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