Context: Clinical education is an integral part of nursing education and also it is considered as the heart of professional education. Internship is a part of nursing education program which provides internship students with suitable opportunities to enhance their skills in applying the theoretical knowledge in the clinical placement. Aims: The objectives of this study were to (1) gain a deep understanding of the experiences and perspectives of nursing students and clinical instructors and (2) explain challenges of clinical education in nursing. Setting and Design: This study was a qualitative content analysis conducted in Qom University of Medical Sciences. Materials and Methods: The study participants included 25 senior nursing students in 7^th and 8^th semesters and 8 nursing instructors. Purposive sampling was conducted until data saturation was reached. Data were collected using semi-structured interviews. Statistical Analysis Used: MAXQDA version 10 was used to store the interview data and codes and “qualitative content analysis with an inductive approach” was used to analyze the data. Results: Data analysis revealed two themes and nine categories which were as follows: “lack of effective clinical education facilitators” (demands for diverse clinical learning methods, setting professional values, and focus on autonomy-based education) and “barriers to effective clinical education” (experiential learning by working in the ward, factors undermining scientific learning, focus on routine-oriented work, ineffective educational planning, nurse mentors' superficial knowledge, and communication barriers). Conclusion: Clinical training as facilitators of learning in the clinical environment requires the participation of faculty, clinical instructors, students, and medical staff. Moreover, the paper has addressed the potential problems which are related to the nursing students, instructors, and clinical setting.

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Context: Pain associated with needle procedures is very common among children and causes discomfort among them. Aim: The purpose of this study is to evaluate the effectiveness of combined external cold and vibration during immunization on pain and anxiety levels in children. Setting and Design: This study was a randomized clinical trial in the Abdullahi Comprehensive Health Services Center in Qom, Iran, in 2019. Materials and Methods: One hundred and five eligible children were allocated into experimental (external cold and Buzzy), placebo (off Buzzy device without cold), and control groups (no intervention). Simultaneous external cold and vibration (with Buzzy device) and appalling off Buzzy device were used in the experimental and placebo groups, respectively. Children in the control group had received routine care during immunization. The pain and anxiety levels of the children were measured using the Wong–Baker FACES Scale and Children's Emotional Manifestation Scale. Statistical Analysis Used: Data were analyzed using Chi-square, one-way ANOVA, ANCOVA, and Scheffe post hoc analysis. Results: Pain during immunization in the experimental group (3.71 ± 1.61) was significantly lower than the placebo (5.25 ± 1.37) and control groups (4.45 ± 4.45). The difference between before and after anxiety level was not significant in the three study groups (P < 0.001). Conclusion: The simultaneous external cold and vibration (with Buzzy device) can be used as an effective intervention in pain reduction during intramuscular vaccine injection in children.

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Context: Due to the wide prevalence of coronavirus disease 2019 (COVID-19) in Iran, there is a great deal of pressure on nurses who are taking care of patients with COVID-19. Aims: This study aims to investigate the spiritual needs of nurses caring for patients with COVID in Imam Khomeini Hospital in Sari. Settings and Design: This descriptive–correlational research method based on structural equations modeling was conducted at Mazandaran University of Medical sciences. Materials and Methods: The statistical population of the study included all nurses working in the corona ward of Imam Khomeini Hospital in Sari. One hundred out of 140 nurses were randomly selected using Krejcie Morgan formula as the sample size. The Spiritual Needs Questionnaire designed by Büssing et al. was used to assess the spiritual needs of nurses. Statistical Analysis Used: SPSS and PLS 3 software were used at the significance level of ≤0/05 for the analysis of regression equations. Results: The results of the study demonstrated that there is a significant relationship between spiritual needs and its subfactors in nurses caring for COVID-19 patients in Imam Khomeini Hospital in Sari which is based on the path coefficient between nurses “spiritual needs and religious needs (0.752), the need for inner peace (0.699), existentialism needs (0.539), and actively giving needs (0.586).” Furthermore, the PLS 3 of the research was 0.691 which indicated that the structure of the model is well suited to the data. Conclusion: This research led to make a model showing the relationship between spiritual needs and religious needs, the need for inner peace, the existentialism needs, and the actively giving needs in COVID-19 ward.

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Context: Health literacy and rational drug use are associated with controlling high blood pressure. Aim: The aim of this study was to evaluate the effects of education given by nurses on rational drug use and health literacy of patients receiving hypertension treatment. Settings and Design: The type of study is a randomized controlled experimental study. This study was carried out at the family health center. Materials and Methods: One hundred patients with hypertension were assigned to the intervention (50 patients) and control (50 patients) groups using the simple sampling method. Data were collected twice with 3 months intervals with the patient identification form, the Rational Drug Use Scale (RDUS), and the Adult Health Literacy Scale (AHLS). Statistical Analysis Used: The data were analyzed by SPSS 22. Independent samples t-, Mann–Whitney U-, Paired samples t-, Wilcoxon signed-rank, and Chi-square tests were used for statistical analysis of within-group and between groups. Results: The mean age of the intervention group was 55.38 ± 7.07 years and 68.0% were female. The mean age of the control group was 55.12 ± 6.88 years and 64.0% were female. Intervention group was found a total score of AHLS (13.28 ± 4.10) and a total score of RDUS (50.70 ± 7.82). The scores were statistically significant. After the training given to the intervention group, there was a decrease in blood pressure. Conclusions: It was concluded that the training given by the nurse positively increased the rational drug use and health literacy in patients with hypertension. Necessary training should be given to patients by nurses. These trainings will benefit patients.

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Context: It seems that more students' engagement in the e-learning environment leads to the use of more self-regulated techniques in them; finally, they achieved more success. Aim: This study aimed to determine the relationship between information and communications technology (ICT) engagement with online self-regulated in nursing students of Mazandaran University of Medical Sciences. Setting and Design: This research is a correlational study. The study population included all undergraduate nursing students in the 2^nd to 6^th semesters of Mazandaran University of Medical Sciences. Materials and Methods: The sampling was done by accessible method according to the inclusion criteria. The sample size was estimated 272 students. In this study, in addition to examining the demographic characteristics, two standard questionnaires were used, which include: (a) ICT engagement questionnaire and (b) the online self-regulated learning questionnaire. Statistical Analysis Used: Inferential statistics such as ANOVA, independent t-test, Pearson correlation coefficient, and univariate and multivariate linear regression were used. Results: The results also showed that with multiple regression tests and Enter method, the ICT engagement, age, semesters 3, 5, and 6 and gender explain 30% of the variance of online self-regulated in nursing students. Conclusion: In this study, the ICT engagement and online self-regulated had statistically significant relationship in nursing students and. So, for improving online self-regulated, it is recommended that the officials of nursing schools provide the facility and related to ICT engagement of students.

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Context: Infertility is a global health problem characterized by inability of couple to achieve pregnancy after one year of regular unprotected sexual intercourse; or after 6 months if the woman is older than 35 years of age. Aims: To examine the effect of determinants on the Utilization of Assisted Reproductive Technology (ART) among women Setting and Design: This is a cross sectional survey design conducted on women at the Obstetrics, Gynaecology and Fertility clinics in university of Benin Teaching Hospital, Benin-City, Nigeria, 2020. Material and Methods: This study was conducted among 348 women, selected through stratified probability sampling method, and a self-structured questionnaire was designed, administered and same retrieved. Statistical Analysis Used: Data collected were analyzed using descriptive statistics, means, standard deviation (SD) and Pearson Correlation Coefficient at 0.05 significant levels. Results: The mean (SD) of the determinants: religion, culture, cost, ethics, and husband perception were as follows: 2.47 ± 1.28, 2.34 ± 1.20, 3.37 ± 1.25, 2.35 ± 1.09, 2.33 ± 1.13 respectively. The Pearson Correlation Coefficient, shows significant relationship (P=<0.001, P=0.023) between cost, husband perception and the women decision, while there are no statistical relationship (P=0.591, P=0.892, P=0.934) between religion, culture, ethics and the decision for ART among women. Conclusion: The cost of ART is a major factor, therefore, there is need for international efforts to facilitate globalization of ART services with special attention to manpower development, subsidization of the running cost and establishment a global partnership as obtained in the Sustainable Development Goals (SDGs).

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Context: Training in breastfeeding counseling has positive effects on breastfeeding knowledge and attitudes of health professionals. Aims: This study aims to determine the breastfeeding knowledge and attitudes of midwifery students who received breastfeeding counseling training. Settings and Design: This study was carried out as a pretest-posttest semi-experimental study with a single group of students in the Midwifery Department of University of Health Science, Istanbul, Turkey, between February and May 2019. Materials and Methods: The sample consisted of all students (58 students) who agreed to participate in the study in the 2^nd year of studies in the Midwifery Department. At first, all students were trained about breastfeeding counseling by the researcher. Then, the students were divided into 14 groups and the educational content was shared through peer-assisted learning for 2 h/week during 14 weeks. A “Personal Information Form,” “Breastfeeding Knowledge Evaluation Form,” and the Iowa Infant Feeding Attitudes Scale (IIFAS) were used as data collection tools. Statistical Analysis Used: Data were analyzed using descriptive statistics, a dependent-groups t-test, and a McNemar's test. Results: The students' knowledge of the benefits of colostrum, breast milk, and breastfeeding in maternal health increased after the training (P < 0.05). A significant difference was found between the mean scores of the students on the IIFAS before (65.6 ± 9.7) and after (69.7 ± 7.8) the training (P = 0.008). Conclusion: Breastfeeding counseling training improves students' understanding of basic physiological processes related to breastfeeding and as well as knowledge of and attitudes toward breastfeeding.

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Context: Type 2 diabetes mellitus (T2DM) is a common metabolic disorder. Self-care plays a crucial role in the management of diabetes. Self esteem can affect diabetes management. Aim: This study was conducted to determine the contribution of self esteem and diabetes self-care behaviors to the eating attitudes of patients with T2DM. Setting and Design: This study was conducted in a University Hospital between November 2019 and March 2020. Materials and Methods: The sample of this cross-sectional and descriptive study was composed of 150 patients with T2DM. Descriptive Characteristics Form, Coopersmith self esteem Inventory, and Eating Attitude Test were used to collect data. Statistical Analysis: SPSS 25 software was used along with descriptive and inferential statistics in data analysis. Results: It was found that the self esteem mean score of the patients with T2DM was 63.60 (±15.92), 26% of them had an impaired eating attitude, and there was no statistically significant correlation between eating attitude and self esteem of patients with T2DM (P > 0.05). Conclusions: It was concluded that high self esteem, and self-esteem of patients with T2DM were not associated with eating attitude.

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Context: The emergency staff work in stressful environments and deal with critically ill patients. The occupational nature of their work is such that they are always at risk of being exposed to work violence by patients or patient companions. Aim: The aim of this study was to determine the relationship between anger with general health in emergency personnel. Setting and Design: This was a correlational study that was done in prehospital emergency services and hospital emergency departments in Golestan province, in Iran in 2019. Materials and Methods: The study conducted on 400 of emergency personnel. Samples were selected through multistage sampling. The sampling design included stratified sampling, cluster sampling, and convenience sampling in the first, second, and third stage, respectively. Data were collected using demographic, Spielberger's anger, and general health questionnaires. Statistical Analysis Used: Description of sample under study presented using mean, standard deviation, and frequency. Assessment of associations was performed using Mann– Whitney and correlational analysis at significance level of 0.05. Results: The mean total score of anger of emergency personnel was 121.94 ± 14.66 and for the prehospital and hospital emergency personnel were 123.53 ± 14.08 and 119.38 ± 15.26, respectively (P = 0.002). The mean total score of general health was 12.40 ± 4.22 and for prehospital emergency and emergency personnel were 12.23 ± 4.18 and 12.67 ± 4.29, respectively (P = 0.75). There was a positive and significant correlation between all three dimensions of general health and all three dimensions of anger so that with increasing anger, general health decreased. Conclusion: Emergency personnel were in good general health while their anger score was above average. Furthermore, there was a significant inverse correlation between anger and mental health, so that by increasing the dimensions of anger expression, the general health of prehospital and hospital emergency staff was reduced.

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Context: Childbearing is the most important determinants of population fluctuations. Childbearing decision-making is one of the most important issues in couple's life. Aim: This study was done to determine the effect of transtheoretical model-based education on reproductive age woman's decision-making toward childbearing. Setting and Design: This quasi-experimental study was done in nine urban community health centers in Amol city in Iran in 2017. Materials and Methods: In this study, we used multistage random sampling method was conducted among 75 reproductive age women (38 in the intervention group and 37 in the control group). Education in intervention group conducted in five sessions (specific content for precontemplation, contemplation, and preparation group) and continued in weekly online sessions (for 6 months). Control group got education according to routine program from health centers. All participants evaluated by demographic and decision-making questionnaires (based on transtheoretical model) before, 3, and 6 months after education. Statistical Analysis Used: Mean, standard deviation, frequency, t-test, repeated measures ANOVA, Mann–Whitney U, and Generalized Estimation Equation Test used. Results: The mean (standard deviation) of childbearing decision-making scores in education and control groups were as following: in the preeducation, 99.00 (16.60), 97.07 (13.34), 3 months later 109.34 (17.81), 98.44 (15.60), and 6 months after education 107.06 (16.73), 94.59 (15.24), respectively. Repeated measurement showed a significant difference in woman's decision-making toward childbearing within and between the education and control group by time (P = 0.001). Conclusion: The educational program based on the transtheoretical model had a positive effect on reproductive age women's decision-making toward childbearing.

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Context: Ambulation improves blood flow, wound healing and reduces postoperative complications. Aims: To assess the effectiveness of early ambulation on the level of anxiety, co-operation and to correlate the anxiety level with co-operation among postoperative patients in the experimental and control group. Settings and Design: Pre- and post-test control group design was adapted for the present study. The participants were selected based on simple random assignment technique using the lottery method from the selected hospital at Puducherry. Materials and Methods: A total of 120 participants were selected for the study, 60 patients were allotted for the experimental group and initiated early ambulation. After 15 h of postoperative period, the patient was ambulated for two times a day for a distance of 30–40 feet, continuously for 5 postoperative days. Sixty samples were allotted for the control group who receives regular postoperative instructions. Modified STAI-Y-1 scale is used to measure the level of anxiety and observation checklist was used to monitor the co-operation for postoperative care before the initiation of early ambulation as pretest and after 5 postoperative days as posttest. Statistical Analysis Used: The data were analyzed using SPSS v. 16 (Chicago, Illinois, USA), statistical tests including frequency, percentage, and Chi-square. Results: Both the groups had severe anxiety levels (100%) and were noncooperative to postoperative care in the pretest. In posttest, the majority (85%) of the client shows mild anxiety, 15% shows no anxiety and most (88%) of the clients were fully cooperative for postoperative care in the experimental group. Whereas in the control group, 90% of the clients shows severe anxiety and were noncooperative. Conclusions: Early ambulation is very effective in reducing postoperative anxiety, thereby the patient was very cooperative for care. Therefore, nurses can teach the importance of early ambulation to patients with laparatomy surgeries

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