Iran Journal of Nursing
Year:2021 | Volume:34 | Issue:129|Papers Count:8

Background & Aims: The world's population is ageing, and the elderly constitute large number of the world's population. With ageing, the health status undergoes certain changes, and the risk of developing chronic diseases and disabilities increases in the final years of life. Given the increased index of life expectancy and the subsequent increase in the number of the elderlies in the world, the number of diabetic patients in this population also increases. Diabetes is an important health issue and a common physical illness, which causes numerous complications in old age. Type II diabetes has no definite diagnosis and requires long-term care and proper selfmanagement. Since diabetes has no definite treatment, the early identification of the suspected cases could prevent and delay the associated complications through proper self-management. The self-management of diabetes is complex and may go beyond blood sugar control, requiring the balancing of multiple metabolic and lifestyle factors and helping the patients to discover and exploit their capabilities in this regard. If patients with chronic diseases refrain from self-management and do not actively partake in self-care, positive clinical outcomes will be hard or impossible to achieve. Self-management is a rehabilitative method in which the care activities mainly depend on the patient, and the aim is to attain maximum independence, decision-making, and health improvement based on the abilities and lifestyle of the patient. Therefore, self-management must be evaluated in vulnerable and targeted populations, such as the elderly. Due to the chronic nature of diabetes, the patient must follow a special, long-term medication regimen that is prescribed by the treatment team, which is only possible with the active participation of the patient in the treatment and implementation of the recommendations of the treatment team members; this is referred to as treatment adherence. One of the main concerns and clinical problems that is frequently faced by healthcare providers is the problems associated with the lack of adherence to the prescribed treatment, particularly in the patients with chronic diseases that require long-term treatment. In the absence of proper self-management and medication adherence in elderly patients, heavy costs of the treatment of the disease and its complications will be imposed on the patients, their family, the community, and the health system. In addition, the subsequent psychological and social costs should be considered in this regard, and special attention has to be paid to this issue. Several studies have shown the unsatisfactory state of self-management and medication adherence in elderly diabetic patients, emphasizing on the periodical and frequent assessment of this issue. Given the necessity of healthy, active, and successful aging, the present study aimed to evaluate self-management in the elderly with type II diabetes in the teaching hospitals affiliated to Iran University of Medical Sciences. Materials & Methods: This descriptive, cross-sectional study was conducted on the elderly patients with type II diabetes referring to the endocrine clinics of the teaching hospitals affiliated to Iran University of Medical Sciences. The patients were selected via continuous sampling during January-May 2020. For the evaluation of self-management and treatment adherence in the patients, the minimum sample size was estimated at 280 patients at the confidence level of 95%, accuracy of d=0. 2, and standard deviation of 1. 7. The inclusion criteria of the study were age of more than 60 years and less than 75 years, at least one year since the definitive diagnosis of diabetes by a physician, treatment with antihypertensive drugs for a minimum of six months, and no cognitive impairment with the score of ≥ 7 in the abbreviated mental test (AMT). Data were collected using the short-form AMT, a demographic form, diabetes self-management questionnaire (DSMQ), and drug adherence questionnaire (MMAS). After the completion of the questionnaires by the researcher, the data were coded, and the analysis of the raw data was performed using descriptive statistics (adjusting frequency distribution tables, calculating frequency indices, and frequency numerical indices) for the qualitative variables. In addition, the minimum, maximum, mean, and standard deviation were determined using inferential statistics and Chi-square, independent t-test, analysis of variance (ANOVA), Pearson' correlation-coefficient, Scheffe post-hoc test, and regression analysis at the significance level of P≤ 0. 05. Results: The mean age of the patients was 66. 64 years, and the majority were married (6%). Based on the questionnaire data, 77. 1% of the elderly patients had at least one underlying diseases, and patients with cardiac diseases constituted the majority in this regard (50. 4%). In addition, the duration of the disease was more than five years in most of the patients (70. 4%) (Table 1). On a scale of 0-10, the mean score of self-management in the elderlies was 6. 55, and 63. 2% of the research units obtained a higher score than eight in drug adherence, which indicated favorable self-management and drug adherence. According to the data obtained by the multivariate analysis and among the regression factors, the variables of education level (P=0. 017), housing status (P<0. 001), and income adequacy (P=0. 01) were significantly correlated with self-management. Furthermore, selfmanagement in the domain of physical activity (mean score: 7. 07) had the highest mean score, while the domain of diet control (mean score: 6. 05) had the lowest mean score compared to the other domains. Self-management had a significant correlation with education level (P=0. 017) and income adequacy (P=0. 01). The results of independent t-test also showed that self-management was significantly lower in the unmarried patients (single/widowed/divorced) compared to the married elderlies (P=0. 003). Drug adherence was significantly lower in men compared to women (P=0. 015) and had significant correlations with education level (P=0. 001), employment status (P=0. 013), and income adequacy (P=0. 019). Conclusion: According to the results, self-management and drug adherence were generally satisfactory in the elderly patients with type II diabetes. However, self-management was significantly lower in the patients who were illiterate, unmarried (single/widowed/divorced), and had an insufficient income, regarded as the vulnerable segment of the society. Therefore, this group of elderlies needs more attention from the health system and healthcare planners, as well as educational-counseling interventions based on the empowerment of vulnerable elderlies in order to promote self-management behaviors, minimize the complications of diabetes, and experience a healthy, active, and successful aging.

Background & Aims: Rheumatoid arthritis is a chronic, inflammatory, and progressive autoimmune disease with variable clinical symptoms, which could also be the main cause of disability, short life, and even death. Pain is the most common symptom of rheumatoid arthritis, which plays a key role in the pattern of sleep and rest, and approximately 80% of patients with rheumatoid arthritis complain of sleep disorders. Among the other influential factors in the sleep pattern are inactivity and medication use. Sleep disturbance could increase pain, fatigue with depression, inflammation, and even disease and symptom deterioration. The patients mostly refer on an outpatient basis and receive routine training. However, the management of chronic diseases requires the empowerment of the patients in terms of disease management, care, and participation in the treatment. Therefore, these patients must receive comprehensive education about the disease, symptoms, and complications (especially the correct methods of self-care) in order to achieve the desired outcomes. Self-care education is an important task of nurses, which promotes healthy behavior. As a result, adult patients learn and take actions to maintain their survival, quality of life, and wellbeing. The feedback-based method is a client-oriented educational approach, which is often preferred over other educational methods. Assessing the proper understanding of the individuals toward the training materials provides feedback to ensure that they have received the training information accurately and completely, which has a significant impact on the quality of self-care and patient satisfaction with the treatment and care. The main complaints of patients with rheumatoid arthritis are pain and sleep disorders, along with daily symptoms, fatigue, drowsiness, depression, mood and cognitive disorders, decreased concentration, and anxiety. Therefore, it is paramount to evaluate the impact of self-care education on the pain management and sleep disorders of these patients. The present study aimed to investigate the effects of feedback-oriented self-care training on the pain intensity and sleep quality of patients with rheumatoid arthritis. We also compared sleep quality and pain intensity before and after the intervention with the assumption that sleep quality would improve and pain intensity would decrease after the intervention. Materials & Methods: This study was conducted based on the one-group evaluation of effect with a pretestposttest design, in which we evaluated the effects of self-care training by the feedback method on the pain intensity and sleep quality of the patients with rheumatoid arthritis referring to the rheumatology clinic of Imam Reza (AS) Hospital in Amol city, Iran. The study was performed during one year (August 2019-July 2020), and 60 patients were selected via continuous sampling within six months (October 2019-April 2020) considering attrition. Four patients were also excluded. The inclusion criteria were rheumatoid arthritis diagnosed by a physician, age of 1860 years, at least one year of disease history, complaints of pain and poor sleep quality (scores >5), basic literacy, awareness of time and location, ability to understand the Persian language, and no psychological disorders based on medical records. The exclusion criteria were employment in the health system, other chronic diseases (e. g., cardiovascular diseases, asthma, cancer, and mental illnesses), using psychotropic drugs, absence in one training session, and unwillingness or the impossibility of continuing participation. The training was implemented in three sessions using the feedback method. At the pre-training stage and one month post-training, data were collected using the Pittsburgh visual pain scale and sleep quality index, which were completed and compared. Data of 56 patients were analyzed in SPSS version 16 using descriptive statistics, paired t-test, and Wilcoxon test at the significance level of P<0. 001. Results: The mean age of the subjects was 45. 04 ± 8. 83 years. The majority of the patients (89. 3%) were female, married (87. 5%), had an undergraduate degree (71. 5%), and poor economic status (71. 4%). In addition, 32. 1% were unemployed, 55. 3% were housewives, 58. 9% had no history of other diseases, and 64. 3% had a history of surgery. Also, 64. 3% of the patients had a family history of rheumatoid arthritis, and 35. 7% the duration of the disease to be 6-10 years. The highest involvement was with the joints of the upper torso (55. 4%), while 76. 8% of the patients did not use sleeping pills, 92. 9% did not smoke, and 96. 4% did not consume alcohol. Before the intervention, the sleep quality of the majority of the patients (96. 4%) was poor. After the intervention, the sleep quality of the majority (92. 9%) was observed to be favorable, and the sleep quality scores in all the domains were significantly lower after the intervention compared to before the intervention (P<0. 001). According to Table 4, pain intensity was high in 58. 9% of the subjects before the intervention, and none of the patients had low pain intensity. After the intervention, the majority (67. 9%) experienced moderate pain intensity, and high pain intensity was observed in none of the subjects. Furthermore, the mean pain intensity score was significantly lower after the intervention compared to before the intervention (P<0. 001). Conclusion: According to the results, feedback-based training could reduce pain intensity and improve sleep quality in the patients with rheumatoid arthritis. Considering the key role of education in the empowerment of patients with chronic diseases, it is suggested that feedback-based educational approaches be used along with other training methods in order to decrease pain intensity, improve sleep quality, and increase the satisfaction of rheumatoid arthritis patients.

Background & Aims: Nursing, the core and front line of the health system, is considered as one of the most challenging jobs due to problems such as lack of human resources, increasing demand in the clinical environment, constant changes in work schedule, client expectations, legal problems, and client mortality. Paying attention to influential factors including client health is important in creating a positive working environment and increasing the mental health of nurses. One of the issues raised recently is psychological capital, with four dimensions of self-efficacy, optimism, hope, and resilience. Psychological capital has a positive effect on work attitude and behavior and is positively related to constructive performance. In addition, psychological capital leads to better psychological health, better adaptation to stressful conditions, and increases nurses' ability to cope with the problems. Given that nurses are always exposed to physical, mental, and emotional challenges, hospital managers should provide mechanisms to reduce potential workplace risks. Recognition of preventive factors (e. g., psychological capital) is the first step towards the growth and development of effective policies in this area. Therefore, this study was conducted to determine the psychological capital of nurses working in academic medical centers of Iran University of Medical Sciences. Materials & Methods: This descriptive study was conducted to examine the psychological capital of nurses working in academic medical centers of Iran University of Medical Sciences in 2019. The study population was all nurses working in academic medical centers affiliated to Iran University of Medical Sciences in 2019 and the sample included 305 nurses with inclusion criteria (at least 1 year of clinical experience and not facing severe crises or death of loved ones during the last 6 months) from emergency departments, pediatric ward, ICU, CCU, internal ward, psychiatric ward, Operating room, obstetrics ward, surgical ward, dialysis unit, burn unit, oncology, and etc. Sampling was performed using proportional allocation procedure and samples were selected from academic medical centers of Iran University of Medical Sciences. The Psychological Capital Questionnaire devised by Luthans was used to collect the data. The questionnaire Includes 24 items in 4 subscales of hope, selfefficacy, resilience, and optimism, and is scored based on 6-point Likert scale ranging from 1 (strongly disagree) to 6 (strongly agree). Its score ranges from 24 to 144, with a higher score indicating a higher level of psychological capital. The Demographics Survey included information such as age, gender, marital status, employment status, education, work experience, income, employment in one or more hospitals, experience in the current ward, work experience in current hospital, job position, shift work. Sampling and collecting questionnaires took about 5 months (from October 2019 to March 2020) as the nurses were too busy. Data analysis was performed using SPSS software version 16. Descriptive statistics and inferential statistics were used to analyze the data. In the descriptive statistics part, frequency distribution tables were used to analyze the qualitative variables of the research and numerical indices of minimum, maximum, mean, and standard deviation were used to analyze the quantitative variables of the research. In inferential statistics part, Pearson correlation coefficient, independent t-test, ANOVA, and multiple linear regression model were used. Results: The mean age of the subjects was 34. 75 with a standard deviation of 7. 71 years. 86. 9% of the nurses were female and 86. 6% had an undergraduate degree. Most nurses were married (55. 4%). The economic status of 78. 7% of the nurses was average and 89. 8% of them did not report any specific chronic disease. 49. 8% of the nurses were employed. The morning shift accounted for 63. 3% of the work shift. The majority of participants were nurses (85. 2%). Most of the participating nurses were working in intensive care units (38%). The average work experience of all participants was 10. 44 ± 6. 96. Their average work experience in the current wards was 4. 82 ± 4. 41 and also the average work experience in the current hospital was 8. 26 ± 6. 20. The results revealed that the mean of psychological capital was 104. 63 ± 15. 25, and given the score range of 24-144 in the Psychological Capital Questionnaire and the mean score, it can be concluded that nurses had a high level of psychological capital. Among the components of psychological capital, the highest mean score was related to self-efficacy of 28. 29 ± 4. 70 and the lowest mean score was related to resilience of 24. 62 ± 4. 37. Also, psychological capital had a statistically significant relationship with job position (P <0. 001) and chronic disease (P = 0. 050). Tukey's multiple comparison showed that the mean score obtained for psychological capital of nurses was significantly lower than the one obtained for head nurses (P = 0. 002) and supervisors (P = 0. 029). It was also observed that the average score of psychological capital in nurses with chronic diseases was significantly lower than others. It should be noted that other personal and occupational variables had no statistically significant relationship with psychological capital. Conclusion: According to the mean scores obtained from this study, it can be said that nurses have an almost high level of psychological capital and the highest mean score among the dimensions of psychological capital was related to self-efficacy. Regarding the correlation of research variables with demographic characteristics, the results showed that the psychological capital of nurses was less than that of head nurses and supervisors, which increases the importance of addressing psychological capital in nurses. It is possible to provide the basis for improving their personal, professional, and caring performance by focusing on psychological capital in nurses and adopting proper planning for necessary training in this field. Considering that the resilience component of the psychological capital variable obtained the lowest average, paying attention to this component in nurses is of great importance. We can also point out the importance of these variables and their impacts on personal, occupational, and organizational areas, including personal and psychological effects and care outcomes such as improving the quality of care and organizational outcomes, which increases the importance of paying attention to it.

Background & Aims: Thalassemia major (TM) is one of the most common chronic genetic disorders in today’ s world. The number of patients with thalassemia in the world is estimated at 240 million and is reported in 60 countries. Iran is located in the thalassemia belt and has about 26, 000 patients with thalassemia major. Patients with chronic diseases such as thalassemia have to undergo continuous medical treatment throughout their lives and their survival depends on these treatments. The treatment protocol affects different aspects of these patients' lives and can make them anxious. Therefore, any measures taken to reduce the anxiety of these patients are very important. Educational intervention can be a method for improving the quality of life in patients with chronic diseases. Nowadays, the educational methods that engage learners in their learning process have acquired attention. One of the methods to educate patients is peer education which has been effective in promoting their health status. In this educational approach, patients share their experiences about their common disease. Having worked in the thalassemia ward, the researcher realized the importance of peer education as a scientific and codified method for efficient education of these patients. Moreover, considering the clinical observation of psychological problems in patients with thalassemia major and also the lack of continuous and reliable research in this field, the present study aimed to evaluate the effect of peer education on the anxiety experienced by patients with thalassemia major. Materials & Methods: This one-group, quasi-experimental study was conducted at Imam Khomeini Hospital in Zabol between March and July 2020 on 50 participants, who were selected via continuous sampling from the patients with the thalassemia major based on the inclusion and exclusion criteria of the study. Data were collected using a demographic questionnaire exploring participants' age, sex, residency, occupation, level of education, economic status, parents’ familial relationship, the frequency of blood transfusions per month, another family member with the same disease, the type of iron-chelating agent, regular drug consumption, and history of other diseases. In addition, the valid and reliable Beck Anxiety Inventory (BAI) was used to measure anxiety. The study began with the selection of eligible peers educators based on inclusion criteria. Finally, 2 patients with thalassemia major (a man and a woman) who obtained higher scores were selected as peer educators, who were then trained by the researcher in 3 sixty-minute educational sessions within one week. The educational content included explanations about research objectives, the importance and benefits of peer education, educational concepts, communication skills including attention to verbal and non-verbal behaviors, active listening skills, and anxiety control concepts. The educational content was taught through an interactive lecture using audio-visual aids, and question and answer. Based on the training given by the researcher and the experiences expressed by the peer educators, their final evaluation was conducted through a role-play. After training the peer educators, the pre-test was conducted. Afterwards, an anxiety management training program was presented to the participants with thalassemia major which included the definition of anxiety, its symptoms and its role in exacerbating the disease, strategies to reduce and control anxiety, revision of beliefs, and negative and anxious attitudes. The training program, with emphasis on the peer educators’ experiences, was conducted over two 60-minute sessions in two consecutive hours. Participants were placed in groups of 6 to 7 patients. Each group was trained separately by a peer in a training class in the thalassemia ward. After the training sessions, the educational booklet was given to all participants of the study. One month after the intervention, the participants took the post-test. The present research was approved by the Ethics Committee of Iran University of Medical Sciences. The researcher adhered to the ethical policies such as obtaining informed consent from the participants and their voluntary participation. Data analysis was performed in SPSS version 16 using descriptive statistics (mean and standard deviation) and inferential statistics (paired-sample t-test). Results: The mean age of the participants was 24. 5 ± 4. 24 years. In this study, most participants were women, had a diploma, and were unemployed. Moreover, the parents of most of the patients had familial relationships. The mean score of anxiety was 17. 73 ± 11. 63 in the pretest, which reduced to 17. 07 ± 11. 32 in the posttest. The results of paired t-test indicated no significant differences in the pretest and posttest scores of anxiety in the patients with the thalassemia major (t=0. 788; P=0. 434). Conclusion: According to the results, the peer education program did not have any positive effects on the anxiety level of the patients with thalassemia major. Considering the nature of educational interventions, these patients may benefit from concurrent anxiety-reducing interventions such as relaxation exercises and music therapy. The findings also suggest that future researches use other assessment tools, broader educational content, and a control group to assess anxiety in patients with thalassemia major. Furthermore, it is recommended that researchers compare the effects of peer training with other anxiety management training methods used for these patients.

Background & Aims: Ensuring patient safety is the first vital step in improving the quality of healthcare services. Patient safety is defined as an event that prevents unwanted injuries to a patient due to functional and unintentional actions. Safety standards are a set of requirements that are critical to implementing patient safety programs at hospitals. These standards provide an operational framework to help the hospitals fully match with the dimensions of patient safety in order to provide quality and patient-centered services. Therefore, 100% compliance with the required standards of patient safety-friendly hospital should be the priority of every hospital. The COVID-19 pandemic is one of the emerging infectious diseases that has affected the whole world in recent months. As its outbreak is an unexpected event or sequence of events of enormous scale and overwhelming speed, it has led to a high degree of uncertainty and has posed a variety of challenges to healthcare systems. Therefore, the realization of this important issue is felt more than ever in the structures and processes of each hospital of the healthcare system, in order to successfully control and efficiently manage this disease and preserve national assets. Therefore, this study aimed to determine the compliance of Imam Khomeini Hospital of Tehran with the patient safetyfriendly hospital standards with respect to COVID-19 pandemic in 2020. Materials & Methods: This descriptive-analytical cross-sectional study was conducted from September-December 2020 in Imam Khomeini Hospital Complex of Tehran during COVID-19 pandemic. 266 nurses with inclusion criteria were selected via stratified random sampling. For this purpose, the required list of 1, 200 nurses was received from the nursing office of the complex. 866 nurses from 50 different wards were selected from the list based on the inclusion criteria. Then, the nurses who were in the same wards were placed in one stratum, so that the existing 50 wards including emergency department, operating room, ICU, CCU, NICU, dialysis, internal ward, surgical ward, infectious disease wards, oncology, pediatric ward, VIP and diagnostic wards were finally placed in 13 strata. Therefore, 292 samples were selected based on the quota of nurses from 13 existing strata via simple random sampling to provide a specified sample size of 266 nurses with an additional 10% to manage their attrition. Online sampling was performed by sending the link of the questionnaires through the virtual network of the study. The questionnaires included nurses' demographic information and patient safety-friendly hospital standards (Parvizi et al), including 27 items and five dimensions. The minimum score was 27 and the maximum score was 135. A higher score from the point of view of the research unit meant that the hospital was more in line with the standards of a patient safety-friendly hospital. Item 21 was scored in reverse. Scores 108-135 showed high compliance, scores 80-107 indicated moderate compliance, and scores 27-79 indicated the poor compliance of the hospital with the standards of patient safety friendly hospital. The internal consistency of the instrument was determined to be 0. 934 using Cronbach's alpha. After introducing the researcher and explaining the research objectives to the research units, data were collected. Data were analyzed using descriptive statistics including absolute and relative frequency distribution, mean and standard deviation in SPSS software version 16. Results: The mean and standard deviation of the age of nurses was 38. 6 ± 7. 94 years and most of them (90. 2%) were female. The mean and standard deviation of the total length of service as a nurse and the length of service in the current ward was 13. 87 ± 7. 41 and 6. 87 ± 5. 80 years, respectively. ICU nurses had the highest frequency, 25. 6%, compared to other hospital wards, and also rotating shifts with 42. 4% had the highest frequency. The level of compliance with the standards of patient safety friendly hospitals was 97. 35 ± 16. 59 from the perspective of most nurses (61. 7%) (80-107), and 3. 58 ± 0. 62 based on a Likert scale, which indicates moderate compliance. Continuing education dimension with the average compliance equal to 3. 87 ± 0. 69 had the highest mean and governance and leadership with the average compliance equal to 3. 41 ± 0. 71 had the lowest mean scores. Mean scores of dimensions of a safe environment, participation, and interaction with patients and the community, safe clinical services were 3. 45 ± 0. 67, 3. 44 ± 0. 85, and 3. 71 ± 0. 7, respectively. Conclusion: Based on the findings of the present study, the level of compliance with the standards of a patient safety-friendly hospital was moderate in the Imam Khomeini Hospital complex during the coronavirus pandemic. The highest and lowest levels of compliance were related to the dimension of continuing education and the dimension of governance and leadership included in the standards of patient safety-friendly hospital. To improve the current situation, purposeful and evidence-based management of organizational resources, attention to "barriers to achievement" dimensions of patient safety, institutionalizing patient safety culture and promoting safety, attention and focus on patient safety indicators, continuous and effective training of educational staff needs are needed to improve the safety of beneficiaries, especially during the COVID-19 pandemic. Relying on the results of the present study, managers can take appropriate corrective measures to achieve 100% compliance with patient safety-friendly hospital standards and national accreditation standards, and achieve patient safety goals and provide quality and patient-centered services in the healthcare system. The results of the present study can provide a basis for examining the patient safety status and monitoring it in future researches. It is recommended that future researchers, in order to ensure patient safety and monitor the quality of healthcare and patient-centered services, analyze non-compliance in mandatory, basic, and advanced standards of patient safety-friendly hospitals using PSFHI checklist of the World Health Organization through the process of observation, interview, and review of documents in the Imam Khomeini Hospital complex.

Background & Aims: One of the most common diseases during old age is cardiovascular disease. Heart failure is the leading cause of death, disease, hospitalization, and poor quality of life. There are different approaches for controlling heart failure, including self-care, and adherence to self-care behaviors in patients suffering from this disease is very important. People with effective self-care have a better quality of life, and mortality and readmission rates are lower among these people than those with poor self-care. Medication adherence, diet adherence, rest, improving sleep quality and life quality, knowing how to control emotions, and self-care could help control the complications and problems associated with this disease. Meanwhile, knowing how to perform self-care is very important. Despite the importance of self-care in positive health outcomes, many patients with heart failure have inadequate self-care behaviors. Considering the role of nurses in health promotion and instruction of self-care behaviors, they can plan interventions to promote the patients' self-care behaviors and consequently the quality of life in patients diagnosed with heart failure. The present study aimed to determine selfcare status in older adults diagnosed with heart failure. Materials & Methods: This article reports part of the results of a larger cross-sectional study. The study population consisted of the elderly with heart failure hospitalized in the cardiovascular intensive care units of East Guilan public hospitals in 2020. A sample of 125 patients was selected from the population via convenience sampling. The sample of the study met the inclusion and exclusion criteria. Inclusion criteria were: age 60 years and older, heart failure based on clinical signs, electrocardiography (ECG) and echocardiography showing an ejection fraction of less than 40%, functional class II to IV based on the patient medical file and the approval of a cardiologist, the ability to communicate, and informed consent to participate in the study. Patients with severe mental or cognitive impairments, history of neurological problems, cerebrovascular accidents, transient ischemic attack, short-term memory impairment or dementia, mental instability (according to medical records), inability to speak, auditory and visual impairments, and Charlson comorbidity index of 1-2 were not included in the study, and the exclusion criteria included incomplete completion of the questionnaire and unwillingness to continue collaborating in the study. The research instruments included demographic characteristics questionnaire and the self-care of heart failure index (SCHFI) questionnaire. Cronbach’ s alpha was used to check the reliability of the SCHFI in the present study which was 0. 82. Sampling lasted from late May to December 2020. Having obtained permission from the ethics committee of Guilan University of Medical Sciences and relevant officials, the researcher referred to the mentioned medical centers, selected the research units, introduced himself, provided sufficient explanations about the purpose of the research, obtained their written consent, and distributed the questionnaires to be completed during the interview. Data were analyzed using descriptive statistics (frequency, mean, and standard deviation) in SPSS 16. Results: The analysis of the questionnaires revealed that most patients (55. 2%) were male, aged 75-90 (54. 4%), married (57. 6%), with average monthly income (60%), and illiterate (72%). The findings showed that the patients of the study obtained 67. 16 ± 10. 96 for self-care items, 28. 94 ± 4. 39 for self-care maintenance, 17. 98 ± 3. 96 for self-care management, and 20. 49 ± 4. 05 for self-care confidence. The scores of most participants were satisfactory in terms of total self-care (75. 2%) and its subscales including self-care maintenance (59. 2%), self-care management (69. 6%), and self-care confidence (82. 4%). The optimal self-care status was considered satisfactory in terms of adherence to self-care behaviors, self-care management, and self-care maintenance, respectively. The optimal self-care status belonged to self-care confidence, self-care management, and self-care maintenance, respectively. Regarding the items on the self-care maintenance subscale, the best self-care behaviors were selfprotection measures to prevent illnesses, a low-salt diet, and regular visits to a physician or a health center to assess heart condition, respectively, and the most inappropriate self-care behaviors were related to exercise and daily weight. Conclusion: The findings showed that the self-care status of patients with heart failure is generally satisfactory. Despite the study findings, it is essential to pay more attention to nursing care and treatments that promote selfcare behaviors in older adults especially in self-care behaviors related to exercise and daily weighing. It is suggested that hospitals offer educational classes to improve the knowledge, attitude, and self-care practices in patients with heart failure.

Background & Aims: The emergency department is one of the most important wards in a hospital, and its functions can have a great impact on the activities of other wards. In the emergency department, 24-hour emergency services are provided to patients, and there is a large number of patients in this ward, which shows the importance of good performance and effective communication of nurses to maintain patient safety and provide quality care. Effective communication is one of the pillars of nursing and having communication skills is a professional necessity required for all nurses especially those who work in the emergency wards to provide safe and quality care. Nurses’ competent performances in the emergency wards are also affected by their selfefficacy. Thus, this study was conducted to determine the communication s and self-efficacy competency of nurses. Materials & Methods: This descriptive cross-sectional study was carried out in the emergency wards of hospitals affiliated to Iran University of Medical Sciences in 2020. In this study, 234 nurses were selected through census method and based on the inclusion criteria and were evaluated using Communication Competence and Self-Efficacy Scales. The Communication Competence Scale consisted of 35 questions on a five-point Likert scale, ranging from strongly agree (5) to strongly disagree (1). The overall score of the communication competence scale was 35-175, with the higher scores indicating high communicative competence. The Communication Self-Efficacy Scale consisted of 12 items on a 10-point scale ranging from not at all sure (1) to very clear (10). The overall scores of the communication self-efficacy scale were 12-120, with high values indicating higher communication self-efficacy. Data were analyzed using independent t-test, one-way ANOVA, Pearson's correlation-coefficient, and linear regression in SPSS version 16. Results: In total, 234 nurses working in emergency departments participated in this study. The response rate of the participants was 100%. According to the results, the mean score of the nurses’ communication competency was 141. 03 ± 15. 09, which was higher than the average value (108). The highest average communication competencies related to "let others know that you understand them", "listen to what people say" and "support others" were 4. 15 ± 0. 70, 4. 15 ± 57, and 4. 15 ± 0. 68. The lowest mean belonged to the item "you do not pay attention to meeting and talking with strangers" (2. 32 ± 1. 28). The mean score of emergency nurses’ communication self-efficacy was 86. 24 ± 22. 00 that was slightly higher than the average point (66). The highest average communication self-efficacy was related to "Have appropriate nonverbal behaviors (such as eye contact, facial expressions, and gestures) during conversation (7. 84 ± 2. 15). And the lowest average belonged to the item "Have a plan prepared in advance to talk to the patients. Based on the results of the regression model, 11% of communication competency among emergency nurses were explained by working hours per week (P=0. 001), hospital type (P<0. 001) and education level (P=0. 023), and working hours per week with the standard coefficient of-0. 249 had the most effect on nurses’ communication competencies. Based on the mean and standard deviation, the nurses' communication self-efficacy score was 86. 24 ± 22. 00, which was higher than the average (66). Also, only 12 percent of nurses’ communication self-efficacy was explained by independent variables (demographic variables) (P<0. 001). There was a direct linear relationship between the variables of age (P=0. 035) and nursing experience (P=0. 043) with nurses' communication self-efficacy and there was a statistically significant inverse relationship with working hours per week (P<0. 001). Only working hours per week (P<0. 001) was significant in the regression model (standard coefficient=-0. 37). Conclusion: Although the levels of communication competencies and communication self-efficacies of the nurses in the emergency wards were approximately high, due to their activity and their role in the front line of the organization, higher levels of communication competency and self-efficacy are expected. Effective communication of health workers, especially nurses, is essential in improving the quality of care and maintaining patient safety. Due to their role, nurses should have extensive communication with patients and other health workers, so communication competence is an important principle in providing nursing care. Owing to the structure of the emergency department and the patients visiting this department, it is useful and necessary to find the cause and determine the appropriate solutions to increase the communication competency and selfefficacy of emergency nurses to the highest possible level and thus improve quality and safe care. According to the results of the present study, communication competence decreases by increasing working hours, which can be the result of fatigue and high work pressure after spending long hours in the stressful emergency department. The presence of patients in need of immediate and acute care increases fatigue, thereby leading to the low efficiency of nursing services and endangers the safety of patients. It is necessary to plan for employing experienced nurses as well as those with higher and specialized education in the emergency department. However, it will not diminish the importance of increasing the workforce in the emergency departments and reducing the workload of nurses in order to improve the quality of services and improve patient safety. Communication self-efficacy of nurses working in the emergency department was relatively high in this study. The highest communication self-efficacy of the studied nurses was related to having appropriate non-verbal behaviors during the conversation and the lowest communication self-efficacy of the nurses was related to planning to talk to the patients. Self-efficacy is considered an important indicator of a person's confidence in performance, including job performance. A strong sense of self-efficacy increases nurses' confidence in their performance and knowledge. Nurses who are confident in their abilities in all areas, including effective communication, define their goals and are committed to maintaining them.

Background & Aims: Cancer is a chronic disease that has been increasingly considered by researchers, and breast cancer is one of the most common cancer types in the world, accounting for 50% of deaths. In Iran, breast cancer (22 per 100, 000) is the most common cancer among women. In addition, breast cancer affects Iranian women about a decade earlier than in western countries. Cancer-related crisis causes imbalance and disharmony in the thoughts, body, and soul, but the most common condition for the patient is alexithymia during this period. Emotions are a set of schemas based on information processing and include symbolic and non-symbolic processes and visualizations. One of the most important factors to consider in patients with breast cancer is psychological helplessness. Various studies show that people with specific diseases have lower mental health. Many of them suffer from anxiety, anger, sadness, social isolation, and depression, which together cause the person to become psychologically helpless. Another psychological variable that is associated with or can affect cancer is fault tolerance. Failure occurs when a person fails to achieve the desired goal. Failure is generally understood as a state of inhibition in satisfying the motive or interference in goal response or in the mediating action that leads to that goal. Fault tolerance refers to a person's ability to show resilience in the face of repeated failure and a hostile environment. Failure to find local and foreign researches on women with breast cancer makes it necessary to research in this area and determine whether psychological helplessness and fault tolerance can be predicted based on alexithymia in women with breast cancer. Materials & Methods: This cross-sectional predictive correlational study was performed on 230 women with breast cancer who were referred to the specialized surgery and cancer clinic of Dr. Mousavi Hospital in Gorgan and the comprehensive cancer center of Imam Khomeini Hospital in Sari in 2018. The instruments used to collect data included the demographic questionnaire, the Toronto Emotional Dysfunction Questionnaire, the Psychological Helplessness Questionnaire, and the Fault Tolerance Questionnaire. The data were then analyzed using Pearson correlation coefficient and stepwise regression in SPSS version 16. The confidence level was considered at P<0. 01. Results: Regarding the alexithymia variable, 3. 25% of the patients had difficulty identifying emotions and regarding the psychological helplessness variable, 7. 78% of the patients had symptoms of high anxiety, and regarding fault intolerance variable, 6. 17% of the patients had symptoms of intolerance of injustice. There was a direct relationship between the variables of alexithymia and the subscales of depression (P<0. 003), anxiety (P<0. 002), stress (P<0. 001), and psychological helplessness (P<0. 000). It can also be said that there was a direct relationship between alexithymia and subscales of intolerance of emotional failure (P<0. 001), sadness intolerance (P<0. 001), intolerance of failure (P<0. 005), and intolerance of injustice (P<0. 002). Alexithymia was also able to predict psychological helplessness (P<0. 000), and fault tolerance (P<0. 001). Conclusion: The overall result of the study showed a significant direct correlation between alexithymia, psychological helplessness, and fault intolerance, in a way that an increase in alexithymia score increased depression, anxiety, and stress of women with breast cancer, and alexithymia was directly correlated with fault intolerance, meaning that with increasing alexithymia score in women with breast cancer, the ability to tolerate discomfort, injustice, and lack of progress decreased in these women. According to these results, it is necessary to teach emotion regulation strategies along with using other treatment methods to reduce stress, depression, and anxiety and increase resilience and fault tolerance of women with breast cancer.