Iran Journal of Nursing
Year:2020 | Volume:33 | Issue:126|Papers Count:8

Background & Aims: The prevalence of multiple sclerosis (MS) has been on the rise, especially among the youth in Iran. MS is more common in the individuals in their 20s and 40s, while women are also twice as likely to develop MS compared to men. Statistics suggest that there are 2. 5 million MS patients worldwide, and this figure has been reported to be 15-30 cases per 100, 000 in Iran. According to the Iranian MS Association, approximately 50, 000 Iranians have MS, including 9, 000 registered cases, and the rate is constantly increasing. Some of the main symptoms of MS are neurological, sensory, motor, and balance disorders, and fatigue is considered to be the most debilitating and common symptom; about one-third of MS patients report fatigue within the first three years of the disease diagnosis. Fatigue is an early symptom in 40% of MS patients, and 38% experience fatigue as the first diagnostic symptom. Extensive research has assessed the correlations between MS and various demographic variables, including individual factors (age, gender, education level), familial factors (family history of the disease), social factors (support of social institutions), economic factors (monthly income), emotional factors (family support), and disease-related factors (age at onset, length of hospital stay, medication). The present study aimed to measure fatigue in a large population of MS patients and determine its association with demographic variables. Materials & Methods: This correlational study was conducted on 296 MS patients referring to the Iranian MS Association in Tehran, Iran during June-August 2019 via computation within a specific period. Fatigue was measured using Krupp fatigue intensity (1989), which has been used in extensive medical research. The minimum and maximum possible scores in this scale are nine and 63, respectively. Scores 9-18 indicate low fatigue, scores 18-45 indicate moderate fatigue, and scores above 45 show high fatigue. In Iran, Shahvaroughi Farahani et al. (2009) have measured the internal consistency of the items in this scale, which has been confirmed at the Cronbach's alpha coefficient of 0. 96, showing that the items of this questionnaire measure a concept. In addition, the intraclass correlation-coefficient test has been applied to evaluate the relative reproducibility of the Persian version of the questionnaire, with the value reported to be 0. 93. The inclusion criteria of our study were the ability to communicate, basic literacy, dealing with MS for a minimum of one year, and not being in the acute stage of the disease. Participation was completely voluntary and free. The patients were assured of confidentiality terms regarding their personal information, which was only disclosed to the research team and used for scientific purposes. Data of the patients were collected anonymously, and a code was assigned to each questionnaire to prevent the disclosure of information. Data analysis was performed in SPSS version 16 using independent t-test, ANOVA, Pearson's and Spearman's correlation-coefficient, D'Agostino-Pearson omnibus test, a correlation matrix, and Wilcoxon matched-pairs signed ranks test. Results: In total, 296 MS patients were enrolled in the study with the mean age of 37. 15 ± 8. 85 years and mean disease duration of 29. 95 ± 22. 06 years. Regarding the treatment costs, 18 patients reported low treatment costs, 74 cases reported moderate costs, while 102 and 63 patients reported high and extremely high treatment costs, respectively. Notably, the variable of medical expenses was correlated with the type of patient insurance (P=0. 009), and the patients with armed forces insurance paid the least expenses for their treatment. The mean exercise duration of the MS patients was 4. 34 ± 2. 91 hours per week, and the mean total fatigue score was 39. 18 ± 14. 56. According to the obtained results, 31 patients (10. 5%) had low fatigue, 157 patients (53. 3%) had moderate fatigue, and 108 patients (36. 2%) had high fatigue. A significant association was also observed between the involved organs of the patients and fatigue (P=0. 004), so that fatigue was higher in the patients whose four limbs were affected by MS and those with visual impairment in addition to the four affected limbs. In the general classification of disorders in the MS patients (sensory, motor, and sensorimotor disorders), motor disorders were most prevalent (41. 89%), followed by sensorimotor disorders (41. 71%) and sensory disturbance (35. 66%). Furthermore, a significant correlation was observed between the number of hospitalizations due to MS and fatigue (P=0. 001), so that with the increased number of hospitalizations, the patients expressed more fatigue. On average, our participants had three hospitalizations, and a significant association was denoted between marital status and fatigue (P=0. 042). Compared to the single patients, fatigue was more common among the married, divorced, and widowed patients. In addition, monthly income was significantly associated with fatigue (P=0. 001), and the patients with inadequate income expressed more fatigue. Exercise was also significantly correlated with fatigue (P=0. 018), and less fatigue was observed in the patients who had physical exercise. Conclusion: Considering that fatigue is a common symptom in MS patients, special attention should be paid to the influential factors to identify, eliminate or reduce the factors that are changeable. According to the results, fatigue is one of the most debilitating and common symptoms experienced by MS patients. Therefore, these patients, their families, and the treatment team (especially nurses) must recognize the influential factors in fatigue in order to increase patient awareness and reduce fatigue in these patients. We attempted to identify and report some of the influential factors in fatigue, such as individual and psychological, environmental, and disease-related factors, in the MS patients. It is recommended that proper measures be taken to reduce the debilitative factors and strengthen the factors that reduce fatigue. Moreover, healthcare officials should plan to increase income and create suitable job opportunities for MS patients who experience the limitations caused by the disease. The family members of these patients (especially spouses) could also provide great support, which plays a key role in adapting to the disease, taking measures to reduce fatigue, adherence to the treatment regimen, and reducing the number of hospitalizations in MS patients.

Background & Aims: Spiritual health is an important aspect of health, which shows the good relationship of an individual with God and a sense of harmony between himself, God, and life. Nursing profession is associated with numerous stressful encounters in the workplace, such as death and illness. Nurses, nursing faculties, and students are the three main groups in this profession who could largely benefit from spirituality in personal, professional, and organizational dimensions. One of the main benefits of spiritual health in the nursing profession is the improvement of mental health and quality of care. The present study aimed to determine the status of spiritual health in the nurses, nursing faculties, and nursing students of Jahrom University of Medical Sciences, Iran. Materials & Methods: This descriptive study was conducted on 455 participants (268 nurses, 31 lecturers, and 156 nursing students) at Jahrom University of Medical Sciences in 2018. The participants were selected via census sampling. Data were collected using a comprehensive questionnaire to measure spiritual health in the Iranian population and a demographic questionnaire. The questionnaire consisted of 48 items and two cognitive/emotional (insight/orientation) and behavioral (performance) components. The total score of the questionnaire was 100. The questionnaire was provided to the subjects by two research assistants and completed in a self-report manner after obtaining informed consent. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, frequency percentage, mean, and standard deviation) and analytical statistics (independent t-test, oneway ANOVA, and Scheffe post-hoc test). Results: The mean age of the participants was 27. 19 ± 6. 68 years. The mean score of spiritual health was estimated at 79. 89 ± 11. 87, and achieving approximately 80% of the total score indicated the favorable spiritual health of the participants. In addition, the mean scores of the cognitive/emotional and behavioral components of spiritual health were 82. 28 ± 11. 93 and 75. 45 ± 11. 99, respectively. The mean score of spiritual health was 84. 58 ± 9. 58 in the nurses, 86. 67 ± 11. 15 in the nursing faculties, and 68. 44 ± 14. 55 in the nursing students. A significant correlation was observed between age and spiritual health (r=0. 362). The mean score of spiritual health was significantly higher in women compared to men (P=0. 001). The spiritual health of the participants with the work experience of more than five years had no significant difference with those with less work experience (P=0. 507). Moreover, years of teaching had no effect on the spiritual health of the faculty members (P=0. 57). Participation in spirituality courses also had no significant effect on the score of spiritual health (P=0. 658). First-year students had higher a spiritual health level compared to the senior students (P=0. 007). Conclusion: In this study, the participants achieved nearly 80% of the total score, which indicated their favorable spiritual health status. It seems that the religious nature of the Iranian culture and the tendency to preserve spiritual values have been effective in achieving these results. The nurses in our study attained 84% of the spiritual health score. Since Islam is the main religion of the Iranian community, religious beliefs are an integral part of people's lives, and attention to the spiritual issues of patients is inevitable. This makes nurses more sensitive to the concept of spirituality, and they managed to achieve spiritual health as a result. According to the results, the nursing faculties also achieved 84% of the total score, which indicated that they are acceptable role models to their students and have great spiritual capacity to teach spiritual concepts. Meanwhile, the nursing students achieved approximately 70% of the spiritual health total score. Nursing students enjoy respecting, helping, giving hope, and supporting other, and such actions enhance their spiritually. Given the importance of spiritual health in nurses in personal, professional, and organizational dimensions, maintaining and promoting these values are of utmost importance. Therefore, the recognition of the factors with constructive or destructive effects on the spiritual health of nurses should be considered by authorities. Considering the favorable spiritual health of nurses and nursing faculties and their close interactions with nursing students, it is recommended that the spiritual capacity of nurses and nursing faculties be exploited through proper planning and teaching of spiritual concepts to nursing students. Furthermore, the integration of the concepts associated with spirituality in the nursing curriculum and providing executive guarantees for the teaching of these concepts by authorities are highly recommended. Efficient training courses should also be planned and implemented in the form of in-service training in order to promote the spiritual health of nurses and nursing faculties.

Background & Aims: Recently, special attention has been paid to physical and mental health and its predictors among the researchers of psychology. Health is a multidimensional concept, and its dimensions affect each other and the health of the individual and community. Health is essential to the fulfillment of social roles, and humans should be fully active if they feel healthy and are considered healthy by the society. The nursing profession plays a pivotal role in the provision of healthcare services in every country. Therefore, the physical and mental health of nurses and improving their professional performance in patient care are of utmost importance. Identifying and determining the influential factors in the physical and mental health of nurses is crucial in this regard. The present study aimed to provide a model of prosperity and optimism to better understand the physical and mental health of nursing students. The importance of the research subject is that health is not only defined as the absence of diseases and encompasses physical, mental, and social welfare as well. However, this comprehensive definition is rather ideal and unattainable, and it may not be easy to distinguish between health and disease as such. By this definition, health should be considered a high peak that can never be conquered, while everyone must strive to achieve it. Researchers believe that health and disease are not an absolute and independent state, but rather a process in which the influence of cultural, social, and psychological factors is highlighted in the development of the disease. Considering the valuable role of positivity, studies on the influential factors in mental and physical health are of particular importance. In this regard, the variables of prosperity, positive emotions, and optimism have been shown to affect physical and mental health. The present study aimed to provide a model for the assessment of physical and mental health using flourishing mediated by positive emotions and optimism. Materials & Methods: This analytical-correlational study was conducted on the nursing students of Hazrat Fatemeh School of Nursing and Midwifery in Shiraz, Iran in 2019, including 300 subjects (243 females and 57 males). The participants were selected via stratified random sampling and using a questionnaire. Data were collected using SF-36, HFQ, and revised life orientation test (LOT-R). Data analysis was performed in SPSS version 16 and AMOS version 22 software. Results: The findings showed that the flourishing subscales of positive emotions, relationships, and optimism directly affected the physical and mental health of the students. In addition, the variables of positive emotions and relationships in the final model directly and indirectly caused changes in physical health through the variable of optimism, and the subscale of progress in the final model only had an indirect impact through the variable of optimism. On the other hand, the subscale of meaning had no effect on the physical or mental health of the students. Conclusion: With regard to the correlation of optimism and physical/mental health, our findings indicated individuals with high optimism are often active, creative, and hardworking, while they are also good initiators and planners. Furthermore, these individuals are able to make the best of stressful situations, which in turn makes them less exposed to the further risks and pressure caused by stressful events. The immune system performs better in the individuals with high optimism, and they have better coping abilities against stress by using more effective coping strategies, such as reassessment and problem-solving. Therefore, it is expected that training on flourishing and increasing optimism through positive psychology techniques could be an effective mechanism to correct false beliefs and prevent psychosomatic and psychological disorders in nursing students. Furthermore, the effects of such training interventions could be intensified with the incorporation of interventional programs in the field of student empowerment against stress.

Background & Aim: COVID-19, as an emerging infectious disease, affects the whole world. The causative agent for the disease is coronavirus acute respiratory syndrome 2 (SARS-CoV-2) and typical symptoms of the disease include fever, cough, and shortness of breath. Also, muscle pain, sputum production, sore throat, lack of taste and red eyes are among the less common symptoms. In severe cases, the disease can cause severe respiratory failure and even death. COVID-19 is transmitted from sick people to healthy people through respiratory droplets. Disease spread can be prevented by washing hands and other hygiene measures. The rate of transmission and prevalence for the disease is higher than other infectious diseases, however, the main point in controlling the disease is the knowledge and attitude of the community towards Corona disease, which can play a key role in controlling the disease and reduce the increasing trend. It is very important to pay attention to the attitude and awareness of people involved in patient care. According to the literature review, no study has been conducted on the knowledge and attitude for medical students towards COVID-19, therefore, the current research was conducted to determine the attitude and knowledge of medical students across the country about COVID-19. Materail & Methods: The study was performed as descriptive cross-sectional. Data were collected through a virtual self-administered questionnaire. 420 medical students in the country participated in this study by voluntary sampling from April 20 to May 6, 2016. The final data was obtained by removing 10% of the questionnaires due to incomplete filling of 381 samples. A researcher-made questionnaire was used to collect information. The questionnaire included three sections: demographic characteristics, attitude and knowledge about COVID-19. The first part of the questionnaire contained questions related to demographic characteristics including age, gender, degree, field of study, semester, type of residence and university. The second part, consisting of 16 phrases, was set to determine how students' attitudes toward COVID-19 disease’ is based on the Likert scale of five options "totally disagree, disagree, have no opinion, agree, strongly agree" and were considered for each phrase a score of 1 to 5. The awareness section consisted of 4 dimensions (nature of disease, disease transmission, care and prevention, diagnosis and treatment) in the form of three options "yes and no and I do not know" that 1 positive score was applied for each correct answer. Content and face validity were used to determine the validity of the questionnaire. The opinion of 7 faculty members in the university about the questionnaire was obtained and their corrective opinions were applied in the questionnaire. The reliability of the attitude questionnaire with Cronbach's alpha coefficient was 0. 85 and the reliability of the knowledge questionnaire with Kuder Richardson coefficient was 0. 86. Data analysis was performed by one-way ANOVA, Pearson correlation coefficient and independent t-test with SPSS software version 16. Also, the significance level in the research was considered 0. 05. Participants had full authority to complete the virtual questionnaire and data were collected anonymously. Results: Out of 381 samples, 252 (66. 1%) were female students. The age range of students was 16 to 37 years and 51. 1% of them belonged to the age group of 21-25 years. 18 people (4. 7%) in associate degree, 222 people (58. 3%) in bachelor degree, 8 people (2. 1%) in master degree and 133 people (34. 9%) were studying in professional doctoral degree. 271 students (71. 1%) were students of 1-4 semesters and 93 students (24. 4%) of them were studying in 5-8 semesters. 112 students (29. 4%) were studying in medicine, 129 (33. 9%) were studying in nursing and 115 (30. 2%) were studying in paramedical fields. Also, 57. 5% of the students were natives and 96. 9% of the students had no work experience in the corona sector and 83. 5% of the students did not participate in the virtual courses of the Ministry of Health and the World Health Organization related to the corona virus. The mean and standard deviation for students' attitudes toward COVID-19 were generally 58. 75± 5. 56 and their knowledge was 41. 61 ± 6. 27. The results showed that there was no significant relationship between attitude and demographic characteristics. Besides, there was a significant relationship between students' knowledge score and age (p <0. 001), gender (p = 0. 002), degree (p <0. 001), field of study (p <0. 001) and semester under study (p <0. 001). However, there was no significant relationship between students' knowledge score, type of student residence, work experience in the coronary department and history of participating in virtual courses related to coronavirus. Conclusion: According to the results of the current study, students of medical universities have an acceptable knowledge and attitude towards the disease. Despite the favorable scores in students' knowledge and attitudes, our knowledge about COVID-19 is increasing every day. On the other hand, students should have a higher awareness and attitude rather than other students due to their presence in hospitals to minimize the possibility of transmitting the disease to themselves and other people in the community. Therefore, it is necessary for the educational authorities of medical universities to design and implement programs to increase awareness and improve students' attitudes toward COVID-19.

Background & Aims: Endometriosis is a common disorder associated with an increased risk of cancers, especially ovarian cancer. One of the most prevalent symptoms of this disease is pelvic pain, which is the major complaint among patients during menstruation. While the pathophysiology of endometriosis and the mechanisms responsible for its complications, namely pelvic pain and infertility, are not yet well understood, it seems that oxidative stress plays an undeniable role in the pathogenesis of endometriosis. In other words, the production of large amounts of inflammatory mediators by endometriosis tissue can explain and be responsible for the onset and exacerbation of pelvic pain. There is an apparent imbalance between oxygen free radicals and antioxidants in the endometrial tissue of diagnosed women. In addition, decreased total antioxidant capacity is observed in the peritoneal fluid in women with endometriosis, which is indicative of inadequate antioxidant status. Even though a significant relationship has been reported between symptoms of pelvic pain and indicators of peritoneal oxidative stress in women with endometriosis in some studies, there are still conflicting theories about the relationship between serum biomarkers of oxidative stress and endometriosis. With this background in mind, the present study aimed to determine the relationship between serum levels of oxidative stress biomarkers and dysmenorrhea, dyspareunia, and pelvic pain in women with endometriosis who referred to Sarem Fertility & Infertility Research Center in Tehran, Iran in 2017. Materials & Methods: This was a descriptive, correlational and cross-sectional study performed on 60 women aged 15-49 years with symptoms of endometriosis. The inclusion criteria were diagnosis of endometriosis based on clinical symptoms and laparoscopy, no current pelvic inflammation disease and adenomyosis, no smoking, or alcohol and drug consumption, no chronic underlying diseases, and no psychological diseases (data were obtained through self-report). Subjects were selected by convenience sampling, and written informed consent was obtained from the participants prior to the study. Data were collected using a demographic characteristics questionnaire, fertility profile questionnaire, endometriosis symptoms checklist, research laboratory information record sheet, and visual analogue scale (VAS) for measuring pain. Following filling out the scales and questionnaires, 10 ccs of the blood sample were taken from each of the volunteers under sterile conditions in citrate tubes and stored after centrifugation at-20° C. Afterwards, blood samples were analyzed, and data analysis was carried out in SPSS version 16 using Pearson’ s correlation coefficient. In addition, a P-value of below 0. 05 was considered statistically significant. Results: The mean age of the participants was 33. 16 ± 5. 41 years and the mean age of their spouses was 35. 96 ± 8. 62. Moreover, the subjects had a body mass index (BMI) of 25. 92 ± 5. 94 kg/m2, and most of them were housewives (68. 3%) and had an academic degree (51. 7%). Based on VAS score range of 0-100, the mean score of dysmenorrhea in the subjects was reported to be 50. 76 ± 32. 90, whereas their mean scores of dyspareunia and pelvic pain were 23. 70 ± 25. 20 and 21. 05 ± 23. 49, respectively. Furthermore, most of the participants in the study had no history of previous delivery (83. 3%) and abortion (75%). Moreover, dysmenorrhea (96. 7%), dyspareunia (66. 6%) and chronic pelvic pain (73. 3%) were reported in most participants. The results of this study showed that women participating in this study had ROS values of 5. 77 ± 0. 57 micromoles, TAC of 0. 35 ± 0. 12 micromoles and MDA of 38. 06 ± 24. 9 micromoles. According to the results, there was a significant relationship between the level of pelvic pain, dysmenorrhea and dyspareunia. Conclusion: In this study, the majority of the participants suffered from pelvic pain, dysmenorrhea and dyspareunia, which was not unexpected due to the fact that endometriosis is the main factor for these conditions. The high prevalence of these pains has been reported in other studies as well. There is a theory that very small recurrent bleeding in endometriosis lesions and subsequent inflammation may be responsible for menstrual cramps. On the other hand, stretching of the uterosacral ligament, which contains endometriosis tissue, during intercourse, as well as the proximity of nerve fibers to abnormal endometrial tissue, may explain the dyspareunia created in these women. Immune system dysfunction due to endometriosis lesions can be another cause of pelvic pain (e. g., endometriosis), which ultimately leads to neuropathic pains. These patients have also reported pelvic pain caused by tissue degradation induced by immune processes. According to the results, there was no relationship between the severity of dysmenorrhea, dyspareunia, and chronic pelvic pain with the number of reactive oxygen species and the total antioxidant capacity of malondialdehyde in the participants. In a research, Amreen et al. mentioned a significant association between glutathione peroxide levels and dysmenorrhea in women with endometriosis. However, oxidative stress was only slightly exacerbated in the subjects. Moreover, the decrease of antioxidants was insignificant in women with endometriosis and chronic pelvic pain, and even the increase in the concentration of lipid peroxides, which occurs in peritoneal fluid, is not observed in the blood. The results were indicative of no significant relationship between chronic leg pain and dyspareunia with levels of oxidative stress biomarkers. It is generally believed that an increase in oxidative stress of those with dysmenorrhea depends on oxygen-free radicals. However, no studies have clearly mentioned the existence and relationship of oxygen-free radical balance and antioxidant systems with dysmenorrhea. Nonetheless, further studies are required to investigate this issue. It is recommended that oxidative stress biomarkers in peritoneal fluid in women with endometriosis be evaluated in future studies.

Background & Aims: Infertility is an important life crisis that leads to psychological complications and severely stressful experiences. Infertility stress disrupts marital adjustment, and the subsequent incompatibility increases over time. In this regard, numerous factors may affect couples' relationship, and forgiveness between couples has been suggested as a major influential factor in family strength. Forgiveness could a potent mechanism to end a broken relationship or help resolve conflicts between couples and provide the conditions for reconciliation, thereby increasing couples' satisfaction with each other. Couples' forgiveness is a process that allows gaining a greater understanding of themselves, each other, and their relationships in order to become free of the dominance of negative thoughts, feelings, and behaviors after experiencing an unpleasant interpersonal event. To date, no studies have investigated the influential factors in forgiveness, and no interventional research has been focused on forgiveness in infertile couples in Iran. Prior to forgiveness-based interventions, it is essential to evaluate the dimensions and influential factors in different research communities, so that the design and formulation of support programs for infertile couples would be based on the related variables to achieve the desired outcomes. The present study aimed to assess the dimensions of forgiveness and its influential factors in infertile couples. Materials & Methods: This cross-sectional study was performed on 200 infertile couples referring to Omid Royan Infertility Center in Arak, Iran; the cause of infertility was of the female origin. The subjects were selected via continuous sampling during December 2018-September 2019. The inclusion criteria were Iranian nationality, age of 18-49 years, literacy, no drugs abuse, no use of medications for mental disorders, no psychiatric disorders (self-report of subjects), no adopted children, first marriage in both couples, and a minimum of one year since the diagnosis of infertility. Data were collected using demographic and infertility questionnaire and family forgiveness scale (FFS). Face and content validity was used to assess the validity of the demographic and infertility questionnaire. FFS was designed and developed by Pollard et al. in 1998 to measure forgiveness in families and couples, as well as the dimensions of forgiveness. The questionnaire consists of 40 items and two sections. The first 20 items are focused on the family of origin, and the second 20 items are focused on primal relationship (nuclear family). Since the infertile couples in our study were childless, only the second section of the questionnaire (primal relationship) was used, which has five subscales of realization, recognition, reparation, restitution, and resolution. Each subscale has four items, which are scored based on a four-point Likert scale (Never True=1, Almost Always True=4). Notably, the 10-point scoring of this questionnaire is inverse. The scores of each subscale are within the range of 4-16, and the score range of the entire scale is 20-80, with the higher scores indicating more forgiveness. Pollard et al. obtained the Cronbach's alpha coefficient for the subscales of the questionnaire, which are calculated to be within the range of 0. 55-0. 86. FFS has been psychometrically measured for the Iranian population by Seif and Bahari (2003). In a study on a sample of 766 married couples in Tehran (Iran), the reliability of the second section of the scale (primal relationship) was reported to be 85% based on Cronbach's alpha. Data analysis was performed in SPSS version 16 using independent t-test, Mann-Whitney U test, one-way ANOVA, Kruskal-Wallis test, and Pearson's correlation-coefficient, and the P-value of less than 0. 05 was considered as significant. Results: The mean forgiveness score of men and women was 64. 38 ± 4. 89 and 64. 14± 6. 16, respectively. The highest mean score in the dimensions of forgiveness in both women and men was achieved the dimension of resolution (14. 10 ± 1. 84 and 13. 94 ± 2. 18, respectively), while the lowest mean score was in the dimension of recognition in women and men (10. 80 ± 1. 75 and 10. 58 ± 1. 34, respectively). A significant positive correlation was observed between the forgiveness of infertile women and the forgiveness of their spouses (r=0. 44; P<0. 001). Among the studied variables, the forgiveness of infertile women was correlated with the variables of male and female education level, female occupation status, residential status, and type of marriage. On the other hand, spousal forgiveness was only correlated with male education level, male occupation status, and the number of failed pregnancies. Conclusion: According to the results, the mean forgiveness scores of men and women had no significant difference. The highest mean score in both women and men was achieved in the dimension of recovery, while the lowest mean score belonged to the acknowledgment of error. Increased forgiveness in one of the spouses was accompanied by enhanced forgiveness on behalf of the other spouse. Among the studied variables, forgiveness in infertile women was correlated with the variables of male and female education level, female occupation status, residential status, and type of marriage, while the forgiveness of men was only correlated with male education level and occupation status and the number of failed pregnancies. Attention must be paid to the influential factors in forgiveness in the development and formulation of counseling or educational programs based on forgiveness, along with other methods of psychological support for infertile couples in order to improve marital relations and couples' adaptation to the issues and stresses caused by infertility and its treatment.

Background & Aims: Professionalism is the underlying factor in strengthening the social contract between professions and the society. Failure to adhere to this principle in healthcare providers (including nurses) reduces the quality of patient care and endangers community health, while also diminishing public trust and weakening the social image of healthcare professions. In recent decades, researchers of health science education have focused on the nature of professionalism and planning for training in this regard in order to achieve this important outcome in health science graduates. Despite the applications of the study results and the efforts to train students on the basic concepts of professional ethics, the expected outcomes have not yet been realized in terms of the performance of graduates. Today, numerous researchers believe that achieving professionalism is not possible merely through education and the evaluation of its principles, and the required competencies should also be cultivated to facilitate the process of professional socialization, so that a proper professional identity could be attained in medical science graduates. However, further studies should be focused on the top of Miller's pyramid (Does) pertains to the process of developing competencies and their components and has reached the stages of developing a competency-based curriculum, along with the formation of a professional identity, which is equivalent to the "Is" part added to the Miller's model by Cruess et al. (2016). In a study in this regard, the concept of professional socialization was analyzed, and professional identity was introduced as the main outcome of this process. The present study aimed to critically review the current literature regarding socialization and the development of professional identity in health science students. Materials & Methods: This critical review was conducted based on the Carnwell and Daly structure, which consists of six steps, including determining the objectives of the critical literature review, defining the scope of the review, identifying the sources of relevant information, literature review, writing the review, and applying the literature to the proposed study. At the stage of review writing, we followed the three steps proposed by Schutz. Initially, a systematic search was performed to obtain the available conceptual models and frameworks of socialization and professional identity formation in primary scientific databases, such as EBSCO CINAHL, Web of Science, Eric, PubMed, Scopus, and Google Scholar, using relevant keywords with "OR" and "AND" to combine the main concepts. The article search had no time limit until 2019. The eligibility criteria for article selection were proposing a model/conceptual framework, medical sciences, free access, and publication in English language. The exclusion criteria were duplicates and the experimental studies aimed at the measurement, comparison or production of tools. In the second phase of the search and to obtain citations and criticisms for each selected conceptual model/framework, the key concepts of each was systematically searched in the aforementioned databases using "AND" in combination with concepts such as "Criticism, Problems, Challenges, Advantages, Disadvantages". To ensure access to all the possibly relevant reviews, all the citations to each model were tracked through Google Scholar. Results: In total, 2, 112 articles were retrieved in the first stage of the search in terms of the title, followed by the abstract. After reviewing the full texts of the selected articles, nine articles were selected based on the research criteria in the fields of nursing, social work, medicine, paramedicine, and student affairs. These articles were categorized in terms of the study design, model type, model focus, and outcomes. Following that, the selected models were examined chronologically based on the three steps proposed by Schutz, which are the description of the model by its providers, providing the viewpoints of their critics/promoters (if any), and presenting the critical views of the authors of the article. After the analysis of the elements and content/structure of the conceptual models/frameworks, the key concepts of each model were extracted and presented in a table. The studied conceptual models and frameworks consisted of four categories (descriptive, normative-descriptive, causalexplanatory, and descriptive-prescriptive), which described the process of socialization and the role of the influential factors. Some of the findings were mainly focused on the cognitive and psychological dimensions, as well as the social dimension of the process in some cases. In the cases where both the psychological (internal) and social dimensions (external) of the process were considered, a structural approach was not observed regarding the elements and components of each dimension. In addition, the assessment of the content and description of the models revealed various theoretical approaches to this process, some of which were based on a functional structuralism approach and emphasized the role of organizational factors. The other cases involved the cognitive and interactive dimensions and the role of student agencies in this process, as well as the combination of the two approaches. In addition to the role of institutional factors, the active role of students and the impact of interactions were also discussed with regard to the development of professional identity without determining its dimensions and components. The key concepts extracted from the selected models in the present study could be classified into two psychological and social dimensions. The psychological dimension could be classified as cognitive (principles, values, and professional norms), affective (descriptive [sense of belonging to the profession], evaluative [self-confidence], and normative [attitude toward the profession]), and volitive (job motivation). Similarly, the social dimension could be categorized into the communicative domain (effective professional communication), cohesive domain (mutual respect and commitment), and operative domain (professional behavior and effective role performance). Conclusion: Presenting the components of professional identity based on psychological and social dimensions could lay the groundwork for designing a comprehensive, static, structural model of professional identity for medical students, thereby resulting in the development of structured interventions for the management of professional identity formation in further investigations.

Background & Aims: Missed nursing care is a common threat to the safety and quality of patient care, and investigating the influential factors in this regard could prevent or minimize this issue. Missed nursing care could lead to patient readmission and extra costs imposed on patients and healthcare organizations. Supervisor support plays a pivotal role in the commitment of nurses to the organization. The behaviors and activities of health supervisors could promote the positive attitude of the subordinates, thereby leading to their moral commitment. Although missed nursing care is considered to be a highly challenging issue for nursing managers, few studies have evaluated perceived care support and the associated challenges. The present study aimed to investigate the correlation between missing nursing care and perceived supervisory support. Materials & Methods: This descriptive-correlatinal study was conducted on 139 nurses employed in the inpatient wards of Imam Reza Hospital in Urmia, Iran during May-March 2019. The participants were selected via census sampling. Data were collected using a questionnaire, the first section of which consisted of demographic data, the second section was the missed care nursing questionnaire, and the third section included the standard tools for the assessment of perceived supervisory support. The missed care questionnaire was designed and psychoanalyzed by Kalish in 2006, and the items are scored based on a five-point Likert scale (Never=0, Always=4). The scale has four domains of review, interventions and personal care, interventions and primary care, and planning. The family supportive supervisor behaviors (FSSB) perceived support questionnaire consists of 14 items and was designed and psychoanalyzed by Hammer in 2009. The questionnaire items are scored based on a five-point Likert scale, with the higher scores indicating higher parental support. The main dimensions of the FSSB are emotional support, instrumental support, and role models. After obtaining the required permit for sampling, the questionnaire was distributed among the nurses working in different shifts and on different days. With their consent, the contact number of the participants was obtained. The questionnaires were collected from the respondents in the same or the next work shift and with proper coordination. The inclusion criteria were having a bachelor's degree (or higher), informed consent to participate in the research, employment in the hospital as a nurse, and minimum work experience of six months. Data analysis was performed in SPSS version 16 using descriptive statistics (mean and standard deviation), Pearson's correlation-coefficient, independent t-test, and the analysis of variance (ANOVA) at the significance level of P˂ 0. 05. Results: The highest mean scores of perceived supervisory support achieved by the nurses were in the items regarding time allocation to listening to the problems of nurses, listening to the problems of nurses about work difficulties and unemployment, creativity in task assignment to improve teamwork in the ward, ward management to meet the needs of each nurse separately, and welcoming suggestions to facilitate the balance of the professional and routine needs of nurses. The most significant aspects of missed nursing care were helping patients in the toilet within less than five minutes after the patient's request, meal preparation for the patients who are able to eat without help, changing patients' position every two hours, and the oral care (mouthwash use), skin care, and bathing of patients. Pearson's correlation-coefficient indicated a significant, weak, inverse correlation between the total scores of perceived support and missed nursing care (r=-0. 19; P<0. 05). Furthermore, significant, inverse correlations were denoted between perceived support and the subscales of missing nursing care (r=-0. 167; P<0. 05), as well as perceived support and the primary care subscale (r=-134; P<0. 05). However, no significant associations were observed between perceived support, the personal care subscale, and planning (P>0. 05). Conclusion: According to the results, perceived supervisory support was correlated with the dimensions of assessment and interventions and primary care regarding missed nursing care. Nursing managers are advised to pursue and implement the support of clinical nurses as a major hospital policy to prevent the loss of care and improve patient safety. As the first-line managers of the clinical environment, nurses may further contribute to nursing care by adopting supportive strategies, thereby increasing patient satisfaction and reducing the treatment costs imposed on patients and the healthcare organization. Our findings could lay the groundwork for monitoring the supportive role of nursing managers, as well as designing and developing effective support models for nursing managers and nurses to improve the primary indicators of nursing care quality.