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Aim Fatigue and dyspnea are debilitating symptoms in patients with heart failure (HF). The purpose of this study was to evaluate the effects of inspiratory muscle training (IMT) on dyspnea, fatigue and the New York Heart Association (NYHA) functional classification in patients with HF. Methods In this prospective, randomized, controlled trial, 84 patients with HF (NYHA classes II‐III/IV) with a mean age of 56.62 ± 9.56 years were randomly assigned to a 6‐week IMT (n = 42) or a sham IMT (n = 42) program. The IMT was performed at 40% of the maximal inspiratory pressure (MIP) in the IMT group and at 10% in the sham group. The main outcomes were assessed at baseline and after the intervention and included dyspnea severity scale (Modified Medical Research Council [MMRC], Fatigue Severity Scale [FSS] and the NYHA functional classification (based on the presenting symptoms). Results The between‐group analysis showed significant improvements in dyspnea, fatigue and the NYHA functional classification in the IMT group compared to the sham group (P < .05). The within‐group analysis showed significant improvements in dyspnea (from 2.63 ± 0.79 to 1.38 ± 0.66, P < .001), fatigue (from 43.36 ± 8.5 to 28.95 ± 9.11, P < .001) and the NYHA functional classification (from 2.73 ± 0.5 to 2.1 ± 0.6, P = .001) in the IMT group, while fatigue and dyspnea increased significantly in the sham group. Conclusions The 6‐week home‐based IMT was found to be an effective and safe tool for reducing dyspnea and fatigue and improving the NYHA functional classification.

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Aim The aim of the present study was to clarify the relationship between perception of job empowerment and organizational commitment and trust among nurses in teaching hospitals of Khorramabad (Iran). Background Lack of power has been widespread among nurses in their workplaces due to uneven distribution of power among hospital staffs. Giving power to only a few individuals at the top of hospital hierarchy may often make nurses feel weak in their workplaces and causes reduction in the patients' quality care. Methods This is a descriptive cross‐sectional study which included 160 officially employed nurses in four teaching hospitals of Khorramabad (west Iran) selected by stratified random sampling. The instruments used were: The Conditions of Work Effectiveness Questionnaire–II (C.W.E.Q‐II), which measures nurses' empowerment, the Pressure Management Indicator, which measures organizational commitment and the Trust in Management Scale, which measures organizational trust. The data were analysed by the SPSS software using the descriptive and analytic statistical tests employing chi‐square, Fisher's test and the Spearman–Brown correlation coefficient. Results The results showed that the nurses had a below moderate score in their perception of job empowerment ( = 2.38 ± 0.70), with the highest score in their perception of access to “opportunity” subscale ( = 3.11 ± 0.95), and the lowest score in their perception of access to “formal power” ( = 2.43 ± 0.95). Additionally, moderate “organizational commitment” and “organizational trust” were reported with  = 4.5 ± 0.90 and  = 4.01 ± 1.11, respectively. The highest and the lowest perception scores were found for “continuous commitment” and “affective commitment” with  = 4.94 ± 0.97 and  = 4.26 ± 1.21, respectively. There were positive significant relationships between the three major variables of the study (p < 0.001). Conclusion The results showed that there was a positive and significant relationship between nurses' perception of job empowerment, organizational commitment and trust. Implications for nursing management Nursing managers can increase the motivating factors among their nurses through evaluating organizational variables like empowerment and organizational trust. In fact, through recognition of the relationship between empowerment and organizational trust, one can design the interventions of structural empowering for the improvement of professional nursing practice, nurses' workplace well‐being and safe quality care.

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Background The COVID-19 pandemic has initiated digital developments in higher education while closing in-person university classes. As this crisis continues, the need to revive virtual learning opportunities was seriously felt. The present study was conducted to determine the online flipped classroom’s effect on nursing students’ self-directed learning readiness and metacognitive awareness. Methods This quasi-experimental single-group study with pretest-posttest design recruited 34 sophomore students of a nursing school in Lorestan province, Western Iran selected by census according to the inclusion criteria. Online asynchronous learning and online flipped classrooms were used during the semester’s first and second eight weeks, respectively. Students filled out self-directed learning readiness scale and metacognitive awareness inventory online before, in the middle of, and at the end of the semester. Data were analyzed using paired t-test in Stata-14 software. Results There was no significant difference between the mean score of metacognitive awareness before and after Online asynchronous learning (P=0.15), but the mean score of self-directed learning readiness increased significantly after OA (P=0.0004). After applying online flipped classrooms, students’ mean (SD) scores of metacognitive awareness and self-directed learning readiness were 272.03 (53.03) and 162.03 (21.77), respectively, which confirmed their significant improvement compared to before the intervention. A comparison of the mean score changes of both methods indicated that their implementation did not lead to significant differences between the mean total score of metacognitive awareness (P=0.15) and the mean total score of self-directed learning readiness (P=0.07). Discussion Online flipped classroom approach can be used as an effective method in nursing education by improving self-directed learning and metacognitive awareness, which are essential in online education for nursing students.