Background One of the challenges that nurses often face in ethical decision-making situations is moral distress. Moral distress is caused by the conflict between professional and individual values in decision-making situations. Despite its importance, there is no reliable scale in Persian to measure it. Therefore, this study was conducted to validate the moral distress scale in mental health nurses in Iranian culture and Persian language. Methods This study was conducted in two parts: Translation and cross-cultural adaptation and psychometric analysis. The translation and cross-cultural adaptation process was conducted based on the Polit approach. Next, face validity (qualitative), content validity (quantitative and qualitative), and construct validity were examined. This part of the study was a cross-sectional study. In this step, a demographic questionnaire and the Moral Distress Scale were sent to 500 nurses working in selected educational and medical centers in Iran via online questionnaires. Then, the construct validity of the “Moral Distress Scale” was confirmed by confirmatory factor analysis and the reliability of the instrument was examined by studying the internal consistency with Cronbach’s alpha and the internal correlation of the AIC. Results The confirmatory factor analysis showed an acceptable ratio of the expressions in 15 items in three factors: Acquiescence to patients’ rights violations (6 items), Unethical conduct by caregivers (5 items), and low staffing (4 items) in the scale. The internal consistency of the instrument with Cronbach’s alpha was higher than 7.0. Conclusion The Persian version of moral distress with 15 items of the three factors had validity and reliability. According to the present findings, this scale can be used to study moral distress among nurses working in psychiatric wards. Moral distress leads to burnout, increases risks to patient safety and reduces quality of care. Nurses need to be able to assess and manage moral distress. Therefore, considering the side effects, it is necessary to have a reliable and valid scale that can be studied. Considering that culture has an impact on nurses’ moral distress, it is suggested that this instrument be studied in and tested in other languages and cultures.

Background:Tracheostomy facilitates respiratory care and the process of weaning from mechanical ventilatory support.Aims:To compare the complications found in percutaneous dilatational tracheostomy (PDT) and surgical tracheostomy (ST) techniques.Methods:This was a prospective randomized study to evaluate the complications of PDT and ST procedures in patients admitted to ICU unit of a teaching hospital during 2008 to 2011.We studied 40 patients in each group. PDTs were performed with blue rhino technique at the bedside by a skilled clinician and all cases of STs performed by Charles G Durbin technique in operating room under general anesthesia. Bronchoscopic examination through tracheostomy tube was performed to ensure the correct position of tracheostomy tube in the trachea lumen. The duration of procedures and pre- and post-interventional complications were recorded.Results:The most common complications observed in the PDT group were minor bleeding (n=4), hypoxemia, and cardiac dysrhythmias (n=3) whereas in the ST group, the most frequent complications were minor bleeding (n=5) and endotracheal tube puncture (n=3). The difference in overall complications between the two groups was insignificant (P=0.12).Conclusion:PDT with blue rhino technique is a safe, quick, and effective method while the overall complications in both groups were comparable.

Background and objectives Nurses’ caring behaviors, professional activities, and behaviors for the benefit of patients, influence patients’ perception of care and satisfaction with the quality of care provided. Caring behaviors of nurses are contextual and various factors such as patients’ social structure, lifestyle, culture, and interests, as well as their biographical, social, and physiological characteristics, can influence perceptions of caring behaviors of nurses, as caring behaviors are an interactive and mental process between patients and nurses. This study was conducted to provide a transcultural translation and psychometric analysis of Caring Behaviors Inventory (CBI) among nurses in Iran. Methodology Transcultural translation of the 16-item CBI was performed. Then, face validity (qualitative), content validity (quantitative and qualitative), and construct validity were examined in a cross-sectional study of 509 patients. A demographic questionnaire and the 16-item CBI were sent to enrolled patients via online questionnaires. The reliability of the instrument was assessed by internal consistency using Cronbach’s alpha. Then, construct validity of the single factor CBI was assessed using Confirmatory Factor Analysis (CFA). Since one factor CBI was not confirmed, construct validity was examined using Exploratory Factor Analysis (EFA). The final number of factors was confirmed using CFA. Results The internal consistency of the instrument was good with Cronbach’s alpha 0.89. Based on EFA, the CBI were loaded on two factors, eigenvalues >1, no item was removed. The emergent factors were named "Communicating respectfully" and "Professional knowledge and skill". These two factors explained 50.197% of the total variance. Then, CFA showed an acceptable fit for the two factors CBI. Conclusion The results showed that the Persian version of the 16-item CBI had adequate validity and reliability. Accordingly, this instrument can be used to study nurses’ caring behaviors.

BACKGROUND: The high prevalence of coronavirus disease-2019 (COVID-19) has a lot of stress on medical students. This study was conducted to investigating the adaptation strategy with COVID-19 health anxiety in nursing students MATERIALS AND METHODS: This study was designed as a cross-sectional study. Participants of the study were 431 students of the Nursing and Midwifery Faculty of Shahid Beheshti University of Medical Sciences. Inclusion criteria were studying at the time of the outbreak of COVID-19 and willingness to participate in the study. Data collection tools included participated in the study. Data collection tools included a demographic questionnaire, Health Anxiety and Coping Inventory for Stressful Situations (Short Form). Reliability of tools was assessed and confirmed with Cronbach's alpha coefficient. Cronbach's alpha coefficient of health anxiety was 0.76 and Cronbach's alpha coefficient of Coping Inventory for Stressful Situations was 0.79. Data were collected between July 2020 and September 2020. Pearson's correlation coefficient was used to examine the relationship between the data. Data were analyzed with SPSS 26. RESULTS: Findings indicated that most of the participants were female, single, 22–28 years old, and undergraduate students. The mean of COVID-19 health anxiety was 5.59 ± 17.04. Results showed that 19.58 ± 5.05 of the participants used avoidance-focused adaptation strategies, 25.12 ± 3.88 problem-focused adaptation strategies, and 19.32 ± 5.13 emotion-focused adaptation strategies. CONCLUSION: The COVID-19 health anxiety was higher in female, young, and married students. The problem-focused adaptation strategy should be further taught so that students can better coping with COVID-19 health anxiety.

Introduction: The prevalence of coronavirus has led to minimal and emergency surgeries. It is recommended that surgery should be performed if it is necessary during the treatment process in order not to interfere with the treatment of patients, but surgery, which are more likely to transmit COVID-19, should be identified in order to have a safe surgery and improve the safety of patients and staff. Therefore, the present study aimed to identify surgeries with the possibility of transmitting COVID-19. Method: The present study was conducted by an integrated review method. Searching was performed by keywords COVID-19, surgery, operating room, anesthesia, and instructions on PUBMED, Science Direct, Ovid, and ProQuest databases; and 98 studied were obtained. It decreased to 42 items after removing the duplicate items and reviewing the abstract of articles, and finally 23 studies were selected for review based on the inclusion criteria. The inclusion criteria were English and Persian languages; the relevance of articles on COVID-19, surgery and anesthesia. Results: Tracheostomy, ear, nose and throat, maxillofacial, and head and neck surgeries such thoracotomy are high-risk surgeries for the COVID-19 transmission. Conclusion: High-risk surgeries should be performed the full preventive precautions against the COVID-19 transmission.