Introduction: Many patients in coronary care unit (CCU) suffer from decreased sleep quality caused by environmental and mental factors. This study compared the efficacy of foot reflexology massage, foot bath, and a combination of them on the quality of sleep of patients with acute coronary syndrome (ACS). Methods: This quasi-experimental study was implemented on ACS patients in Iran. Random sampling was used to divide the patients into four groups of 35 subjects. The groups were foot reflexology massage, foot bath, a combination of the two and the control group. Sleep quality was measured using the Veran Snyder-Halpern questionnaire. Data were analyzed by SPSS version 13. Results: The mean age of the four groups was 61.22 (11.67) years. The mean sleep disturbance in intervention groups (foot reflexology massage and foot bath groups) during the second and third nights was significantly less than before intervention. The results also showed a greater reduction in sleep disturbance in the combined group than in the other groups when compared to the control group. Conclusion: It can be concluded that the intervention of foot bath and massage are effective in reducing sleep disorders and there was a synergistic effect when used in combination. This complementary care method can be recommended to be implemented by CCU nurses.

Introduction: Nursing students require highly specialized competencies to accurately determine patients' states and to predict and cope with problems that may occur during nursing care. This study explores the definition, domains, and levels of nursing students' competency. Methods: This study was a systematic review of nursing students' competencies in English (ISI, SCOPUS, Ovid, Proquest, Iranmedex, Google scholar, PubMed) and Persian (Scientific Information Database) databases , according to the University of York Center for Reviewers and Dissemination Guidance approach, 2008. Results: From a total of 13,115 articles, 20 were retrieved in the final step. The individual experiences, dynamic process, and positive interactive social and beneficial changes in the equality of one's professional life that cause meta-cognitive abilities, touch reality, motivation, decision making, job involvement, professional authority, self-confidence, knowledge and professional skills formulated the definition of nursing students' competency. Educational, cultural, individual, professional and inter-professional, research, clinical and practical domains were defined as belonging to nursing students' competency. Seven nursing student competency levels were identified. Conclusion: Although the definitions of competency, its domains, and its levels vary by profession and country, this systematic review demonstrated the comprehensive ones in three scopes. However, more research is needed to examine the three scopes in the nursing student competency concept. Cultural-based CompetencyRacial/ethnic disparities in healthcare [11], Ineffective or lower quality care culturally/linguistically inappropriate [17], Cultural innovations in healthcare system and structure design [7], Interactions between patients and healthcare staff [14], Lack of diversity in healthcare leadership and workforce [9], Cross-cultural communication between healthcare providers and patients [17] Educational-based Competency Reflection [9], Problem solving [7], Blueprinting [35], Problem-based learning approach [7], Scientific approach and critical thinking [2]

Background:Despite regular treatment by hemodialysis, patients on hemodialysis are affected by uremic syndrome, which is marked by fatigue. Fatigue is supposed as the most common and the most severe symptom ever reported by patients with chronic kidney disease.Objectives:This controlled study aimed to evaluate the effect of intradialytic physical and mental exercises on fatigue in patients on hemodialysis.Patients and Methods:A total of 66 patients on long-term hemodialysis were selected via purposive sampling and were assigned to two groups, namely, control and experimental groups. The experimental group participated in a intradialytic training program twice a week for two months. The program was designed by a senior expert in physical education. Their fatigue was measured via a fatigue severity scale questionnaire before as well as one and two months after the intervention in both groups.Results:The mean of the fatigue score within the research units was 42.37. Overall, 42.2% and 56.1% of the participants experienced medium and severe fatigue, respectively. The scores of fatigue decreased significantly from the beginning through two months after intervention in the experiment group.Conclusions:With respect to the findings of the study, this method of treatment is recommended due to being cost efficient, easy, applicable, and flexible for alleviating the effect of fatigue on the personal, psychological, and social aspects of life quality in patients on hemodialysis.

Background: In intensive care units (ICU), there should be some more facilities and equipment such as ventilators, monitors, suction pumps, etc. These devices are equipped with an alarm system in their settings. Sometimes, too many alarms cause alarm fatigue among nurses and consequently would jeopardize the safety of patients. Therefore, the current study aimed at designing a tool to assess the alarm fatigue among nurses. Methods: In the current developmental, analytic study, using reliable databases, an alarm fatigue questionnaire was designed with 32 items. The content of the tool was measured by the panel of experts and its reliability was measured by Cronbach's alpha. Data were analyzed with SPSS software version 21. Results:The results showed that 9 out of 32 items of the questionnaire had low content validity index and ratio (CVI/CVR) and should be rejected; the index value of the questionnaire was 0.7 that was acceptable. The results showed that the final questionnaire was reliable (α = 0.806) with test-retest, which was repeatable. Conclusions: Since the alarm fatigue can jeopardize the patients' safety, it is required to use a reliable tool for its assessment. According to the obtained results in the current study, the present questionnaire had a relatively appropriate validity.

Background: With the outbreak of Coronavirus Disease 2019 (COVID-19), the workload of the Iran’s health care system along with Pre-hospital Emergency Service (PHES) increased significantly so that Iranian fledgling emergency system had never experienced such a crisis. With regard to the importance of the function of PHES as the front line staff of Iran’s health system and its role in controlling the recent epidemic crisis, this study was conducted to identify the challenges of PHES function in the face of COVID-19 pandemic. Methods: The study was conducted with qualitative approach through content analysis in 2021. Semi-structured interviews were used to collect data. Sampling was purposive and continued until data saturation. After 24 interviews, the data were saturated. The extracted codes were thoroughly prepared as a data pool. After encoding all available data, the related codes were categorized into a single theme. After extracting the themes, a network of themes, related to the research topic, was drawn, and then, the relationship between the themes was analyzed. Results: Data analysis undertaken for the qualitative study resulted in the identification of four main themes included: challenges related to facilities and equipment, living with uncertainty, professional and organizational capabilities, and burnout. Conclusion: PHES personnel have an important and key role in providing care to patients during COVID-19 epidemic period. Individual and systemic challenges were among the most important issues in the experiences of these personnel. These challenges require organizational planning and special attention of health policy makers to maintain the staff’s physical and mental health during the pandemic and the possible crises ahead.