Background: Midwifery is an emotionally challenging profession, and academic education of midwifery especially clinical learning has its own specific challenges. Midwifery students face with stressful experiences, especially related to instructor and characteristics of clinical environment, which can affect their theoretical and practical abilities. There is insufficient evidence in this field. This study aimed to explore (1) the perceived stress and stressors of midwifery students and (2) the relationships between students' stress and related factors in clinical learning environment. Methods: A cross sectional, survey design was conducted at one university in Iran. A sample of 108 students was selected using Krejcie and Morgan table in 2016. Data was collected using Persian version of Cohen's perceived stress scale, Persian questionnaire of sources of stress and demographic form. Data was analyzed using independent t, ANOVA and correlation coefficient test (α < 0.05). Results: Participants returned 70 surveys (response rate, 64.8%). Approximately 56% of the students perceived a high level of stress. The most common dimensions of stressors were "unpleasant emotions" and "humiliating experiences". The highest stressors were included "feeling suffering due to seeing for patients with critical situation", "instructor's admonition in the presence of clinical staff" and "communication with instructor". The "interest in the field of study" had a negative impact on perception of stressors in dimensions of "clinical practices" and "interpersonal communication". Conclusions:The midwifery students reported their stress in severe level, especially in dimensions of "unpleasant emotions" and "humiliating experiences". The factors associated with the instructors have caused more stress in students. These findings will highlight need for supportive strategies by the clinical instructors. In this regard, the use of experienced instructors, the development of communication skills of the instructors, increasing coping skills of the students and the creation of a supportive environment may be helpful.

Background: Nurses play a key role in providing patient safety. It is known that patient safety requires the improvement of patient safety culture, which can be a difficult process. One of the current challenges of hospitals is to explore the ways to improve patient safety culture. Organizational citizenship behaviors are one of the factors, which can develop organizational culture including safety culture; however, its role is not well established. Methods: In this cross-sectional study, a stratified random sample of 214 nurses was selected from a largest teaching hospital in west of Iran. The institutional research board approved the study protocol. Data were collected using three self-report questionnaires: demographic information; hospital survey on patient safety culture (HSPSC); and organizational citizenship behaviors questionnaire. Data were analyzed using Spearman's correlation coefficient test in SPSS (α < 0.05). Results: Organizational citizenship behaviors were found to be at an intermediate level (56.84 ± 16.22). However, some of its dimensions, including sportsmanship, civic virtue, and courtesy, were at weak levels (< 50%). The mean percentage of positive responses to the patient safety culture was 49.00 ± 14.01. The patient safety culture had significant positive correlations with organizational citizenship behaviors (r = 0.349, P = 0.001) and dimensions of altruism (r = 0.255, P = 0.001), civic virtue (r = 0.434, P = 0.001), and courtesy (r = 0.214, P = 0.001). Conclusion: Our findings proposed the hypothesis that OCB has a statistical significant impact on PSC. Low levels of civic virtue, sportsmanship and courtesy behaviors may be indicative low nurses' interest in participating in organizational affairs and nurses' low attention to measures that prevent harm to their organization. It is recommended that nursing managers focus more on these dimensions, identifying influintioal factors and taking appropriate management measures to promote these behaviors. If our findings are confirmed in future studies, nursing managers can consider the development of organizational citizenship behaviors as one of the managerial approaches for promoting a patient safety culture.

‫هفت‬ ‫(شامل‬ ‫بالینی‬ ‫صالحیت‬ ‫پرسشنامه‬ ‫و‬ ‫مستمر)‬ ‫و‬ ‫هنجاری‬ ‫عاطفی،‬ ‫تعهد‬ ‫های‬ ‫حیطه‬ ‫آنها‬ ‫روایی‬ ‫و‬ ‫پایایی‬ ‫که‬ ‫بود‬ ‫خودارزیابی‬ ‫شیوه‬ ‫به‬ ‫مهارت)‬ 73 ‫ارزیابی‬ ‫منظور‬ ‫به‬ ‫حیطه‬ ‫استفاده‬ ‫با‬ ‫ها‬ ‫داده‬ ‫بود.‬ ‫شده‬ ‫تایید‬ 0/95 ‫و‬ 0/79 ‫کرونباخ‬ ‫الفای‬ ‫ضریب‬ ‫محاسبه‬ ‫با‬ ‫ترتیب‬ ‫به‬ ‫هم‬ ‫ضریب‬ ‫آزمون‬ ‫و‬ ‫معیار)‬ ‫انحراف‬ ‫و‬ ‫میانگین‬ ‫فراوانی،‬ ‫(توزیع‬ ‫توصیفی‬ ‫آمار‬ ‫های‬ ‫شاخص‬ ‫از‬ .)P>0/05( ‫شد‬ ‫تحلیل‬ SPSS 17 ‫افزار‬ ‫نرم‬ ‫با‬ ‫پیرسون‬ ‫بستگی‬ ‫سازمانی‬ ‫تعهد‬ ‫و‬ )74/42±11/69( ‫خوب‬ ‫سطح‬ ‫در‬ ‫پرستاران‬ ‫بالینی‬ ‫صالحیت‬ ‫ها:‬ ‫يافته‬ ‫بالینی‬ ‫صالحیت‬ ‫با‬ ‫کلی‬ ‫سازمانی‬ ‫تعهد‬ ‫شد.‬ ‫ارزیابی‬ )91 ±10/77( ‫متوسط‬ ‫سطح‬ ‫در‬ ‫آنها‬ ،P=0/037( ‫راهنمایی‬ ‫و‬ ‫آموزش‬ ‫و‬ )r=0/256 ،P= 0/002( ‫کیفیت‬ ‫تضمین‬ ‫های‬ ‫حیطه‬ ‫در‬ ‫کلی‬ ‫بالینی‬ ‫صالحیت‬ ‫با‬ ‫عاطفی‬ ‫تعهد‬ ‫بعالوه‬ ‫داشت.‬ ‫مستقیمی‬ ‫همبستگی‬ )r=0/176 ‫و‬ ‫آموزش‬ ،)r=0/185 ،P=0/028( ‫کیفیت‬ ‫تضمین‬ ‫های‬ ‫حیطه‬ ‫و‬ )r=0/170 ،P= 0/045( ‫همبستگی‬ )r=0/205 ‫تشخیصی(510/0=‪،P‬‬ ‫اقدامات‬ ‫و‬ ،)r=0/190 ،P=0/024( ‫راهنمایی‬ ‫داشت.‬ ‫مستقیمی‬ ‫که‬ ‫شود‬ ‫می‬ ‫پیشنهاد‬ ‫پرستاری‬ ‫مدیران‬ ‫به‬ ‫مطالعه،‬ ‫های‬ ‫یافته‬ ‫براساس‬ ‫گیري:‬ ‫نتیجه‬ ‫های‬ ‫مراقبت‬ ‫کیفیت‬ ‫تا‬ ‫نمایند‬ ‫اجرا‬ ‫پرستاران‬ ‫عاطفی‬ ‫تعهد‬ ‫ارتقاء‬ ‫برای‬ ‫را‬ ‫الزم‬ ‫راهکارهای‬ ‫گردد.‬ ‫تضمین‬ ‫پرستاری‬ ‫ای‬ ‫حرفه‬ ‫توسعه‬ ‫بالینی،‬ ‫پرستاران‬ ‫سازمانی،‬ ‫تعهد‬ ‫بالینی،‬ ‫کلماتکلیدی:صالحیت‬ ‫پرستاران‬ ‫بالینی‬ ‫صالحیت‬ ‫و‬ ‫سازمانی‬ ‫تعهد‬ ‫بین‬ ‫ارتباط‬ ‫،شايستهصالحی‬ ‫نداخدادادی،بهروزرضائی‬ ‫نداخدادادی‬ ‫مرکز‬ ‫پرستاری،‬ ‫ارشد‬ ‫کارشناســی‬ ‫آموخته‬ ‫دانش‬ ‫اسالمی،‬ ‫آزاد‬ ‫دانشگاه‬ ‫جامعه،‬ ‫ســالمت‬ ‫تحقیقات‬ ‫ایران‬ ‫اصفهان،‬ ‫(خوراسگان)،‬ ‫اصفهان‬ ‫واحد‬ ‫مؤلفمسؤول:بهروزرضائی‬ ‫بهداشــتی‬ ‫خدمات‬ ‫مدیریت‬ ‫دکتری‬ ‫اســتادیار،‬ ‫آزاد‬ ‫دانشگاه‬ ‫مامایی،‬ ‫و‬ ‫پرستاری‬ ‫دانشکده‬ ‫درمانی،‬ ‫ایران‬ ‫اصفهان،‬ ‫فالورجان،‬ ‫واحد‬ ‫اسالمی،‬ beh.rezaei@gmail.com ‫آدرس:‬ ‫شايستهصالحی‬ ‫دانشگاه‬ ‫جامعه،‬ ‫سالمت‬ ‫تحقیقات‬ ‫مرکز‬ ‫دانشیار،‬ ‫اصفهان،‬ ‫(خوراسگان)،‬ ‫اصفهان‬ ‫واحد‬ ‫اسالمی،‬ ‫آزاد‬ ‫ایران‬ ‫سالهفتم،دورههفتم،شمارهاول‬ ‫بهار7931‬