Background: Patient's rights as one of the basic pillars in defining the standards of clinical services indicate that the patient's biopsychosocial and spiritual needs are met in the form of standards, rules, and regulations. This study aimed to evaluate the level of awareness and observance of patients' rights by nurses working in hospitals affiliated to Larestan University of Medical Sciences.Methods: In this descriptive cross-sectional study, 83 clinical nurses were recruited by convenience sampling method. To collect the research data, researcher-made questionnaires, including Patient's Rights Awareness and "Patient's Rights Observance were used. The reliability of the two parts of the questionnaire was reported using Cronbach's alpha coefficients as 0.51 and 0.69, respectively. The obtained data were analyzed in SPSS using descriptive and Chi-squared tests. Results:The knowledge of patient rights was poor, moderate, and good in 81.9%, 16.9%, and 1.2% of the nurses, respectively. Additionally, nurses' performance regarding patients' rights was reported as moderate in 83.1%, poor in 13.3%, and good only in 3.6% of them. Chi-squared test results revealed that among the demographic variables, only gender and education were significantly correlated with the knowledge and practice of nurses regarding the observance of patients' rights (P<0.05). Conclusion:The study participants' knowledge of patients' bill of rights was poor, and their observance of patients' rights was moderate; thus, interventions should be performed to prevent the violations of patients' rights. Continuing education programs and in-service training about the observance of the patients' bill of rights should be considered more seriously.

Background: Sleep is one of the most basic and physiologic needs, which has impressive effects on the humans' physical and mental health. According to the need for permanent presence of the nurses in the hospitals, they often suffer from shift work effects such as sleep disorders. Objectives: Considering the high sensitivity of nursing jobs, the aim of this study was to evaluate the prevalence and consequence of sleep disorders in shift work nurses. Methods: This cross-sectional study was conducted on all of the nurses employed in hospitals of Larestan city in south of Iran in 2017. After screening based on inclusion criteria, 100 nurses were selected. to evaluate the prevalence and consequence of sleep disorders in the nurses, the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleep Quality Index (ESQI) and Insomnia Severity Index (ISI) were used. Data were analyzed using SPSS software version16. Descriptive and analytical statistical tests, including One-way ANOVA, paired t-test, independent t-test, Kruskal-Wallis, chi-square, and Pearson correlation coefficient were used to analyze the data. A P ≤ 0.05 was considered statistically significant. Results: The results showed the mean score of sleep quality index was 6.52 ± 4.23 and according to this index, 56% of the studied nurses are in hazardous situations. In all of the nurses, sings of insomnia were observed during routine works; consequently, 78.5% were sleepy, 16.5% were very sleepy, and 5% were severe sleepy. By the increased rate of night shift work per week, the severity of insomnia was also increased in the nurses (R 2 = 0.78). Sleep disorders in the nurses working in the surgical section were higher than the nurses in other sections of the hospitals (P < 0.05). Conclusions: A high percentage of the nurses employed in different sections of the hospitals have poor sleep quality and increased rate of night shift work per week plays a major role in decreasing their sleep quality. Regarding the adverse effects of poor sleep quality on the health status of the nurses and their quality of job performance, it is necessary to carry out proper planning to improve the sleep quality of night shift work nurses employed in different sections of the hospitals.

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Dear Editor, Dokha has been smoked by Bedouins and sailors in Arab countries since ancient times. It is a combination of dry tobacco leaves smoked in a pipe called "Midwakh". This traditional pipe of Arab countries is a small tool, which has a small bowl and is filled with about 0.5 g of Dokha for each use. People who smoke Dokha can usually completely burn and refill the tobacco in Midwakh only with two inhalations (1).This tobacco is a combination of tobacco leaves with all kinds of skins, herbs, spices, dried flowers, or dried fruits and has up to five times more nicotine than regular cigarettes (2). Although there is evidence of the effect of Dokha on people's health, health officials are concerned that Dokha may be considered a better alternative to other forms of smoking in the community (3). Dokha consumers often have the misconception that using Dokha is less harmful compared to tobacco and cigarettes (4). Dokha is a popular type of tobacco product that is used in various parts of the Middle East, especially the Persian Gulf (2). Nonetheless, tobacco is one of the leading causes of death in the world. According to reports, approximately 13 out of 24 million children (13-15 years old) worldwide use smokeless tobacco products (3). The use of non-smoking tobacco products has grown significantly in recent decades. Nearly 36% of global tobacco consumers use exclusively non-smoking tobacco products (5). Meanwhile, the use of Dokha has become common in parts of the Arab world and its popularity is increasing (2). Based on evaluations, the use of Dokha causes many problems for people's health. High levels of nicotine cause side effects such as dizziness, increased systolic blood pressure, increased heart rate and respiratory rate, as well as lip and oral cavity cancer (6,7). In a study by AlMulla et al on tobacco users (617 people) in Qatar, 4.7% of the consumers of tobacco products used Dokha (8). The findings of a study

Objective: Treatment adherence in chronic patients results in favorable treatment outcomes. Today, one of the main causes of mortality in hemodialysis patients is that of lack of treatment adherence. Identifying barriers to adherence to treatment is the first step to help these patients. The purpose of this study is to determine the effects of cognitive behavioral interventions on removing barriers to treatment adherence in hemodialysis patients. Methods:This clinical study was carried out in the hemodialysis wards of Imam Reza Hospital of Larand Vali-e-Asr Hospital of Lamerd. The sample included 70 patients who were randomly assigned into two groups of intervention (n=35 for even days)and control (n=35 for odd days). The intervention group received a six-step cognitive behavioral treatment. The level of barriers to treatment adherence was assessed using a self-report questionnaire in two stages (pre-intervention and post-intervention). Data were analyzed using SPSS via independent t-test.Results: Before the intervention, the two groups were not significantly different in terms of barriers to treatment adherence (p=0.68). However, after the treatment regimen, the barriers significantly decreased for the intervention group. There was a significant difference between the two groups in terms of barriers to treatment adherence (p<0.001). Conclusion:Given the efficacy of cognitive behavioral intervention, it can be used to identify barriers to adherence and design individualized education programs based on barriers to adherence in hemodialysis patients to increase their treatment adherence.