Iranshahr University

Early prediction of hospital-acquired pressure injuries (HAPIs) is crucial for delivering prompt therapeutic interventions and personalised preventive measures to hospitalised patients. However, existing pressure injury (PI) assessment tools often lack transparency, objectivity, comprehensiveness and reliability. This study protocol aims to identify risk factors, develop a screening tool (Pressure Injury after Hospital Admission - PIAHA), and conduct a two-step validation for the early prediction of PI after hospital admission. This multiphase, multicentre, sequential research design comprises five phases. The first phase involves an umbrella review to synthesise comprehensive information on PI risk factors in hospitalised patients from published review studies. The second phase will use conventional content analysis and qualitative interviews with national and international experts to identify context-specific predictors of HAPIs. The third phase will employ a three-round E-Delphi method to integrate findings and establish a structured list of potential predictors. In the fourth phase, a cross-sectional study will evaluate the predictive value of identified risk factors for HAPI development among hospitalised patients, contributing to the development of the PIAHA screening tool. The final phase consists of a two-step validation: (1) a cross-sectional comparison of the PIAHA tool against the gold standard and (2) a cluster randomised controlled trial to compare the effectiveness and cost-effectiveness of the novel 'IDEAL SKIIN CARES' prevention bundle, administered by trained wound specialist nurses, vs routine standard care. Ethical approval was granted by Baqiyatallah University of Medical Sciences (IR.BMSU.REC.1402.059) covering all study phases. Written informed consent will be obtained from participants or their legal representatives. The study follows the Declaration of Helsinki. Results will be disseminated via peer-reviewed publications, conferences, webinars, policy briefs and public engagement through social media, educational videos and podcasts. The PIAHA tool promises to enhance early detection of HAPI risk, facilitating individualised prevention and optimising clinical resource allocation. Implementation of the IDEAL SKIIN CARES bundle may improve patient outcomes and reduce healthcare costs by standardising evidence-based preventive care. CRD42024532133. NCT06369688.

The global rise of chronic diseases requiring long-term management highlights the need for effective palliative care. Nurses play a central role in providing this care, yet frequently face ethical challenges such as moral distress, complex decision-making, and occupational stress. This systematic review aimed to identify, categorize, and synthesize evidence on nurses’ ethical perspectives, challenges, and professional interventions in palliative care for patients with chronic diseases in both hospital and home settings. The review addressed the following questions: (1) What are nurses’ ethical perspectives in delivering palliative care ? (2) What ethical challenges and decision-making dilemmas do they encounter? (3) Which strategies and interventions support ethically sound care? Following PRISMA 2020 guidelines, five databases (PubMed, Scopus, Web of Science, SID, and Magiran) and gray literature via Google Scholar were systematically searched for studies published between 2015 and 2025 in English or Persian. Eligible studies included qualitative, quantitative, mixed-methods, and peer-reviewed reviews addressing nurses’ ethical challenges in palliative care. Qualitative data were analyzed using inductive content analysis, quantitative findings were synthesized descriptively, and mixed-methods results were integrated to allow convergence across study designs. Extracted codes were organized into themes, grouped into categories, and synthesized into overarching domains. Thirty-four studies met inclusion criteria. Four main domains of ethical challenges emerged: (1) Clinical decision-making and patient autonomy—dilemmas regarding life-sustaining treatments, medication and fluid management, palliative sedation, and conflicts between patient preferences and family/cultural expectations; (2) Justice and resource allocation—insufficient ethics education, high workload, limited organizational support, poor interprofessional collaboration, and scarce resources; (3) Beneficence and patient-centered care—ethical issues related to technological innovations, informed consent, data privacy, and environmental pressures such as ICU or emergency care conditions; (4) Non-maleficence and moral distress prevention—moral distress, burnout, reduced ethical courage, and legal concerns affecting clinical decisions. Nurses encounter substantial ethical challenges in delivering palliative care for patients with chronic diseases. Addressing these challenges requires ethics education, structured organizational guidance, interprofessional collaboration, and context-sensitive strategies to safeguard patient dignity and reduce moral distress. These findings provide evidence for policymakers, educators, and managers to develop practical interventions and ethical frameworks across diverse care settings.

Background: Infertility presents significant emotional and psychological challenges for couples, often impacting marital satisfaction. This study investigates the efficacy of Gottman’s couple- oriented counseling in enhancing marital satisfaction among infertile couples. Methods: In a randomized controlled clinical trial conducted in 2020, 60 infertile couples were randomly assigned to either an intervention or a control group. The intervention group participated in eight sessions of couple-focused counseling based on the Gottman Method and GATHER principles, while the control group received standard psychological counseling. Both groups completed the ENRICH Marital Satisfaction Questionnaire and a demographic survey before the intervention and four weeks after the final session. Data were analyzed using ANCOVA for between-group comparisons, paired t-tests for within-group changes, and independent t-tests for between-group differences, with a significance threshold of p < 0.05. Results: The intervention group exhibited significant improvements in marital satisfaction. Women’s mean scores increased from (150.18 ± 7.23) pre-intervention to (157.38 ± 7.23 )postintervention, (p = 0.001). Men’s mean scores also rose significantly, from (153.22 ± 8.07) to (158.51 ± 8.07), (p = 0.02). No significant changes were observed in the control group. Conclusion: Gottman’s couple-oriented counseling significantly enhanced marital satisfaction among infertile couples, with a more pronounced effect in women. This intervention fosters emotional connection and support, making it a valuable tool for improving relationship quality during infertility treatment. Trial Registration: IRCT20120215009014N368

Self-care is one of the most critical factors in disease prevention. Adults with pre-diabetes are at 5 to 15 times higher risk of developing type 2 diabetes compared with others. Without self-care behaviours to promote health and prevention, more than 70% will ultimately develop type 2 diabetes during their lives. This study aimed to design and psychometrically evaluate the self-care of adults with pre-diabetes. This study was a sequential exploratory mixed-methods study. In the first phase of the mixed-methods study, a qualitative study was conducted with a directed content analysis approach according to Riegel etal.'s middle-range theory as a guide. This qualitative-directed content analysis was conducted on prediabetes from June 2023 to October 2023. The experiences of 39 adults with pre-diabetes and 6 healthcare workers were assessed through individual, face-to-face, semi-structured interviews. The data were analysed based on the Elo and Kyngäs's method. The psychometric properties of the primary tool were evaluated in the second phase. Face and content validity, item analysis, structural validity, internal consistency, relative and absolute reliability, interpretability, responsiveness, and feasibility were evaluated, and the scoring method was determined. The concept of self-care in prediabetes includes behaviours that are performed to return blood sugar to a normal state in a routine and usual way (self-maintenance) and behaviours in response (self-management) to the changes that have been detected following the follow-up and interpretation of symptoms, periodic examinations and tests (self-monitoring). The primary tool entered the psychometric evaluation phase with 57 items (blueprint). After performing face and content validity and item analysis, the number of items was reduced to 29 items. Exploratory factor analysis was performed with 29 items and 207 people with prediabetes, and finally, three subscales with 19 items were formed, which explain 38% of the total extracted variance. The results of confirmatory factor analysis with 200 samples indicated the acceptable fit of the model. The Cronbach's alpha of all subscales was higher than 0.7, and the intraclass correlation coefficient of the scale was higher than 0.90. The standard error of measurement was 1.340, the minimum detectable change was 6.57, and the minimal important change was 3.71. The total score of the questionnaire had no ceiling and floor effect; the percentage of unanswered items was within the acceptable range. The results show that the self-care questionnaire for prediabetes has good psychometric properties and can measure self-care in adults with pre-diabetes.

Preoperative anxiety in children is common and may negatively affect anesthetic management and postoperative recovery. Parental Presence during Induction of Anesthesia (PPIA) is widely used as a non-pharmacological strategy, but its effectiveness remains uncertain. This systematic review and meta-analysis evaluated the effect of PPIA on perioperative anxiety in children. Randomized and quasi-randomized trials comparing PPIA with no parental presence or alternative interventions for perioperative anxiety in children undergoing elective procedures under general anesthesia were systematically reviewed. Five electronic databases were searched from inception to June 30, 2025. Study quality was assessed using the Cochrane Collaboration’s Risk-of-Bias tool and GRADE framework. Data were pooled using a random-effects meta-analysis, with effect sizes reported as Weighted Mean Differences (WMDs) or Standardized Mean Differences (SMDs). The primary outcome was perioperative anxiety assessed at follow-up time points, and the secondary outcome was the change in perioperative anxiety from baseline to each follow-up time point. A total of 24 studies were included, evaluating four intervention comparisons: PPIA versus no parental presence, PPIA versus sedative premedication, PPIA combined with sedative premedication versus sedative premedication alone, and PPIA versus other non-pharmacological interventions. Compared with no parental presence, PPIA was associated with reductions in children’s anxiety and heart rate from baseline to induction (SMD= ˗1.13, P = 0.022; WMD= ˗8.74, P = 0.004). In contrast, PPIA alone was less effective than midazolam in reducing anxiety at induction and from baseline to induction (SMD = 1.06, P = 0.022; SMD = 2.15, P = 0.004), and combining PPIA with midazolam offered no additional benefit over midazolam alone at induction (SMD: ˗0.40, P = 0.402). One study suggested that video distraction may be more effective than PPIA. The certainty of evidence ranged from low to moderate, and only five studies were rated as high quality. PPIA modestly reduces perioperative anxiety and heart rate in children compared with no parental presence but is less effective than midazolam and provides no additional benefit when combined with it. Therefore, high-quality studies are needed to clarify the clinical relevance of PPIA and to optimize its implementation in pediatric anesthesia. CRD42024596457

Effective patient communication and mastery of technical skills, such as suturing, are essential competencies for nursing students that directly impact the quality and safety of patient care. Hybrid simulation, which integrates standardized patients with technical skill practice, has emerged as an innovative educational approach, yet empirical evidence on its effectiveness in undergraduate nursing education remains limited. This study aimed to evaluate the impact of hybrid simulation-based training on suturing skills and patient interaction among nursing students. A quasi-experimental, two-group pretest–posttest design was conducted with undergraduate nursing students at Birjand University of Medical Sciences. Participants were randomly assigned to either a hybrid simulation intervention or a routine training control group. Data were collected using a demographic questionnaire and two validated checklists assessing communication and suturing skills. In the intervention group, training was conducted using a standardized patient equipped with an artificial arm. A pretest was administered solely to evaluate patient interaction skills using the standardized patient, whereas the posttest assessed both patient interaction and suturing skills using the hybrid simulator. Data were analyzed using Wilcoxon, Mann–Whitney, Analysis of Covariance, and two-way ANOVA tests (α ≤ 0.05). Following the intervention, the mean patient interaction score in the hybrid simulation group increased significantly (p < 0.001) and was also significantly higher than that of the control group (p < 0.001). Additionally, the mean post-intervention suturing skill score was 17.38 ± 1.18 out of 20 in the intervention group and 15.11 ± 3.60 out of 20 in the control group, demonstrating a statistically significant difference between the groups (P = 0.013). Hybrid simulation-based training is an effective, experiential approach for concurrently improving patient communication and suturing skills in nursing students. Its integration into clinical skills curricula can enhance learning quality, foster professional competence, and provide a safe environment for repeated practice. Future studies should investigate long-term effects, broader student populations, cost-effectiveness, and comparisons with alternative simulation modalities to optimize its implementation in nursing education.