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Background: One of the factors effective in controlling acute coronary syndrome (ACS) symptoms, such as heart failure, is sufficient knowledge of the disease, factors effective on its occurrence, and its prevention. Moreover, the improvement of self-efficacy, which is a predictor of important life factors in these patients, such as treatment process and quality of life (QOL), must be considered as one of the main goals of nursing care for these patients. The aim of this study was to determine the effect of the family-centered self-care program on the health literacy level and self-efficacy of patients with ACS during hospital discharge. Materials and Methods: The present study was a quasi-experimental study performed with a pretest-posttest design. The statistical population of the study consisted of all patients with ACS hospitalized at Shahid Chamran Hospital in Isfahan in 2020. Through the convenience sampling method, 50 patients were selected and randomly divided into intervention and control groups. For the intervention group, 6 sessions of 45-60 minutes of family-centered self-care intervention were held. The subjects completed the Health Literacy for Iranian Adults (HELIA) questionnaire before and after the intervention. Data were analyzed using Chi-square test, independent t-test, and paired t-test in the SPSS statistical software. Results: The mean score of health literacy did not significantly differ between the intervention and control groups before the intervention (p > 0.050). However, after the intervention, this rate was equal to 82.16 (7.94) and 60.85 (15.71) in the intervention and control groups, respectively, which was significantly higher in the intervention group compared to the control group (p < 0.001). Furthermore, there was no significant difference between the two groups in terms of the mean self-efficacy score before the intervention (p > 0.05). However, after the intervention, this score was significantly higher in the intervention group 34.71 (10.11) compared to the control group 35.22 (13.30). Conclusions: Family-centered self-care program after discharge, as a simple, applicable, and efficient method can improve the health literacy level and self-efficacy of patients with ACS.

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AIMS: Ostomy plays an important role in management of medical conditions, especially postoperative status of colorectal and bladder cancers. Nurses who have the highest contact level with these patients, face many situations while providing care and need to acquire adequate knowledge and practice responding to patients' needs. The aim of this study was to explore the lived experiences of nurses in caring of abdominal ostomy patients. DESIGN: A qualitative content analysis study. METHODS: In this qualitative content analysis study, 17 participants were selected using purposeful sampling method and data were collected through in-depth and semi-structured interviews. Data analysis was done using conventional content analysis method. RESULTS: Analysis of the findings led to the emergence of 78 sub-subcategories, 20 subcategories and seven main themes, including 'Inefficient educational system', 'Nurse Characteristics', 'Workplace challenges', 'Nature of ostomy care', ' Counseling and preparation of patients for surgery', 'Acquaintance with ostomy complications', and 'Proper planning of patient education'. Results showed that nurses in surgical wards provide non-special ostomy care due to lack of sufficient knowledge and skills and absence of up-to-date and local clinical guidelines which is vital to provide evidence-based scientific care and avoid unfounded and arbitrary care.

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BACKGROUND: With the increase in the elderly population in the world and the consequent increase in diseases and their physical and mental problems, improving self-care behaviors by increasing self-efficacy in the elderly plays an important role in promoting their health and can increase their life satisfaction. This study aimed to investigate the effect of self-care self-efficacy program on life satisfaction of the elderly referred to selected health centers in Isfahan, Iran, in 2014. MATERIALS AND METHODS: This study was a quasi-experimental study with two experimental and control groups and was performed on 64 elderly people referred to selected health centers in Isfahan. The samples were randomly divided into experimental and control groups, and a self-care self-efficacy program was performed on the experimental group. Data collection tools included demographic information questionnaire and life satisfaction indexes A questionnaire. Data were analyzed using the statistical tests such as Chi-square, independent t-test, Mann-Whitney, repeated measures analysis of variance, and Least Significant Difference (LSD) post hoc test. RESULTS: There was no significant difference between the two groups in terms of demographic characteristics. Before the intervention, the mean score of life satisfaction was not statistically significantly different between the two groups (P = 0.88). However, immediately and 1 month after the intervention, the mean score of life satisfaction in the experimental group increased, and this score was significantly different between the two groups (P < 0.001). CONCLUSIONS: The results of this study showed that the self-care self-efficacy program has been effective in increasing the life satisfaction of the elderly. Therefore, using this self-care self-efficacy program is recommended to promote life satisfaction in the elderly.

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BACKGROUND: The objective of the present research was to assess the influence of self-compassion training on the self-efficacy of clinical performance in nursing students, owing to the significance of proposing novel approaches to ameliorating efficiency in nursing students, underscoring the growth of positive psychologic aspects, such as self-compassion. MATERIALS AND METHODS: The present study is a field research conducted in 2016 where 52 internship nurses were chosen via simple random sampling and were randomly divided into two groups (intervention and control); these two groups were compared in two phases: Prior to and following the intervention. Self-efficacy of clinical performance, as a standard questionnaire, was collected from the samples. Data were analyzed through the use of paired t-test, independent t-test, Chi-square, Mann--Whitney tests. RESULTS: Independent t-test indicated that, compared with the control group, the efficaciousness of students' self-efficacy of clinical performance in the intervention group noticeably increased (t 54= 6, p < 0.001). CONCLUSIONS: In nursing students, self-compassion training enhances their effective clinical performance.

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BACKGROUND: Nursing adverse events (AEs) are well-defined problems in the healthcare system and may have irreparable consequences. Due to the complexity of care, many factors contribute to AEs and affect patient safety, one of which is occupational stress. The present study aimed to determine the relationship between nursing AEs and occupational stress in nurses in centers affiliated to Isfahan University of Medical Sciences, Isfahan, Iran, in 2015. MATERIALS AND METHODS: In this descriptive correlational study, the participants were selected through random and quota sampling methods. The data collection tool was a three-part questionnaires consisting of a demographic characteristics form, the Nurses' Job Stress Questionnaire, and Nursing Adverse Events Questionnaire. Descriptive and analytical statistics were used to analyze the data in Statistical Package for the Social Sciences software. RESULTS: Among the four factors affecting occupational stress in nurses, administrative factors had the highest impact; subsequently followed, by environmental factors and interpersonal factors. The mean score of AEs was reported as 30 cases per year. There was a significant correlation between the overall mean score of occupational stress and AEs (r = 0.12, p = 0.04). CONCLUSIONS: According to the results of this study, moderate to high levels of job stress were observed among nurses. The results also showed that occupational stress can lead to nursing AEs. Given that nurses believe the highest mean of occupational stressors is related to administrative factors, an appropriate and comprehensive leadership is necessary to improve the current conditions.

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BACKGROUND: Prehypertension is one of the cardiovascular disease predicators. Management of prehypertension is an appropriate objective for clinicians in a wide range of medical centers. Massage therapy is primarily nonpharmacological treatment that is used to control blood pressure (BP). This study intends to investigate the long-term effect of massage therapy on BP in prehypertensive women. METHODS: This was a single-blind clinical trial study conducted on 50 prehypertensive women who referred to Sedigheh Tahereh Cardiovascular Center, during 6 months in 2009. Participants were selected by simple random sampling and were divided into control and intervention groups. The test group (25 patients) received massage for 10-15 min, three times a week for 10 sessions, and the control group (25 patients) was relaxed in the same environment but with no massage. Their BP was measured before and after each session and 72 h and 2 weeks after finishing the massage therapy. Analyzing the data was done using descriptive and inferential statistical methods (Chi-square, Mann-Whitney, paired t-test, and Student's t-test) through SPSS software version 18 and a significant level was considered as P < 0.05. RESULTS: The results indicated that the mean systolic BP (SBP) and diastolic BP (DBP) in the massage group were significantly lower in comparison with the control group (P < 0.001). Evaluation of durability of the massage effects on BP also indicated that 72 h after finishing the study, still there was a significant difference between the test and control groups in SBP and DBP (P < 0.001), but after 2 weeks, there was not a significant difference in SBP and DBP (P > 0.05) between the two groups. CONCLUSIONS: Although massage therapy seems to be a safe, effective, applicable, and cost-effective intervention to control BP of prehypertensive women, its effects do not persist for a long time.

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PURPOSE: Ostomy patients suffer from many physical and mental problems, which can be solved to a large extent with the help of education and follow-up programs. These follow-ups can be done in person or on the telephone by the nurses, or even, by sending a text message that is an easier way for the patients to adapt to their condition. This study aimed to investigate the effect of an interactive follow-up program on the adjustment of ostomy inpatients after being discharged. METHODS: This study is a clinical trial, conducted on 64 ostomy patients who were discharged from the surgical wards of the hospital affiliated to Isfahan University of Medical Sciences. Subjects in the experimental group participated in a 6-week follow-up program via text message. The information about the patients were collected by Olbrisch Ostomy Adjustment Scale. RESULTS: The obtained results have suggested that 34.4% of the patients in the experimental group and 28.1% of the patients in the control group were female. Before the intervention, comparing the mean score of ostomy adjustment and its dimensions in the two groups showed no significant difference (P > 0.05). However, a significant difference was observed between the two groups immediately after the intervention (P < 0.05) and 1 month after the intervention, except for dimension of negative acceptance (P > 0.05). CONCLUSIONS: The findings of this study suggested that using SMS can be considered as a proper tool or method for following up the ostomy patients.

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BACKGROUND: High blood pressure is the greatest risk factor of death, and patients should manage to control it. Peer support program is used to control chronic diseases. This study aims to determine the effect of peer support program on adherence to the regimen in patients suffering from hypertension. MATERIALS AND METHODS: This study is a clinical trial conducted among 64 patients with hypertension referring to the Hypertension Research Center (Isfahan. Iran). The information was collected in three stages - before the start of intervention, immediately after, and 1 month after the intervention using a questionnaire of adherence to the treatment regimen for high blood pressure. The questionnaires were filled using a questioning method by patients who were not aware of the study. The experimental group attended 6 sessions of the peer support program (1 hour), and the control group attended two sessions held by the researcher. Data were analyzed using the Statistical Package for the Social Sciences version 18 software, and statistical tests were analyzed using independent t-test and analysis of variance with repeated measures. RESULTS: Before the intervention, there was no significant difference in adherence to the treatment regimen score between the two groups regarding the three aspects of medication regimen, diet, and activity program. Increase in scores of control group immediately after and 1 month after peer support program was higher (p < 0.001) compared to before the intervention. CONCLUSIONS: This study showed that peer support programs had a positive impact on adherence to the treatment regimen in patients suffering from hypertension.

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BACKGROUND: Lifestyle modification is an essential factor in the promotion of health in patients with acute coronary syndrome (ACS). One of the interventions to promote lifestyle is interactive follow-up, which, according to the traditional methods, requires spending significant amount of time and cost. Therefore, this study aimed to determine the effectiveness of interactive text message follow-up on health promoting lifestyle of patients with ACS. MATERIALS AND METHODS: This was a randomized controlled trial among 100 patients suffering from ACS during October-February 2016. The participants were randomly assigned to the experimental and control groups. Collection of data on lifestyle was performed before, 3, and 4 months after the beginning of the intervention using Walker's Health Promoting lifestyle questionnaire. Six messages were sent to the intervention groups each week, and participants asked the questions by sending text message, each week 1 message were sent to the control group for 12 weeks. The statistical analysis of data was performed using independent t-test, Chi-square, Mann-Whitney U test, and repeated measures analysis of variance (ANOVA). RESULTS: Before the intervention, there was no significant difference between the mean score of lifestyle of the two groups, however, 3 months and 4 months after the beginning of the intervention, the mean score of lifestyle in the intervention group was significantly higher than that of the control group (P < 0.001). CONCLUSION: The interactive text message follow-up is effective in promoting the lifestyle of patients with ACS and can be considered in the planning of follow-up of patients with ACS.

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BACKGROUND: Increased level of blood lipids is one of the risk factors for cardiovascular diseases. Considerable research has done to assess the effects of physical exercises on lipid profile, of which aerobic exercises are the main part of evidence. However, in recent years, resistance exercise has been less investigated. Thus, the present study investigates the effect of resistance exercise on lipid profile in coronary artery disease patients. MATERIALS AND METHODS: This study was a randomized clinical trial. Forty eligible participants were selected through selective sampling and were assigned randomly to either intervention or control groups (20 participants in each group). Fasting blood sample was taken for measurement of lipid profile before, after, and after 4 weeks of the end of intervention. The intervention period lasted 8 weeks and included two exercise sessions of 45-60 minutes per week. Resistance exercise was performed by use of light weights in the range of motion of the elbow, shoulder, and knee joints. The number of repetitions was initially 10 and was gradually increased to 15. Then, the weight was increased by 3-5% and the number of sets too. Data were analyzed on significant level of P < 0.05. RESULTS: In both the groups, the mean and mean changes of lipid profile, before, after. and 4 weeks after the end of the intervention were not significantly different (P < 0.05). CONCLUSIONS: The 8-week of resistance exercise did not lead to a significant decrease in the mean lipid profile.

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BACKGROUND: Performance appraisal is an essential component of health care organizations for the improvement in quality of patients' care. Awareness of managers' and employees' perception of performance appraisal can lead to improved performance appraisal quality. The purpose of this study was to compare the perception of performance appraisal among managers and nursing staff of hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. MATERIALS AND METHODS: This descriptive-analytical and cross-sectional study was conducted among 75 managers and 313 nurses in 2014. The participants were selected through a two-stage quota-random sampling. Data were collected using two researcher-made questionnaires (nursing managers and nurses' questionnaires). Data were analyzed using descriptive and statistical tests using the Software Package for the Social Sciences software. RESULTS: The mean score of managers' and nurses' perception of the current performance appraisal was 56.8 (14.2) and 51.4 (14.5), respectively. A significant difference was observed between managers' and nurses' perception of performance appraisal (P = 0.004). The participants' perception was examined in terms of performance appraisal method, the consequences of performance appraisal, and the necessity of performance appraisal. In general, perception of managers was more positive than employees. CONCLUSIONS: The evaluation of the perception of nurses revealed deficiencies in the process of performance appraisal. Moreover, managers had a more positive perception than employees toward the current pattern of performance appraisal. The results of this study can be effective on the decisions of authorities in this field.

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BACKGROUND: Coronary artery diseases and therapies such as coronary angioplasty would lead to changes in the quality of life in patients. The aim of this study was to determine the effects of collaborative care model on the quality of life in patients after coronary angioplasty. METHODS: This randomized controlled clinical trial was conducted in Isfahan, Iran during 2015. In this study, 50 samples were selected by simple sampling and randomly allocated into two equal groups of intervention and control. Collaborative care model was performed in the intervention group for 3 months. Data were collected using quality of life (SF-36) questionnaire which includes 36 questions on physical and psychological dimensions and was completed before and one month after the intervention in both groups. Data were analyzed using descriptive and analytical statistics and by independent t- test, paired t test, Chi square and Mann-Whitney tests through SPSS 18. RESULTS: After the intervention, the mean score of quality of life in the intervention group was significantly higher than the control group (P<0.05). The results of independent t-test showed a significant difference between both groups regarding the mean of changes in the score of quality of life and its dimensions in patients undergoing coronary angioplasty 3 months after the intervention (P<0.001). CONCLUSION: Results revealed that patients who had been cared based on collaborative care model had better scores of quality of life in all the physical, mental and social dimensions than the control group. Therefore, using this model for taking care of patients after coronary angioplasty is recommended. Trial Registration Number: IRCT2015120120912N4.

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CONTEXT: Successful aging is a pattern of aging that has gained much attention during recent years. One factor that has a negative impact on successful aging variables is hypertension. The phenomenon of aging when accompanied with hypertension promotes spiritual needs. The aim of this study was to examine the effect of the Islamic spiritual program on successful aging in elderly patients with hypertension who were referred to health centers of Isfahan, Iran, in 2014. SETTINGS AND DESIGN: This study was a randomized clinical trial. MATERIALS AND METHODS: The participants (52 elderly patients with hypertension) were randomly divided into experimental and control groups. While the control group received training related to health promotion, the Islamic spiritual program was implemented in the experimental group for eight sessions in two health centers of Isfahan. The data collection tools consisted of the 12-item General Health Questionnaire developed by Goldberg and the satisfaction with life scale developed by Diener. The questionnaires were completed in three steps; pretest, posttest, and follow-up (1-month). STATISTICAL ANALYSIS USED: Data were analyzed using SPSS statistical software version 20 and Chi-square, independent t-test, and repeated measures ANOVA. RESULTS: Statistical tests showed that the mean score of general health and life satisfaction of the experiment group had a meaningful difference from that of the control group in the posttest stage (P < 0.001). This difference was also meaningful in the follow-up stage (P < 0.001). CONCLUSION: The results of the study indicated the effectiveness of an Islamic spiritual program on successful aging variables.

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BACKGROUND: Depression is not only common after menopause, but also affects postmenopausal women more than other women. Some studies show the positive effects of spiritual intervention on postmenopausal women and depressed patients. However, there is inadequate experimental data for supporting the effectiveness of such interventions. OBJECTIVES: This study investigated the effect of a spiritual intervention on postmenopausal depression in women referred to urban healthcare centers in Isfahan, Iran. PATIENTS AND METHODS: A randomized controlled clinical trial was conducted on postmenopausal women referred to the healthcare centers of Isfahan. Sixty-four women with postmenopausal depression were assigned randomly into an experimental group (n = 32) and a control group (n = 32). The experimental group received eight sessions of spiritual intervention while the control group received two sessions of training on healthy diet for postmenopausal women. All subjects in the experimental group and the control group responded to the Beck's depression inventory at the start of the study, at the end of the fourth week, and a month after the last educational session. In addition to descriptive statistics, the chi-square test, independent samples t-test and repeated measures analysis of variance were used to analyze the data. RESULTS: Before the intervention, the study groups did not differ significantly in terms of mean depression scores (20.76 ± 4.61 vs. 19.58 ± 5.27, P = 0.33). However, immediately after intervention and after one month, the mean depression scores of 11.01 ± 7.85 and 11.21 ± 9.23 in the experimental group were significantly lower than the control group (19.22 ± 4.94 and 19.34 ± 4.92, respectively) (P = 0.001). In repeated measures analysis of variance, Mauchly's test of sphericity was not significant (P = 0.672), and in the test of within-subjects effects, a significant interaction was found between the spiritual intervention and time. CONCLUSIONS: Spiritual intervention effectively could reduce the severity of postmenopausal depression. Considering the high prevalence of depression in postmenopausal women and the effectiveness, simplicity, and affordability of spiritual intervention, using such interventions in postmenopausal women is recommended.

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BACKGROUND: Cardiac self-efficacy is an essential factor in persistence of healthy behaviors in patients with coronary artery disease (CAD). Today, telenursing methods have numerous applications in health care. Therefore, this study aimed to determine the effect of a text message and telephone follow-up program on cardiac self-efficacy of patients with CAD. MATERIALS AND METHODS: This was a randomized controlled trial on 70 patients with CAD who were hospitalized in Shahid Chamran Hospital (Isfahan, Iran). The participants were randomly assigned to the experimental and control groups. Collection of data on cardiac self-efficacy was performed before, 3 months after, and 4 months after the beginning of the intervention using Cardiac Self-Efficacy Scale designed by Sullivan et al. During the 3 months of intervention, six messages were sent to the subjects each week and calls were made twice a week in the first month and once a week during the second and third months. The statistical analysis of data was performed using independent t-test, Chi-square, Mann-Whitney U test, and repeated measures analysis of variance (ANOVA). RESULTS: Before the intervention, there was no significant difference between the mean scores of cardiac self-efficacy of the two groups. However, 3 months and 4 months after the beginning of the intervention, the mean score of cardiac self-efficacy in the experimental group was significantly higher than in the control group (P < 0.001). CONCLUSIONS: The text message and telephone follow-up program is effective in promoting the cardiac self-efficacy of patients with CAD.

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BACKGROUND: Heart failure is one of the most important and prevalent diseases that may have negative effects on the quality of life (QOL). Today, the promotion of QOL in patients with heart failure is important in nursing care programs. This research aimed to determine the efficacy of hope-promoting interventions based on religious beliefs on the QOL of patients with congestive heart failure (CHF). MATERIALS AND METHODS: In this randomized clinical trial (IRCT2014100619413N1) conducted in Isfahan, Iran, 46 adult patients with CHF were selected and randomly assigned to study and control groups. Ferrans and Powers Quality of Life Index (QLI) was completed by both groups before, immediately after, and 1 month after the intervention. For the study group participants and their families, 60-min sessions of hope-promoting interventions based on religious beliefs were held twice a week for 3 weeks. Independent t, repeated measures analysis of variance (ANOVA), Chi-square, Mann-Whitney, and Fisher's exact tests were adopted for data analysis. RESULTS: The mean (standard deviation) overall QOL score in the area of satisfaction significantly increased in the study group, compared to the controls, immediately [70.7 (8.5) vs. 59.2 (12.5)] and 1 month after the intervention [75.2 (7.4) vs. 59.4 (12.9)] (P < 0.05). There was also a similar difference between the two groups in the area of importance immediately [73.6 (5.8) vs. 65.7 (7.5)] and 1 month after the intervention [76.3 (8.1) vs. 66.8 (8.5)] (P < 0.05). CONCLUSIONS: Hope-promoting intervention based on religious beliefs is a useful method for improving QOL in patients with CHF.

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BACKGROUND: Lack of spiritual health in patients with hypertension leads to many mental, social, and physical effects, On the other hand, considering the prevalence of hypertension among the elderly, interventions to enhance their spiritual wellbeing is essential. Therefore, the aim of this study was to examine the effect of religious programs based on Islam on spiritual wellbeing in elderly patients with hypertension who referred to the health centers of Isfahan in 2014. MATERIALS AND METHODS: This study was a randomized clinical trial. The participants (52 elderly patients with hypertension) were randomly divided in to experimental and control groups. Religious program was implemented for the experimental group in eight sessions in two Isfahan health centers. Spirituality wellbeing survey (SWB) questionnaire was completed in three steps, namely, pretest, posttest and follow-up (1 month) in two groups. In the study, Chi-square test, independent t-test, and repeated-measures analysis of variance were performed for analyzing the data. RESULTS: Before the intervention, there was no significant difference between the mean scores of spiritual wellbeing, the religious dimension, and the existential aspect of spiritual wellbeing of the two groups. However in the posttest step and follow-up stage, the mean scores of spiritual wellbeing, the religious dimension, and the existential aspect of spiritual wellbeing in the experimental group was significantly higher than in the control group (P < 0.001). CONCLUSIONS: The religious program based on Islam promoted the SWB of elderly patients with hypertension; further, nurses can use these programs to promote the SWB of elderly patients with hypertension.

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BACKGROUND: One of the most important risk factors for cardiovascular disease is hypertension. 1 billion people in the world and 25-35% of the adult population in Iran suffer from hypertension. Despite the emphasis on medicational treatments, non-medicational treatments and modification of lifestyle, including physical activity and exercise, are important for the control and treatment of hypertension and lead to a reduction in cardiovascular diseases. Among the various types of exercises, resistance exercise has been considered important by the cardiologists. The present study investigates the effect of resistance exercise on mean blood pressure in the cardiovascular patients. MATERIALS AND METHODS: In a randomized clinical trial, 40 patients admitted to the rehabilitation unit of cardiovascular research center were assigned to study and control groups. Demographic data were collected. Their blood pressure values were measured and recorded once 1 day before the beginning of the intervention and another time 1 day after its completion. All study subjects participated in two 45-60 min exercise sessions for eight straight weeks. The control group followed routine rehabilitation unit protocol that was aerobic exercise. The study group subjects performed resistance exercise in addition to routine exercise. The weight was determined in the first session of the intervention. At the beginning, the number of the repetitions in the range of motion was 10, which was increased gradually to 15. After it reached 15 repetitions, the amount of weight was increased by 3-5% and the number of sets increased. RESULTS: One day before the beginning of the intervention, mean systolic blood pressure was 128.21 (15.39) mmHg in the study group and 120.00 (20.51) mmHg in the control group. Mean diastolic blood pressure was 82.50 (9.35) mmHg in the study group and 82.00 (13.11) mmHg in the control group. There were no differences between the groups in terms of mean systolic and diastolic blood pressure (P > 0.05). After the end of the intervention, mean systolic blood pressure values were 116.42 (7.18) mmHg and 112.00 (12.60) mmHg in the study and control groups, respectively. There were no significant differences between the groups (P = 0.24). Mean diastolic blood pressure values were 81.78 (7.99) mmHg in the study group and 78.25 (12.48) mmHg in the control group. There was no significant difference between the groups (P = 0.35). At the end of the intervention, mean systolic blood pressure in the study group decreased significantly (P = 0.02). CONCLUSIONS: In the present study, the effect of resistance exercise on mean systolic blood pressure showed a significant difference, caused by the aerobic exercise.

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BACKGROUND: Nursing continuing education with development of knowledge, skill, and attitude results in improvement of nursing activity, and thus improves the health care in the society. If the education is not planned and implement properly, it affects the patient care. This study was designed to explore the challenges of nursing continuing education in Isfahan University of Medical Sciences hospitals. MATERIALS AND METHODS: The research was conducted from April 2012 to February 2013 in Isfahan, Iran. The sampling was begun with purposeful method and continued with snowball method. Thirty-nine participants were selected among the nurses of Alzahra, Kashani, and Noor hospitals, nursing and midwifery faculty, continuing education center, and the vice-chancellery for treatment. The participants were both learners and planners of continuing education program. In this descriptive explorative qualitative research, we interviewed 39 participants in five focus group and five individual interviews, until data saturation was achieved. We used semi-structured interviews and field notes for data gathering, and members checking, triangulation (data and method), peer debriefing, and peer review to increase the strength of data. Data were analyzed with thematic analysis method that was proposed by Broun and Clarke in 2006. RESULTS: Data analysis produced 175 initial codes, 8 subthemes, and 5 main themes. The main themes included: Learners related factors, teachers related factors, educational process related factors, inadequate facilities, and defective evaluation. CONCLUSIONS: According to the results, we need to revise the educational process in nursing continuing education. To achieve this goal, we need a team for needs assessment, planning, and evaluation. In addition, we must pay attention to educators' and learners' issues.

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BACKGROUND: Pain is the common complication after a surgery. The aim of this study was to evaluate the effect of aromatherapy with Rosa damascena Mill. on the postoperative pain in children. MATERIALS AND METHODS: In a double-blind, placebo-controlled clinical trial, we selected 64 children of 3-6 years of age through convenient sampling and divided them randomly into two groups. Patients in group A were given inhalation aromatherapy with R. damascena Mill., and in group B, the patients were given almond oil as a placebo. Inhalation aromatherapy was used at the first time of subjects' arrival to the ward and then at 3, 6, 9, and 12 h afterward. Common palliative treatments to relieve pain were used in both groups. Thirty minutes after aromatherapy, the postoperative pain in children was evaluated with the Toddler Preschooler Postoperative Pain Scale (TPPPS). Data were statistically analyzed using Chi-square test, one-way analysis of variance (ANOVA), and repeated measures ANOVA. RESULTS: There was no significant difference in pain scores at the first time of subjects' arrival to the ward (before receiving any aromatherapy or palliative care) between the two groups. After each time of aromatherapy and at the end of treatment, the pain score was significantly reduced in the aromatherapy group with R. damascena Mill. compared to the placebo group. CONCLUSIONS: According to our results, aromatherapy with R. damascena Mill. can be used in postoperative pain in children, together with other common treatments without any significant side effects.