Advances in Nursing & Midwifery

Abstract
Introduction: Moral distress is one of the issues considered in the educational environment. That it can affect the physical, psychological, and social dimensions of individuals and access to ethical and educational goals. This study aimed to investigate the moral distress in operating room technologist students of Iran University of Medical Sciences.
Methods: This cross-sectional study was performed on Iran University of Medical Sciences' operating room technologist students in 2017. Data were collected with two questionnaires, including demographic information and a moral distress questionnaire. Data were analyzed by SPSS software using an independent t-test and one-way ANOVA (P < 0.05).
Results: In this study, 121 operating room technologist students participated. The mean score of moral distress in the scores' severity and frequency dimensions was (3.5 ± 1.76) and (3.11 ± 1.6), respectively. The results showed that only age and semester had a significant relationship with the total score of moral distress, and with increasing age and semester, students’ moral pain has decreased.
Conclusions: This study's results indicated that the moral distress in operating room technologist students was moderate, which requires investigating the factors involved in creating moral distress and providing strategies and measures to reduce its adverse effects in the educational setting.

Abstract
Introduction: The FGF-21 biomarker is an essential factor in reducing the incidence of various cancers and improving the metabolic status of individuals, and improving the metabolic of heart cells. This study aimed to assess the difference between the effect of resistance, aerobic, and combined training on the salivary levels of FGF-21 in active older men.
Methods: The present study method was semi-experimental and performed with a pre-post-test design and three experimental groups. The subjects were randomly assigned to study 36 divided into three groups 1. Resistance training, 2. Aerobic training, and 3. Combined training (n = 12). The serum FGF-21 salivary value in subjects was evaluated and recorded using special sandwich analysis methods by special kits according to the kit brochure's method. The subjects then performed relevant training protocols for eight weeks, after which the post-test data training was evaluated and recorded similar to the pretest conditions. Statistical analysis was performed using descriptive statistical tests, dependent t-test, one-way ANOVA, and Scheffe post hoc in SPSS version 24. The significant level was 0.05.
Results: The results showed that the number of salivary FGF-21 increased significantly after applying aerobic, resistance, and combined training, and this increase was 38.9%, 23.8%, and 14.7% for combined, resistance, and aerobic activity, respectively.
Conclusions: According to the findings of this study, combined exercises should be used to improve metabolic risk factors and reduce the risk of cancer due to increased FGF-21 levels in the elderly community.

Background: Considering the large number of nursing students and the need for their skills training as an internship in the field under the supervision of clinical nurses, performance appraisal plays an essential role.

Objectives: the purpose of this study is to determine the current status and evaluate the clinical performance of nursing students in the clinical field.

Methods: The present study is a descriptive cross-sectional study. The research sample includes all students of the 7th and 8th semesters of nursing who had internships in the field, of which 145 were and all of them participated in the study with satisfaction. The clinical performance evaluation checklist of Esmaili nursing students and colleagues in 2013 was used. This questionnaire has 28 questions in three areas of nursing process with 12 questions, professionalism with 9 questions and ethical principles with 7 questions. Validity The face and content validity of the instrument and its reliability were obtained by internal correlation with Cronbach's alpha / 92. SPSS statistical software version 20 was used for data analysis. Descriptive statistics were used to describe the data.

Results: The results showed that the mean and standard deviation of the total performance evaluation of 7th and 8th semester nursing students is 2.03 + - .5 which is in the average range. It was related to the scope of the nursing process with 2 + - .5. The mean score of the professional behavior range was 2.1 + - .6.

Conclusion: Findings showed that 7th and 8th semester nursing students are moderate in their performance evaluation.

Abstract
Introduction: The coronavirus (COVID-19) pandemic is a global public health crisis that started in 2020. Although health authorities believe that reducing social contact between students is necessary to protect students’ health, there is limited research on the lived experiences of school nurses caring for children and adolescents with intellectual disabilities (ID) in special schools during the COVID-19 pandemic. The aim of this study was to explore the experiences of school nurses caring for children and adolescents with ID in Hong Kong.
Methods: This study used a phenomenological research design focused on experiences, events, and occurrences. Nine school nurses working in special schools in Hong Kong shared their lived experiences of caring for students with ID during the COVID-19 pandemic. Transcripts were analyzed according to the steps in Colaizzi’s method to understand and accurately describe the experiences of school nurses.
Results: The role of school nurses during the COVID-19 pandemic was complex and multi-dimensional. Three themes emerged from the interview data: (1) the unpredictable and uncertain situation of COVID-19, (2) the extreme emotions experienced while caring for students during the outbreak of COVID-19, and (3) the inevitability of committing nursing errors during the outbreak of COVID-19.
Conclusions: This study provided first-hand insights into nurses’ experiences in caring for students with special health needs during the COVID-19 pandemic. The findings indicated that continuous support from school organizations is needed to enable school nurses to care for students and their parents during a public health crisis, and to help school nurses to cope with unpredictable situations.

Abstract Introduction: Diagnosis and understanding of patient conditions require nurses 'clinical reasoning skills, as in the absence of this skill; the nurses will not be able to diagnose the patients' condition and will impose harmful consequences on the patient. The purpose of this study is to evaluate and compare the clinical reasoning skills of the nursing students at Shahid Beheshti University of Medical Sciences at the end of theoretical courses in medical-surgical nursing in 2018. Methods: In this descriptive-comparative study, 150 nursing students from freshmen, sophomores, and juniors studying at the Faculty of Nursing and Midwifery of Shahid Beheshti University of Medical Sciences were selected by stratified sampling method. Students in each year comprised one category and the total number of was 3, also the number of students per category was 50, and the total number of categories will be equal to 9. Data were collected using a researcher-made questionnaire employing Key Feature Problem (KFP) method and analyzed using descriptive statistics by SPSS V.20 software. Results: The results showed that there is a significant difference between the grades of third-year students and those in their first and second years of study (P <0.001). Based on the results, the clinical reasoning skill in the first year was poor (51.59 ± 0.06%), in the second year was very weak (48.41 ± 0.09%) and in third-year students was very weak (37.62 ± 0.88). Also, the average skill of clinical reasoning of all students was very weak with a mean percentage of 46.01%. Conclusions: The findings indicate that the level of students' clinical reasoning skills has been declined comparatively from freshmen to juniors. In general, the level of clinical skills in nursing students of Shahid Beheshti University of Medical Sciences is disappointingly low.