Advances in Nursing & Midwifery

Currently, the nursing care paradigm in confronting Emerging Infectious Diseases (EIDs)—such as COVID-19, pandemic influenza, and other novel viruses—has shifted from purely experiential practice to precise science and clinical evidence. Under these circumstances, the nurse serves not merely as a caregiver but as the frontline in identifying, controlling, and managing such crises. Nursing interventions must be executed based on the latest guidelines from the World Health Organization (WHO) and national protocols [1], following a distinct hierarchy of priorities.

The primary objective entails infection control and the severance of transmission chains; consequently, bio-safety takes precedence over all therapeutic interventions. Scientific evidence demonstrates that failure in infection control precipitates the collapse of healthcare systems. To this end, the rigorous implementation of standard isolation measures, tailored to transmission routes (droplet, airborne, contact), is imperative [2]. This includes the selection of appropriate Personal Protective Equipment (PPE)—specifically respiratory protection for airborne infections and fluid-resistant gowns for patients presenting with diarrhea caused by emerging viruses. Furthermore, modern nursing leadership is critical in navigating these crises [3].

Subsequent measures focus on the management of patient "cohorting." This involves segregating suspected cases from confirmed ones, and symptomatic patients from asymptomatic carriers, to prevent nosocomial infections. Furthermore, education and strict supervision regarding hand hygiene and PPE usage are emphasized, particularly the direct monitoring of "donning" and "doffing" procedures by other healthcare personnel, given that the highest risk of contamination occurs during the exit process.

Secondary Priority: Rigorous clinical surveillance and the early identification of clinical deterioration are paramount. Given that the clinical trajectory of emerging diseases is often unknown, modern nursing emphasizes the utilization of standardized screening tools. Through the application of early warning scores, regular monitoring of vital signs (every 4–8 hours or more frequently as indicated), and continuous screening, nurses can anticipate septic shock or respiratory failure prior to the onset of catastrophic events. Subtle changes in blood pressure or respiration may signal the onset of acute respiratory distress syndrome (ARDS). Therefore, precise monitoring of pulmonary function and targeted oxygen therapy are essential. This involves the use of accurate pulse oximetry and SpO2 monitoring, alongside the implementation of "Awake Proning" strategies for severely ill patients requiring oxygen. Research indicates that the prone position in conscious patients receiving oxygen therapy reduces the necessity for mechanical ventilation [4]. Concurrently, monitoring for thromboembolism and coagulopathies—by assessing limb appearance, skin (petechiae), and Glasgow Coma Scale (GCS)—facilitates the early detection of blood clots, which are highly prevalent in novel viral infections.

Tertiary Priority: Protocol-based pharmacological management and the control of adverse effects are critical. As treatments for emerging diseases are often experimental or combination therapies, the nurse's role in medication safety is vital. This involves the precise administration of antiviral or corticosteroid therapies, ensuring strict adherence to timing, and monitoring for side effects such as hyperglycemia or hepatic and renal dysfunction. Additionally, fluid management and detoxification are pursued to prevent fluid overload, which can lead to pulmonary edema, utilizing fluid balance scales and central monitoring for critically ill patients. In later stages, palliative care and the management of drug complications become the focus; should new treatments induce severe adverse effects, the nurse must be the first to identify symptoms and alert the specialist.

Quaternary Priority: Psychosocial and communicative support (stress and isolation management) is integrated into the care plan. Communicable infectious diseases are invariably accompanied by fear, social stigma, and isolation. Modern nursing regards mental health as equivalent to physical health. Interventions to mitigate isolation stress include facilitating patient-family communication via technology, providing calm and supportive status updates, and ensuring a tranquil environment within the isolation room. Furthermore, the management of psychiatric sequelae—such as sepsis-associated encephalopathy or drug-induced delirium—is implemented using ICU delirium assessment scales. The prevalence of mental health symptoms among healthcare workers and patients during such pandemics is significant, necessitating proactive psychological support [5]. Establishing a regular sleep-wake cycle by minimizing light and noise at night, alongside providing psychological support to families through regular, transparent reports (even telephonically) to alleviate their anxiety—which directly impacts the patient's mental health—is essential.

Quinary Priority: The issue of self-care and nurse resilience (Sustainability of Care) is addressed. It is axiomatic that an exhausted and impaired nurse cannot provide scientific care. Therefore, nurses must attend to self-care by managing energy and work schedules, adhering to ergonomic principles, and ensuring rest between shifts to prevent medical errors induced by fatigue. Monitoring staff health is also a crucial supportive measure; conducting regular screening tests and vaccinating healthcare personnel based on occupational safety principles significantly contributes to the nurse's capacity for self-care.

In summary, evidence-based nursing in emerging infectious diseases represents an integration of "clinical expertise," "current research," and "patient preferences." The prioritization of actions commences with environmental safety, progresses to precise physiological monitoring, and culminates in psychosocial support. Through this approach, the specialist nurse not only saves the patient’s life but also breaks the chain of transmission within the community and preserves the healthcare system from collapse.

DEAR EDITOR,
Narrative medicine was introduced in the early 2000s by Rita Charon as a method to better understand patients by listening to and interpreting their stories of illness. However, its application is not limited to the medical profession alone it emphasizes the need for the nursing community to be equipped with narrative knowledge as well. A narrative is someone telling someone else that something happened. Narrative knowledge is what we use to understand the meaning and significance of the patient's story [1]. Narrative nursing, as a human-centered nursing intervention, focuses on listening to, understanding, and interpreting patients’ narratives in order to provide more holistic, personalized, and high-quality care. It fosters a deeper and more empathetic relationship between the nurse and the patient [2]. In other words, narrative nursing is based on active listening, deep understanding of lived experiences, and reflection of those experiences in care delivery, treating the patient’s story as a valuable source of human-centered care [3].
Children in accordance with their age and cognitive development, also have their own narratives about their illness, treatment, and the hospital environment. Narrative nursing in pediatric care carries particular significance and complexity, as children have specific cognitive, emotional, and linguistic needs at each developmental stage. While children’s lives are impacted by illness just like adults, they often lack the skills to articulate themselves clearly. Their emotions, hopes, needs, anxieties, fears, preferences, and perceptions may be expressed in vague or nonverbal ways. Nurses must consider that a child’s cognitive and language development greatly affects how they express and narrate their experiences, and thus, narratives must be accessed through multiple channels [4].
Children often use tools such as play, drawing, storytelling, or even silence to express fears and make sense of their illness. These narrative forms offer an opportunity for the nurse to act as a listener and supporter [4]. Nurses can utilize age-appropriate and creative techniques including art, drawing, photography, video, interviews, puppetry, crafts, journaling, and storytelling to hear the child's voice. This enables them to access deeper layers of the child's illness experience and provide comprehensive and individualized care to both the child and the family. In addition, families play a crucial role in the narrative of a child’s illness and treatment. Often, the child’s narrative alone is insufficient, and parents act as narrative mediators. Using narrative nursing in collaboration with parents enhances family-centered care, fosters a better understanding of cultural context, values, and psychological challenges, and facilitates participatory care [4]. Studies show that narrative nursing improves adaptation to illness, reduces anxiety, enhances cooperation, and leads to better clinical outcomes in children [3, 5]. It also reduces negative emotions and increases family satisfaction with nursing care [4]. Analyzing and interpreting children’s narratives in narrative nursing means uncovering hidden messages, emotions, and actual needs conveyed through their stories. Nurse reflection on those narratives is a vital tool for understanding the implicit content and offering more humanized care [6]. Qualitative analysis methods, such as content analysis, can be effectively used in this context [7].
In short, in pediatric care, we must recognize that children, in their own language and ways, can be credible narrators of their lived experiences. Narrative nursing in child and family care is an innovative approach that identifies and addresses nursing problems and diagnoses based on the narratives of children and their families. The health system in Iran faces several challenges, including a shortage of human resources, heavy workloads, a predominant focus on the patient’s physical condition, and insufficient training in narrative nursing within pediatric hospitals. It is recommended to foster a culture among healthcare teams that values the importance of children’s narratives, conduct training workshops for nurses on narrative nursing, and teach techniques for receiving and understanding the stories of hospitalized children. Training pediatric nurses in
narrative-based approaches enhances their empathy,
holistic care abilities, and communication with children
and families moving the nursing profession one step
closer to truly humanized and child-centered care.
AUTHOR CONTRIBUTIONS
Fatemeh Ebrahimpour conceived the idea, prepared the first draft of the manuscript, and performed the revisions and finalization of the manuscript.
FUNDING
There is no funding or support.
CONFLICT OF INTEREST
There is no funding or support.

Abstract
Introduction: Marital satisfaction and justice are crucial components of a healthy marriage, yet little is known about the psychological factors that may influence this relationship. Understanding the role of anxiety in the relationship between marital satisfaction and justice can provide valuable insights into the dynamics of marital relationships and inform interventions to improve marital well-being. This research aims to investigate the direct and indirect effects of marital justice on marital satisfaction, with anxiety as a potential mediator, among married students.
Methods: This descriptive study employed structural equation modeling (SEM). A sample of 356 married students from Azad University, Ahvaz, Iran, was selected in 2023 using stratified random sampling. Research instruments included the Marital Satisfaction Scale, Marital Justice Scale, and State-Trait Anxiety Inventory. Data were analyzed using SEM with SPSS-26 and Amos-26 statistical software.
Results: The results indicated that marital justice had a significant negative correlation with anxiety (β=-0.21, P=0.002). Additionally, both marital justice (β=0.25) and anxiety (β=-0.19) were significantly correlated with marital satisfaction (P<0.01). The results also indicated an indirect relationship between marital justice and marital satisfaction through the mediation of anxiety (P=0.011).
Conclusions: The study found a strong negative correlation between marital justice and anxiety, indicating that increased marital fairness leads to decreased anxiety. Additionally, the research confirmed that marital justice positively impacts marital satisfaction both directly and indirectly by reducing anxiety levels.

Introduction: The elderly population’s doubling, the prevalence of chronic diseases, and the increase in the number of deaths constitute the current and the future image of global health. The increase in the demand for Home Health Care (HHC) has attracted the attention of not only governments, but also economic enterprises for the development of HHC centers. This study aims to investigate and collect HHC quality evaluation indicators in the existing studies through conducting a scoping review study.
Methods: This study is a scoping review that investigates the extent of the research conducted in the field of HHC quality indicators and written based on the PRISMA-ScR Checklist. The inclusion criteria consisted of the study’s being written either in English or in Farsi, the study’s focusing on the structure and process of HHC monitoring or the results regarding HHC quality monitoring. Therefore, descriptive, multi methods and mix methods studies were included in the study. The search was conducted on studies that were published between January 1, 2000 to March 31, 2022. The data extracted from the included studies were re-examined by all the authors. The quality of extracted review studies was checked with PRISMA checklist, qualitative studies with COREQ and descriptive studies with STROBE checklist.
Results: Out of 4977 extracted publications, 37 were finally included in the present study. Based on the findings of the included studies, HHC quality evaluation indicators were classified into three areas: structure (Appropriate physical space, equipment, and sufficient facilities- Effective document management system- Supply, and development of workforce), process (Patient-Centered Approach-Establishing safety and reliability- Efficient and timely support -Continuous Quality Improvement) and outcome (Functional Indicators-Clinical Indicators-Social indicators).
Conclusions: This scoping review identified a comprehensive set of quality indicators for evaluating Home Healthcare (HHC), categorized into structure, process, and outcome domains. Common indicators include hospital readmission rates, unplanned emergency visits, functional status, symptom management, and patient satisfaction. Tools such as RAI-HC and OASIS are widely used for standardized assessment. The Efficiency Index (EI) helps compare service quality across HHC providers and informs policy decisions. Additionally, local, culturally-sensitive tools -especially for regions with religious considerations- should be developed and psychometrically validated. Ensuring appropriate infrastructure, effective documentation, and skilled workforce is also essential for quality care.

Abstract
Introduction: Given the widespread use of e-learning during the COVID-19 pandemic and the post-pandemic period—particularly in the critical field of medical sciences—examining students' perspectives on factors influencing e-learning quality is essential. The present study was conducted to investigate medical sciences students' perspectives on the factors affecting e-learning quality.
Methods: In this descriptive cross-sectional study, 854 medical sciences students at Alborz University of Medical Sciences, Karaj, Iran, were selected using convenience sampling between January and May 2022. The data collection instrument was a researcher-developed questionnaire comprising two sections: demographic information and factors influencing e-learning quality. After data collection, the data were analyzed using SPSS version 20, employing descriptive and inferential statistics at the P ≤ 0.05 significance level.
Results: The mean score for instructor-related factors was 141.64 ± 19.41 (range: 35–175); for factors related to the educational content delivered, it was 55.32 ± 7.84 (range: 13–65); and for factors related to facilities, equipment, and infrastructure, it was 26.52 ± 3.63 (range: 6–30). Based on the results of the Friedman test, the highest-ranked domain was "factors related to facilities, equipment, and infrastructure". Among all dimensions, the items with the highest mean scores were as follows: teaching skills, mastery of the subject matter, ability to integrate theoretical and clinical content during instruction to facilitate better understanding, clear presentation of key and practical points in the instructional content, alignment between the amount of educational content and the learning objectives, scientific accuracy of the content, and inclusion of up-to-date material, the functioning microphone and uninterrupted audio, adequate internet speed, and availability of online class recording.
Conclusions: The development of adequate technical infrastructure, targeted investment, and the establishment of clear standards for evaluating learners' performance are essential for the effective utilization of e-learning. It is recommended that educational authorities and policymakers focus their efforts on enhancing the infrastructure of educational platforms and improving internet speed and quality. Additionally, organizing training workshops for faculty members on the principles of designing and conducting online classes, as well as producing standard electronic content, can contribute to improving instructors’ teaching competencies and better addressing students’ learning needs.

Abstract
Introduction: Multiple sclerosis is one of the most prevalent debilitating neurological diseases among
young people. Multiple sclerosis is a multifactorial disease in which both environmental and genetic
factors are involved. Despite numerous studies conducted in this field, it remains a challenging topic.
Therefore the present study aimed to explore the environmental factors associated with multiple
sclerosis.
Methods: This case-control study was conducted in 2020-21 in three geographical areas of Iran. A
total number of 445 subjects were included in the study, among whom 172 belonged to the case group
and 273 to the control group. The inclusion criteria for patients were the confirmation of the disease
by a neurologist, the age range from 15 to 50 years, full consciousness, not having acute or critical
conditions of MS disease. The inclusion criteria for healthy subjects were not having the MS, not having
any neuro-inflammatory peripheral disease, not having a cancer. The patient participants were
randomly selected from the medical records of the MS Association of each city. The control group was
randomly selected from among the people visiting the medical centers of each city. The collected data
were punched into SPSS 20. Descriptive and inferential statistics including mean, standard deviation,
frequency and chi-square were used to describe the research variables. Mann-Whitney U-test was used
to compare the mean of interval variables in two groups, and chi-square test was used to determine the
relationship between qualitative variables in two groups. A logistic regression analysis was used to
estimate the relationship between risk factors and the disease.
Results: There was a significant difference between the two groups in terms of the duration of
sunbathing , OCP, gender , history of blood transfusion , family history of MS , history of crisis , physical
activity before illness , history of accident , job, ethnicity, predominant type of cooking, consumption
of liquids and tea, salt consumption, Infant nutrition, consumption of vegetables and chicken,
consumption of canned food, dairy products, nuts and beans (p<0.05).Bivariate logistic regression
analysis of factors associated with multiple sclerosis showed that the most influential factors in the
disease were: positive family history, history of accidents and trauma, baby nursing, and a high-salt diet
(p <0.05).
Conclusions: The successful control of this disease depends on the identification of the complex
network of factors. Despite the many researches about the factors related to MS, it seems that this issue
has many complications and detailed and advanced studies should be done in this field. By better
understanding these factors, we can create preventative strategies to reduce the risk of developing MS,
develop more effective treatments, and lessen the burden of the disease on affected individuals and
society

Introduction: Hostile attribution, interpreting a partner's ambiguous actions as
malicious, significantly contributes to marital conflict by perpetuating negative
interaction cycles and eroding trust. This investigation aimed to explore the
association between hostile attribution and divorce proneness in women, specifically
examining the mediating influence of self-differentiation.
Methods: This study adopted a cross-sectional correlational design. Data were
gathered from a convenience sample of 350 married women residing in Karaj, Iran,
during 2024. Participants completed a battery of standardized self-report measures,
specifically the Hostile Attribution Scale, the differentiation of Self Inventory, and the
Divorce Propensity Questionnaire. The collected data underwent statistical analysis
using Structural Equation Modeling (SEM) to thoroughly assess the hypothesized
direct and indirect relationships among the variables.
Results: Findings indicated a significant positive correlation between hostile
attribution and divorce proneness (r=0.40, P<0.001). Additionally, hostile attribution
was negatively correlated with self-differentiation (r=-0.30, P<0.001). Furthermore,
self-differentiation was negatively correlated with divorce proneness (r=-0.50,
P<0.001). Crucially, self-differentiation emerged as a statistically significant mediator
in the relationship between hostile attribution and divorce proneness. The structural
model demonstrated good fit (χ²/df=1.78, CFI=0.94, RMSEA=0.045).
Conclusions: These results suggest that hostile attribution contributes to a
diminished capacity for self-differentiation, which, in turn, increases a woman's
predisposition to divorce. Understanding this psychological pathway is vital for
developing targeted interventions aimed at fostering healthier relational cognitions
and enhancing marital resilience.

Introduction: Recognizing the critical role of emotional maturity and Psychological Capital (PsyCap) in marital adjustment, this study evaluated the efficacy of premarital education using Dialectical Behavior Therapy (DBT) and Acceptance in a Caregiving Relationship (ACR) approaches in enhancing these attributes among young adults preparing for marriage. Methods: The study employed a three-group quasi-experimental design to evaluate the efficacy of two distinct premarital education approaches: one grounded in DBT and another focused on ACR, in comparison to a control group. Data collection encompassed pre-test, post-test, and a one-month follow-up assessment. The target population comprised 90 young adults approaching marriage (30 per group) from marriage counseling centers in Isfahan during spring and summer 2023. Participants were recruited via convenience sampling and randomly assigned. Data were gathered using the Emotional Maturity Scale and the Psychological Capital Questionnaire. Intervention groups received eight 90-minute sessions. Data analysis utilized SPSS version 26, employing descriptive statistics and repeated measures ANOVA. Results: Both DBT and ACR interventions significantly improved emotional maturity (DBT: pre-test M=115.93 to post-test M=137.83, P<0.001; ACR: pre-test M=114.10 to post-test M=137.36, P<0.001) and PsyCap (DBT: pre-test M=71.93 to post-test M=87.16, P<0.001; ACR: pre-test M=71.50 to post-test M=83.76, P<0.001) compared to the control group, with gains maintained at follow-up. DBT showed greater PsyCap improvement than ACR at follow-up (P=0.033). Conclusions: Structured premarital education using DBT or ACR can significantly enhance emotional maturity and PsyCap in young adults, with DBT demonstrating greater efficacy in sustaining PsyCap. These findings suggest that premarital programs incorporating DBT may better equip individuals for marital resilience, while ACR remains effective for emotional maturity. Counselors should integrate these evidence-based approaches into premarital education, tailoring interventions to individual needs to optimize marital readiness.

Introduction: Patient’s Readiness for Hospital Discharge (RHD) is one of the affecting factors on implications after being discharged. So, identifying variables related to RHD is important. Nurses’ Vigilance in Care may effect on RHD. To determine the correlation between Nurses’ Vigilance in Care and Patient’s readiness for Hospital Discharge.
Methods: In this correlational study, 351 discharged patients in different wards of three educational hospitals of Kurdistan University of Medical Sciences in Sanandaj city were selected with Convenience Sampling. Before discharge, demographic form, the questionnaire of RHD and the questionnaire of Nurses’ Vigilance in Care from the patient’s point of view. The analysis of the data was conducted by the SPSS version 21 application. Frequency, Mean and standard Deviation for descriptive and spearman test to correlational was used.
Results: The findings reveal the overall score of Nurses’ Vigilance in Care was at the intermediate level at 61.84±9.91, while the overall score of the patient's RHD was at a poor level at 47.6±2.58. The results showed that nurses Vigilance in Care, higher education, being employed, having family support, and having the ability to self-care were predictor of RHD.
Conclusions: The patients’ RHD and Nurses’ Vigilance in Care weren’t in a desirable, both. Furthermore, their positive significant correlation indicates that planning is required to raise Nurses’ Vigilance in Care to increase patients’ RHD.

Introduction: Divorce represents a complex and often traumatic life event, profoundly impacting various facets of individuals' personal and social lives. Given the significant psychological challenges associated with marital dissolution, identifying factors that bolster mental well-being in divorced women is critical. This study aimed to predict mental health based on mindfulness and forgiveness in the context of divorce among divorced women.
Methods: Conducted as a descriptive-correlational study in 2024, the statistical population comprised all divorced women residing in Qom, Iran. A convenience sampling method was employed to select 209 participants from January to March 2025. Data were collected using Ryff's Psychological Well-being Scale, Mindfulness Attention Awareness Scale, and Forgiveness in the Context of Divorce Questionnaire. Data analysis was performed using Pearson correlation coefficients and simultaneous multiple regression.
Results: Findings revealed a significant positive correlation between mindfulness and mental health (r=0.35, P<0.001). Similarly, forgiveness in the context of divorce demonstrated a significant positive correlation with mental health (r=0.57, P<0.001). The multiple correlation coefficient between the predictor variables and mental health was R=0.59, explaining 35.0% of the variance in mental health. Standardized beta coefficients indicated that both mindfulness (β=0.16, p=0.008) and forgiveness in the context of divorce (β=0.51, P<0.001) were significant positive predictors of mental health.
Conclusions: The results underscore that mindfulness and forgiveness play significant roles in predicting the mental health of divorced women who often face emotional distress, financial instability, social stigma, and single parenthood challenges. These constructs can act as protective factors against the negative psychological consequences of divorce. These findings emphasize the importance of incorporating these variables into psychological interventions aimed at improving the mental health of this group, such as through culturally adapted counseling programs in community settings.

Introduction: Health literacy is a crucial determinant of preventive health behaviors;
however, its role in enhancing the effectiveness of educational interventions for
cervical cancer screening, particularly in underserved populations, remains
under-explored. This study investigated the interaction between health literacy and a
Protection Motivation Theory (PMT)-based educational intervention on Pap smear
testing among women in Muchesh City.
Methods: In 2023, a randomized controlled trial was conducted in Muchesh City,
Iran, involving 216 eligible women (aged 18–54, married for at least three years, with
no history of cancer or hysterectomy) recruited from local health centers. Participants
were stratified by health literacy level (high or insufficient), as measured by the
validated Health Literacy Assessment Tool for Iran (Cronbach’s alpha: 0.72–0.89),
and randomly assigned to intervention or control subgroups using block
randomization. The intervention group attended four 45-minute educational sessions
based on Protection Motivation Theory (PMT), while the control group received
standard information after the study concluded. Data were collected using a
Sociodemographic Information Questionnaire, the Health Literacy Assessment Tool,
and a PMT Constructs Questionnaire. Pap smear uptake was assessed three months
post-intervention. Logistic regression and the Sobel test were employed to examine
the relationships among health literacy, the intervention, and Pap smear uptake (p <
0.05), using SPSS version 26.
Results: Participants had a mean age of 31.69 ± 7.64 years. Regarding education,
34.2% had completed high school and 29.1% had completed middle school, while
92.2% were homemakers. The intervention group was significantly more likely to
undergo Pap smear testing compared to the control group (odds ratio = 2.503, 95%
CI: 2.848–9.505, p < 0.001). Additionally, each one-unit increase in health literacy
score was associated with a 2% increase in the likelihood of undergoing screening
(odds ratio = 1.020, 95% CI: 1.008–1.033, p = 0.002). Health literacy significantly
mediated the effect of the educational intervention on Pap smear uptake (Z = 2.5, p <
0.001).
Conclusions: The PMT-based educational intervention significantly increased Pap
smear uptake, with health literacy serving as a key mediating factor. These findings
underscore the importance of incorporating health literacy-oriented strategies into
cervical cancer screening programs, particularly in low-resource settings.

Introduction: Skin injuries from opening glass ampoules pose a significant threat to healthcare personnel, particularly nurses. This study investigated the effect of a tabletop ampoule opener on the incidence of these injuries among nurses at selected teaching hospitals affiliated with Shahid Beheshti University of Medical Sciences (2024-2025).
Methods: A quasi-experimental pre-test/post-test design was employed at Loghman Hakim Hospital in Tehran. The study population included nurses and nurse assistants meeting inclusion criteria. Prior to intervention, demographic and ampoule-related skin injury data were collected over six months. Subsequently, participants received training on the tabletop ampoule opener (face-to-face, posters, videos). The device was then used for six months, with ongoing skin injury data collection. SPSS version 20 was used for analysis.
Results: Notably, none of the injured were using the tabletop device at the time. Of 294 participants (254 nurses, 40 assistants; 197 female, 97 male), 103 (36.78%) reported prior skin injuries. Post-intervention, only 31 (11.07%) reported injuries, a statistically significant 25.71% reduction (P < 0.0023). Intensive care units had the highest injury incidence, infectious diseases the lowest.
Conclusions: The use of a tabletop ampoule opener significantly reduces skin injuries from ampoule breakage among nurses, demonstrating its potential as a crucial preventive tool for occupational safety in healthcare settings.

Introduction: Fetus in Fetus (FIF) is a very rare anomaly in which a single fetus develops in a living fetus. This case report aims to present the maternal and intrapartum findings, neonatal presentation, and surgical outcomes of a rare fetus-in-fetus diagnosed at term gestation.
Case Presentation: A 21-year-old primigravid woman (G1P0) at a gestational age of 39 weeks and 5 days presented to Bent-Al-Huda Hospital (A medical center) in Bojnurd with complaints of labor pain. In the fetal ultrasound examination, an abdominal mass with a spine was observed inside the abdomen, suggesting Fetus in Fetu. The diagnosis of fetus-in-fetu was made at birth, at 39 weeks and 5 days of gestation. After a normal vaginal delivery, the baby underwent surgery 7 days later and was discharged from the hospital in good general condition.
Conclusions: Fetus-in-fetu is considered a rare congenital condition resulting from aberrant embryonic division in monozygotic twin pregnancies, leading to the presence of a parasitic twin within the host. The clinical presentation varies depending on the size, location, and degree of organ differentiation of the mass, with most cases presenting as an abdominal mass in neonates. Consistent with previously reported cases in the literature, complete surgical excision remains the treatment of choice and generally leads to excellent outcomes when the mass is fully removed. The findings in our case align with prior reports emphasizing early recognition, careful imaging evaluation, and timely surgical management to prevent compressive complications and ensure a favorable neonatal prognosis.

Introduction: Competency-based education (CBE) is a contemporary teaching approach with potential impacts on clinical competence (CC). This study aimed to review and synthesize the best empirical evidence in order to evaluate the effects of CBE on knowledge and CC among nursing students and nurses.
Methods: This systematic review included studies published between 2009 and 2024 that investigated the effects of CBE in nursing. An online search was performed in the Proquest, Science Direct, Scopus, PubMed, Google Scholar, SID, Magiran, and IranMedex databases. The quality of the selected articles was assessed using the Cochrane checklist was sued for experimental studies and the Greenhalgh and colleagues’ Critical Appraisal checklist for quasi-experimental studies. Fourteen studies were included.
Results: The included studies had reported the positive significant effects of CBE on cognitive and behavioral skills, CC, learning satisfaction, special and general clinical performance, academic efficacy, metacognitive abilities, communication skills, and cognitive load among nursing students and nurses.
Conclusions: CBE significantly enhances knowledge and CC in nursing students and nurses. Nursing education authorities can use CBE to develop and implement the nursing curriculum and thereby improve the effectiveness of clinical education.

Introduction: Infertility, a prevalent global health concern, imposes significant psychological and social burdens—including stigma and distress—particularly on women, adversely affecting their well-being. This study examines the associations among infertility stigma, perceived infertility stress, and fertility-related quality of life (FertiQoL) in women, emphasizing the mediating role of sexual function.
Methods: A descriptive-correlational design utilizing structural equation modeling (SEM) was employed. The study population comprised married women aged 20–45 years with a confirmed diagnosis of primary infertility in Ahvaz, Iran, in 2024. A convenience sample of 295 women was recruited. Data were collected using validated Persian versions of the Infertility Stigma Scale (ISS), Fertility Problem Inventory (FPI), Female Sexual Function Index (FSFI), and Fertility-Related Quality of Life (FertiQoL) scale (Cronbach's alphas: 0.89–0.93). SEM was conducted using SPSS v.26 and AMOS v.24 to analyze relationships among variables.
Results: The SEM model exhibited a good fit. Perceived infertility stress showed a significant negative direct effect on FertiQoL (P<0.01), whereas the direct effect of infertility stigma on FertiQoL was non-significant. Sexual function significantly mediated the relationships between both infertility stigma and perceived stress (P<0.01) with FertiQoL, indicating an indirect effect.
Conclusions: These findings underscore the importance of addressing psychological stress and sexual dysfunction to enhance FertiQoL in infertile women. While infertility stigma lacks a direct effect, its influence is fully mediated through sexual function. Clinical interventions should prioritize stress reduction and sexual health, which may also positively influence infertility treatment outcomes, to improve well-being.