Introduction: Acute fatty liver of pregnancy (AFLP) is a rare but lethal disease with liver involvement that appears in the third trimester of pregnancy. There is no specific treatment for AFLP. Because liver dysfunction is the most pathogenesis in AFLP the following hypothesis will be raised that plasma exchange can be useful.
Case Report: A 26-year-old mother was referred to our emergency ward with AFLP. The ultrasonography reported a single alive anhydramnios fetus at 34 weeks and fatty liver G1-2. Emergent cesarean was performed and the patient was then admitted to the intensive care unit. The day after surgery, our patient developed periumbilical tenderness and displayed abnormal coagulative factors. Ultrasonography reported 500cc liquid in the abdominal space. Relaparotomy was performed and during the next several days, her general condition worsened and supportive treatment was not effective and the patient experienced a seizure. We started plasmapheresis and after 10 days platelet levels started to rise, lactate dehydrogenase began to reduce, the edema reduced significantly, and her orientation became better. We continued plasmapheresis for about 20 sessions. After one month, the patient was discharged from the hospital in good general condition.
Conclusion: Plasmapheresis may be effective in the treatment of fatty liver of pregnancy.

Background & Aim: Novice nurses often find it difficult to adjust in the workplace especially during the role transition phase and may find spiritual distress if they find their work meaningless and dissatisfying. The following paper aims to elaborate on the unique aspect of spiritual distress among novice nurses’ during their role transition phase and its impact on nurses’ retention, self-efficacy, and job satisfaction. 

Materials & Methods: Grounded theory approach was taken. A purposive sample of novice nurses who had graduated within the last six months were selected as participants.  Individual in-depth interviews were taken. Data was analyzed using constant comparative analysis approach. Data was transcribed, translated, and various categories were formulated. Ethics was obtained from the University Research Ethics Board.

Results: Most novice nurses were facing spiritual distress during their role transition phase. Spiritual distress was affecting their productivity, satisfaction and quality of work in the hospital.

Conclusion: This study informs existential motives to be incorporated in occupational health policies within a hospital setting to smoothen role transition as well as to improve quality care and job satisfaction among novice nurses.

Background & Aim: Although trachea-bronchial suctioning (TBS) is one of the important nursing procedures in intensive care units (ICU), it may be associated with some complications. Using closed system suctioning (CSS) is one of the ways to decrease the rate of complications due to continued ventilation and oxygenation at the time of suctioning. However, CSS' secretion removal is not efficient enough. Higher values of suction pressure have been recommended to enhance the efficacy of CSS. The aim of this study was to compare the efficacy of two levels of negative suction pressure in secretion removal of CSS used for mechanically ventilated (MV) patients.
Materials & Methods: Fifty eligible adult MV patients (twenty in each group) with Random allocation participated in this clinical trial study with cross-over design. Each patient was suctioned using CSS, connected to a central suction device, with 100 and 200 mmHg pressures with a two-hour interval. Efficacy of suctioning was measured by the absence of secretion flow at the end of suctioning. Volume of the secretions was measured and compared in each suctioning. Statistical analyses were done using Minitab and SPSS software considering the significance level of 0.05.
Results: CSS using 200 mmHg resulted in an efficacy of 96% for removing secretions, compared to 34% for 100 mmHg (P = <0.0001). Suctioning volume was increased significantly higher with 200 mmHg suction pressure compared to values with 100 mmHg (1.72 [95% confidence interval (CI): 1.4; 2.0]; P<0.0001).
Conclusion: Application of CSS with Suctioning pressure 200 mmHg is recommended for trachea-bronchial suctioning in mechanically ventilated patients, because nearly complete removal of respiratory suctioning in most subjects.

Background & Aim: Low-fidelity simulation is an educational method that provides active learning. This research was conducted to determine student nurses’ opinions of the low-fidelity simulation method.
Materials & Methods: This descriptive research was carried out with 54 student nurses between April–May 2017 in a skills development laboratory in the Nursing Department of a Health Sciences Faculty in Turkey. A questionnaire prepared by the researchers was used for data collection.
Results: The results of the research show that student nurses believe low-fidelity simulation was an educational method that improved skills and provided effective learning. Satisfaction levels of the student nurses related to this educational method were high and all of the student nurses felt that an education using this simulation method was very useful.
Conclusion: Based on these results, we recommend that low-fidelity simulation method should be used in nursing education programs.

Background & Aim: Nowadays, organ transplantation is the final treatment for the patients with end-stage organ dysfunction. Considering the importance of the organ donation and the important role of nurses in increasing the number of organ donations, the present study aimed to determine the knowledge and attitudes of nurses in Sanandaj hospitals toward organ donation.
Materials & Methods: This study was descriptive-analytic (cross-sectional). 250 nurses working in hospitals in Sanandaj city were selected by stratified sampling method in 2017 and completed the questionnaire on knowledge and attitude towards organ donation. Data were analyzed by SPSS software version 20, using independent t-test and ANOVA.
Results: The results showed that the mean score of knowledge was 13/2 ± 04/ 57 and the mean score of attitude was 44.7 ± 82.75 and 207 (82.2%) did not have a donation card, while 146 nurses (58.4%) tended to receive a donation card. The mean score of nurses' knowledge about donation was 13.2 ± 26/49 and the mean score of their attitude was 13.2 ± 07. 91. There was also a significant correlation between attitude and level of education (p=0/045).
Conclusion: According to the results, the knowledge and attitude of the majority of nurses were moderate and most of them did not have a donation card. Considering the importance of this effective group in increasing the culture of the community toward organ donation, education and preparing appropriate background for receiving, and increasing knowledge and attitudes toward organ donation for the nurses is necessary.

Background & Aim: Nursing shortage is a growing global challenge in healthcare organizations. Promoting nurses’ organizational commitment may help alleviate nursing shortage. This study sought to evaluate the relationships between organizational commitment, job satisfaction, organizational justice, and self-efficacy among nurses.  
Materials & Methods: This cross-sectional study was conducted on 401 Iranian nurses randomly selected through two-stage cluster sampling. Data were collected using self-administered questionnaires and analyzed using the SPSS (v. 17.0) and the Amos (v. 17.0) software.
Results: The goodness of fit indices were as the following: χ²/df = 2.76 (P < 0.001), GFI = 0.93; AGFI = 0.87, NFI = 0.96, RMSEA = 0.068, and CFI = 0.95. Organizational commitment had significant positive relationships with self-efficacy (β3 = 0.28, P < 0.001) and job satisfaction (γ3 = 0.73, P < 0.001), while organizational justice had significant positive relationship with job satisfaction (γ2 = 0.89, P < 0.001). Moreover, job satisfaction had a mediating role in the relationship of organizational justice with organizational commitment.
Conclusion: Hospital managers can promote nurses’ organizational commitment through employing strategies to enhance their perceived organizational justice and thereby, improving their job satisfaction.

Background & Aim: Evidence-based practice refers to the use of the best research evidence, personal knowledge and clinical expertise, and patients’ values and preferences for the provision of healthcare services. This study aimed to evaluate hospital nurses’ perception of evidence-based practice.
Materials & Methods: This descriptive-analytical study was conducted in 2015 on 374 nurses randomly recruited from five teaching hospitals in Ardabil and Khalkhal, Iran. Data were collected using the Evidence-Based Practice Questionnaire and analyzed through the SPSS software (v. 13.0).
Results: The total mean scores of nurses’ perception of evidence-based practice and its practice, attitude, and knowledge/skills domains were 107.40±18.76, 4.66±1.34, 3.63±1.48, and 4.63±1.03, respectively. The mean scores of these domains had significant correlations with each other (P < 0.05).
Conclusion: Nurses’ perception of evidence-based practice is at moderate level and hence, they have moderate readiness for evidence-based practice. Coherent policies, educational strategies, and environmental improvements are needed to improve nurses’ perception of evidence-based practice.