Benchmarking aims to compare the processes and practices of one institution to another institution with lower and higher standing. In nursing, benchmarking is conducted to improve their international reputation and ranking in terms of research outputs, research grants, and publications as well as students’ perceptions of their experiences and employers’ evaluations of the graduates. This editorial will provide readers steps on how to benchmark their institution for improvement or to provide evidence that their institution is on par with other high ranking institutions regionally and internationally.

Background & Aim: There is a high incidence of dysphagia after stroke that, depending on the assessment, methodology and time elapsed, can range from 8.1% to 80%. Early and systemic dysphagia screening is associated with a decreased risk of aspiration pneumonia and prevents inadequate hydration/nutrition. The purpose of this systematic review was to identify dysphagia screening tools for acute stroke patients available for nurses validated against reference test. The research question was: which dysphagia screening tools for acute stroke patients available for nurses?
Methods & Materials: Three electronic databases were searched from January 2007 to November 2017: on PubMed, Scielo and CINAHL Plus. Two independent reviewers screened all titles and abstracts, assessed methodological quality and extracted data. The methodological quality analysis and evaluation was guided according to four domains: patient selection, index test, reference standard and flow and timing. Divergences between reviewers in data extraction were consensualized through discussion.
Results: From the 377 articles retrieved, only three articles met criteria for review: Barnes-Jewish Hospital-Stroke Dysphagia Screen; the Gugging Swallowing Screen and, The Toronto Bedside Swallowing Screening Test. None of the screening tools complies with all psychometric properties, which means that a still significant proportion of patients will be kept nil by mouth without being necessary or that some patients will “fall through the cracks” interrupting the diagnostic process. The tools identified are different from each other, making their comparison impracticable.
Conclusion: Due to psychometric proprieties and dietary recommendations adjusted to dysphagia severity, of all available tools, GUSS is a suitable screening tool for nurses in clinical practice.

Background & Aim: The radiation-related oral mucositis is common in patients with head and neck cancer. Patients trying pharmacological and non-pharmacological methods to cope with oral mucositis. In this study, it was aimed to determine the non-pharmacological methods in dealing with oral mucositis of head and neck cancer patients.
Methods & Materials: In this descriptive study, the data were collected from a University Hospital's radiotherapy unit and a special cancer treatment center between June 2017 and October 2018.  The study included 108 individuals aged 18 and over, who were diagnosed with head and neck cancer, could be communicated verbally and accepted to take part in the study during the study period. A convenience sample of patients was obtained from among all patients meeting the criteria for inclusion. A 20-item questionnaire (including the sociodemographic items, risk factors, oral mucositis history, and non-pharmacological methods) form developed by researchers were used in the study. The written permissions were obtained from the Ethics Committee of Ege University, Faculty of Nursing, the centers that research conducted and the participants. IBM Statistical Package for Social Science for Windows package program version 25.0 was used for analyzing the data.
Results: Of the 108 individuals included in the study, 64.8% (n=70) were male. The mean age of the participants was 59.73±8.92. It was found that 58.3% (n=63) of the participants had mouth problems after starting treatment. 69.8% of the individuals who developed oral mucositis used a non-pharmacological method to cope with oral mucositis. The most commonly used non-pharmacological method was the mixture of carbonate and salt with 60.7%. The second most common method was black mulberry syrup with 37.7%. Other methods were including propolis, mulberry syrup, raspberry syrup, tea tree oil, thyme, and sumac.
Conclusion: While some methods used by the patients were effective, the others were ineffective. Health professionals, especially nurses, requirement be informed about the non-pharmacological methods, therefore, they can guide the patients about using the right methods.

Background & Aim: Delirium is prevalent in the intensive care unit (ICU), especially among mechanically-ventilated patients. Delirium is associated with a significant increase in adverse outcomes but it usually remains undiagnosed, making it necessary to develop and validate diagnostic tools. This study determined the validity and reliability of the Persian version of the Confusion Assessment Method for Intensive Care Units) CAM_ICU( in Iran.

Methods & Materials: This cross-sectional study was conducted in open-heart ICU of three university hospitals of Tehran, Iran. After piloting the translated CAM-ICU on 10 patients and refining the translated scale accordingly, 40 ventilated patients were consecutively selected and screened for delirium by two independent evaluators (applying CAM-ICU), and one psychiatrist (using DSM-IV criteria for diagnosis). Inter-rater reliability between the two evaluators was assessed by the Kappa coefficient. Validity indices (i.e., sensitivity and specificity) of the Persian-CAM-ICU and 95% confidence intervals were calculated, given the psychiatrists’ diagnosis as the reference standard. Data were analyzed in Stata software (v. 11).

Results: Of 40 selected patients, CAM_ICU detected delirium in 30%. The Persian-CAM-ICU had a sensitivity and specificity of 75% and 96%, and a positive and negative predictive value of 92% and 85%, respectively. Youden’s J statistic of the scale was 71%. Each of the four domains of the CAM-ICU showed a sensitivity and specificity of more than 69% and 90%, respectively, suggesting acceptable construct validity. There was good agreement between the two evaluators in terms of delirium diagnosis with the Persian-CAM-ICU (kappa coefficient = 0.74, P<0.0001).

Conclusion: The Persian version of the CAM_ICU is an effective, valid and reliable diagnostic tool in critically ill ICU patients. Application of the scale is recommended for the prompt diagnosis and prevent potential delirium in ventilated patients.

Background & Aim: Professional autonomy is a key component of decision-making and empowerment of the nurses. However, ICU nurses sometimes experience a degree of moral distress in their decision-making but the relationship of this distress with their autonomous performance in intensive care units is unclear. The aim of this study is determining the relationship between professional autonomy and moral distress of ICU nurses.
Methods & Materials : In this correlational cross-sectional study, 180 ICU nurses were selected by census method from educational hospitals of Guilan University of Medical Sciences in 2017. Research tools were Varjuss professional autonomy and Corely et al. moral distress questionnaires. Data were analyzed using SPSS software version 16.
Results: Most of the subjects were female (93.89%), full-time nurses (61.67%), with age mean and standard deviation of 35±5.97. Mean and standard deviation of professional autonomy and moral distress were 77.04±4 and 140.85±5.45, respectively. Moral distress of most nurses (55.6%) was moderate. There was a positive and significant correlation between professional autonomy and moral distress scores (p<0.001, r=0.33).
Conclusion: This study showed that by increasing the professional autonomy, the moral distress of ICU nurses increases as well. These results, by informing nursing mangers, remind the necessity of using some approaches for reducing the moral distress of nurses along with improving their professional autonomy.

Background & Aim: The aging of the population poses new challenges, among others, a greater concern with the teaching of geriatrics and gerontology, especially to future health professionals. The simulation game "Aging Nursing Game" ® was used with the objective of evaluating the impact of an aging simulation game on nursing students' attitudes towards the elderly.
Methods & Materials: A pre-test and post-test type quasi-experimental study was performed, without control group. The research was developed between February and July 2018. The subjects of this study were second-year undergraduate nursing students. A game was used as an intervention. To measure the effectiveness of the game, a questionnaire was applied before and after the intervention. The data collection instrument consisted of a questionnaire composed of two parts, the first part for sociodemographic characterization, and another consisting of the Portuguese version of the Kogan Scale (KAOP).
Results: The sample consisted of 45 undergraduate nursing students from the 2nd year corresponding to 75% of the population. The attitude towards the elderly person improved significantly before and after the intervention. Of the 34 items on the Kogan Scale (KAOP), 21 improved significantly.
Conclusion: The simulation game has proven to be effective in teaching students changing attitudes towards the elderly (p <0.05).

Background & Aim: Ostomy surgery is used to provide a means of collecting waste through a channel. However, ostomy can produce functional problems and major changes in adaptability and life satisfaction among the patients. This study attempts to investigate the relationship between adaptability and life satisfaction among ostomy patients.
Methods & Materials: This study is descriptive-correlational. 100 ostomy patients referring to Iran Ostomy Association were selected and studied using continuous sampling method and questionnaires of demographic information, Satisfaction with Life Scale (SWLS), and Bell Adjustment Inventory (BAI).
Results: The mean ± standard deviation of life satisfaction scores and adaptability scores were 16.8±4.4 (of 35) and 53.1±23.7, respectively. A positive and significant correlations were observed between life satisfaction and adjustment (r=0.597, p<0.001), and also adjustment dimensions, including home (r=0.585, p<0.001), health (r=0.611, p<0.001), social (r= 0.460, p<0.001), emotional (r=0.538, p<0.001) and occupational adjustment (r=0.380, p<0.001).
Conclusion: According to the results, there was a positive and significant relationship between life satisfaction and adaptability. Thus, therapeutic department members have to help improve life satisfaction among ostomy patients by facilitating adaptability.