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Introduction: A complete heart block is a cardiac electrical conduction disorder with a very rare occurrence in pregnancy, which may be asymptomatic. There are no specific guidelines for the management of asymptomatic complete heart block in labor, vaginal delivery, and cesarean with only a few reports of cesarean management of patients with complete heart block.
Case report: A 30-year-old woman, Gravida 4, abortion 3, gestational age of 41 weeks without any specific problems, was referred to our maternity hospital. The pulse rate and blood pressure were 68 and 60/110, respectively. Labor was induced with oxytocin and, after three hours, was discontinued due to late decelerations of fetal heart rate. Electrocardiography confirmed a maternal pulse rate of 42. Cardiac consultation led to the diagnosis of a complete heart block. Due to the frequent late decelerations of fetal heart rate and no response to atropine therapy, the patient was a candidate for a cesarean. Before cesarean, the pacemaker was installed. Cesarean was performed with general anesthesia, and the infant was delivered in good condition. In Postpartum, the pacemaker was removed (PR = 55, BP = 125/80), and the mother was discharged the next day. Due to the lack of specific guidelines, fetal indication for an emergency cesarean, mother poor obstetrics history, and none response to atropine therapy, we chose to incorporate pacemakers and remove it after cesarean safely.
Conclusion: Vital signs assessment during pregnancy and childbirth is recommended to detect cases of complete heart block and provide optimal care.

Background & Aim: Adherence of nurses to hand hygiene is important for the prevention of healthcare-associated infections. This study aims to systematically review the existing studies that assess Iranian nurses' adherence to hand hygiene and estimate their amount with meta-analysis.
Methods & Materials: We performed a systematic search for peer-reviewed journals published from 2005 to 2018. The systematic search was conducted using both international (Google Scholar, PubMed, SCOPUS, and Web of Sciences) and Iranian databases (Scientific Information Database, IranMedex, Magiran, and MedLib). The search was carried out using a combination of the following terms: “adherence”, “compliance”, “hand hygiene”, “nurse”, “Iran”, “nursing practice”, “nursing”, and “guidelines”. The combinations of these words with Boolean operators like ‘AND’, ‘OR’ and ‘NOT’ were used.
Results:  A total of 22 articles were used in the final analyses. The pooled proportion of hand hygiene adherence was 40.5 percent [95% confidence interval [CI]: 31.1–49.8]. Sensitivity analysis confirmed that the overall estimated pooled proportion of hand hygiene adherence did not vary significantly with the elimination of any of the 22 studies, observer or self-reported hand hygiene, instrument of measurement, unit of measurements, sample size, and time.
Conclusion: The level of adherence of Iranian nurses to hand hygiene can potentially increase the chance of healthcare-associated infections and put patients and nurses at risk. Hospital and nursing managers should take practical steps to investigate factors contributing to the failure of hand hygiene adherence among nursing staff. They should ensure the continuous implementation of hand hygiene improvement strategy.

Background & Aim: Breastfeeding self-efficacy refers to a mother’s perceived ability to breastfeed her new infant and is a salient variable in breastfeeding duration. This study aimed to review the current state of knowledge, including the predictors and interventions, and discuss relevant findings and gaps in the breastfeeding self-efficiency theory.
Methods & Materials: Scoping review of peer-reviewed articles between the years of 2009-2019. Using the keyword breastfeeding, self-efficacy, and breastfeeding confidence, an extensive search of the PubMed, Scopus, and ProQuest databases was performed. A total of 1,200 publications were found, from which, after excluding duplication and non-related papers, only 34 publications were considered relevant to the subject and examined in-depth. This study utilized the data extraction form developed by the Joanna Briggs Institute.
Results: There were various predictors of breastfeeding self-efficacy, such as fetal attachment, social support, and positive prenatal experience. Studies have claimed that educational programs through educational sessions, information packages, and peer education have a positive effect on breastfeeding self-efficacy and the duration of exclusive breastfeeding.
Conclusion: To facilitate successful breastfeeding, health care institutions could promote interventions regarding positive breastfeeding experiences. The data suggest that breastfeeding self-efficacy moves beyond our current understanding of motherhood. However, this evidence is limited to the study conducted in western and developed countries, and results are coming from studies with limited sample size. To provide an assessment and information on Asian mothers in developing countries, data are needed to describe their experiences and to examine factors associated with breastfeeding self-efficacy in this population.

Background & Aim: Bioethics education nourishes consciousness in bioethics and influences the attitude and perception of death. The purpose of this study was to investigate the effect of bioethics education by employing standardized patients for freshmen nursing students.
Methods & Materials: A quasi-experimental single group pretest-posttest design was used to assess the effect of bioethics education employing standardized patients on 33 freshman nursing students’ perception of dignified death and empathy who took the course of bioethics of a university.
Results: The perception of dignified death appeared higher in post-education than pre-education, and the subdomain of personal distress under empathy appeared higher in post-education than pre-education. In regard to the replies on the question of “disclosure of diagnosed cancer”, 54.6% of respondents approved, while 90.9% expressed “it should be at the discretion of doctors.”
Conclusion: bioethics education employing standardized patients appeared assisting students experiencing changes in perception of a dignified death. It may be useful in applying the teaching module for students with courses in bioethics.

Background & Aim: The leadership role adopted by nurse managers has a fundamental role in the quality of care. Leadership is fundamental to the successful provision of health services due to its effect on health professionals and patients. This study aims to characterize the leadership roles of nurse managers in clinical nurse’s perspective.
Methods & Materials: This is a descriptive and correlational study. Non-probabilistic convenience sampling with 219 nurses from different health institutions in Portugal. Data collection occurred from November 2019 to January 2020 using the Leadership Skills Questionnaire adapted by Parreira and collaborators o the Portuguese population, based on Quinn’s framework and the instrument developed by him. The data were analyzed using SPSS (version 22) with descriptive and inferential statistics according to the nature of the variables.
Results: The results demonstrated that the study participants recognize the leadership roles of their nurse managers in a balanced manner: Mentor (4.85±1.53), Director (4.62±1.32), Coordinator (4.56±1.34), Producer (4.55±1.31), Monitor (4.40±1.30), Broker (4.36±1.40), Facilitator (4.35±1.40), and Innovator (4.03±1.38).
Conclusion: It is observed greater orientation to the fulfillment of goals. There is a clear orientation to compliance with rules and, therefore, to internal orientation and control. The current study has different implications for nurse managers, education, and research.

Background & Aim: This study aimed to explore the transitional challenges of newly hired psychiatric nurses in the care of clients with schizophrenia and the coping mechanisms that they use to overcome their transitional challenges.
Methods & Materials: This descriptive-qualitative study interviewed six purposively selected newly hired psychiatric nurses caring for patients with schizophrenia who work for about six months to two years in a Psychiatric Training Hospital in the Philippines.  An interview protocol was used to obtain data with strict observance of relevant ethical considerations. In determining the emerging themes and subthemes from the transcribed data with trustworthiness, thematic analysis was employed.
Results: Two major prior codes were explored, namely, transitional challenges and coping mechanisms. On the one hand, five subthemes emerged under the transitional challenges that include emotional challenges, need for professional growth, nurses’ recognition of the inability to patient care management, need support from more experienced colleagues. Experience/feel the shock in the encounter of people with a mental health condition. On the other hand, four subthemes were unearthed under coping mechanisms that include emotional responses, professional coping strategies (i.e., reliance on the adequate support system, establishing the professional nurse-patient relationship, call to professional advancement, and commitment to evidence-based practice), and institutional coping strategies.
Conclusion: While newly hired nurses experience tremendous transitional challenges, their coping mechanisms continuously emerge and develop. The nursing administration needs to foster sustainable mentoring and resilience programs essential in aiding newly hired nurses’ adaptation and adjustment to the professional work environment.

Background & Aim: Effective communication with the patients and engaging patients in decision-making and care planning are necessary to improve health outcomes and satisfaction with the treatment. Communicating effectively can help prevent and manage complications following the treatment of cancer. Therefore, this study aimed to describe and explain cancer patients’ communication facilitators' experiences between patients and nurses.
Methods & Materials: This is a qualitative conventional content analysis study. The study was conducted on 22 cancer patients who were selected based on a purposeful sampling approach. Semi-structured interviews were performed to collect the data. The data were then analyzed using conventional content analysis. Also, the Lincoln and Guba criteria were used to measure the trustworthiness of the data.
Results: The researchers have identified the main theme as “humanitarian care”. Besides, five categories of “good-naturedness”, “empathy”, “patience”, “confidentiality”, and “honesty” were also extracted from 18 subcategories.
Conclusion: Effective nurse-patient communication facilitates patients’ healing, enhances clinical outcomes and improves patients’ response to treatment. Hence, these ethical features need to be reinforced among nurses.

Background and Aim: Stress is one of the most important issues that nurses face in the workplace that can affect the quality of patient care. Increasing nurses' self-efficacy can reduce their stress. The aim of this study was to investigate the effect of  education of nursing care based on mobile social network on job stress and job self efficacy of nurses in oncology wards.
Method: This randomized clinical trial study was performed on 78 nurses working in oncology wards of selected hospitals in Tehran. Nurses were randomly divided into control and intervention groups. Intervention group received nursing care materials in chemotherapy for four weeks via social network. The control group received routine training during this time. The level of stress was assessed through Expanded Nurses Job Stress Questionnaire (ENSS) and job self-efficacy through the Job Self-efficacy Questionnaire (JSEQ) before and one month after the intervention. Data analysis was done by descriptive and inferential tests of SPSS version 25.
Results: The results showed that the mean stress score in the experimental group was significantly decreased compared to the control group (P <0.05). Comparison of stress score changes between the experimental and control groups showed that the mean of stress score changes in the experimental group was significantly higher than before the intervention (P <0.05). The mean score of self-efficacy in the experimental group was significantly increased compared to the control group (P <0.05). Comparison of changes in self-efficacy score between the two experimental and control groups showed that the mean score of self-efficacy in the experimental group was significantly higher than before the intervention (P <0.05).
Conclusion: Educational intervention through social network had a positive effect on oncology nurses' job stress and job self-efficacy. Reducing stress and increasing nurses' job self-efficacy leads to improved clinical performance. This easy, inexpensive and effective teaching method can be used by health managers and educators to improve staff performance.