Journal of Research Development in Nursing and Midwifery

Bridging the gap in palliative care nursing training: The emerging role of virtual and innovative learning models in Middle Eastern countries

Maryam Rassouli

Palliative care is a critical component of Universal Health Coverage and a key approach for reducing serious health-related suffering; however, major educational gaps persist among nurses across the Eastern Mediterranean Region. Although nurses deliver palliative care in hospitals, communities, and homes, many report insufficient knowledge, skills, and confidence, especially in end-of-life communication, complex symptom management, and psychosocial–spiritual support. These gaps are driven by limited curricular integration, shortages of trained faculty, resource constraints, and scarce post-graduation training. Digital and virtual education models (e.g., Project ECHO, web-based modules, and virtual simulation/VR) offer scalable solutions by improving access, reducing time and cost barriers, and strengthening competence and self-efficacy. These models need to fit local health‑system capacities and the cultural and religious norms of Middle Eastern communities, especially around family‑centered decisions and sensitive conversations. Continued investment in faculty training, technology, and mentorship is essential for bringing culturally responsive virtual palliative care education into nursing programs.

Influence of attitudes toward death, vulnerability to abuse, and family functioning on suicide Riskin Mexican older adults

Donovan Casas-Patiño

Background: Aging is a complex and multidimensional process characterized by biological, psychological, and social changes that may increase vulnerability among older adults. Suicide in later life is recognized as a multifactorial public health issue influenced by several psychosocial factors, including attitudes toward death, vulnerability to abuse, and family functioning. Therefore, this study aimed to investigate the extent to which attitudes toward death, vulnerability to abuse, and family functioning predict suicide risk among older adults.
Methods: An analytical cross-sectional study was conducted in 2025 comprising 260 older adults from Coahuila State. Participants were selected via non-probability convenience sampling. Data were collected using a sociodemographic questionnaire, the Plutchik Suicide Risk Scale, the Revised Profile of Attitudes toward Death (PAM-R), the Vulnerability to Abuse Screening Scale (VASS), and the Family APGAR. Statistical analysis included descriptive statistics, Spearman’s correlation analysis, and multiple linear regression using SPSS version 25.
Results: A total of 260 older adults with a mean age of [69.25±6.80 years] years participated in the study. The majority of the cohort were female, married, and had completed secondary education. The prevalence of suicide risk was 13.8%, and vulnerability to abuse was identified in 10% of participants. An ambivalent attitude toward death was observed, and 33.9% of the sample exhibited moderate to severe family dysfunction. The regression model explained 17.4% of the variance in suicide risk (Adjusted R² = 0.174, F = 13.457, p < 0.001), with family functioning (β = - 0.350, p < 0.001) identified as the strongest and only significant predictor.
Conclusion: The risk of suicide in older adults is a multifactorial phenomenon in which family functioning plays a central protective role. These findings highlight the importance of preventive strategies in collective health, focused on strengthening families and early detection of psychosocial risk factors.

Generational comparison of marital adjustment, pregnancy acceptance, and maternal role among married pregnant women from generation Y and generation Z in Türkiye

Hediye Karakoç

Background: Although societal change and evolving family roles shape generational identities, limited research has investigated whether these shifts are reflected in psychosocial adaptation during pregnancy. This study compared marital adjustment, pregnancy acceptance, and maternal role adaptation between pregnant women from Generation Y and Generation Z.
Methods: This cross-sectional study was conducted between November 30, 2022, and February 29, 2023, among 347 married pregnant women in Türkiye (Generation Y: n = 170; Generation Z: n = 177). Participants were recruited from pregnancy-related social media platforms using non-probability convenience sampling. Inclusion criteria were birth between 1980 and 2015, being married and pregnant, being literate, and providing consent to participate. Data were collected online using the Prenatal Self-Evaluation Questionnaire and the Marital Adjustment Test. Independent-samples t-tests, chi-square tests, and multiple linear regression analyses were performed using IBM SPSS Statistics version 27.0 (IBM Corp., Armonk, NY, USA).
Results: In bivariate analyses, marital adjustment scores were higher among Generation Y participants (p = 0.026). However, this association was no longer statistically significant after adjustment for age, duration of marriage, number of pregnancies, employment status, and planned pregnancy (β = -0.148, p = 0.122). No significant generational differences were observed in pregnancy acceptance or maternal role adaptation (p > 0.05).
Conclusion: Initial comparisons suggested a generational difference in marital adjustment; however, this difference was attenuated after adjustment for sociodemographic and reproductive characteristics and was no longer statistically significant. No statistically significant differences were observed between generations in pregnancy acceptance or maternal role adaptation. Because the overall regression model was not statistically significant, adjusted findings should be interpreted cautiously.

Nurses’ perceptions of corporate social responsibility and associated factors in the hospitals of Golestan province, Iran

Fatemeh Mehravar

Background: Nurses' perceptions of corporate social responsibility (CSR) in Iranian hospitals remain underexplored, particularly where formal CSR education is limited for academic nurses. Nurses' understanding of CSR-as conceptualized by Carroll's pyramid encompassing economic, legal, ethical, and philanthropic responsibilities-is crucial as they translate organizational commitments into patient care quality and safety. This study examined nurses’ perceptions of CSR and the associated factors.
Methods: This cross-sectional study was conducted in 2025 among 309 nurses from 12 hospitals affiliated with Golestan University of Medical Sciences, Iran. Participants were selected using stratified proportional sampling by hospital size with convenience sampling within strata. Organizational-level CSR was assessed using Carroll's CSR questionnaire (20 items; Cronbach's α=0.89; four dimensions; 5-point Likert scale, score range: 20-100). Associations between CSR scores and demographic factors (Age, gender, marital status, education, and ethnicity) and occupational factors (Work experience, clinical unit, and job title) were analyzed using SPSS version 26.0. Group differences were examined using one-way ANOVA, and multiple linear regression was used to identify factors independently associated with total CSR scores.
Results: The mean total CSR score was 72.39 ± 13.22 (Economic: 17.32 ± 3.67; legal: 18.68 ± 3.56; ethical: 18.35 ± 3.74; philanthropic: 18.04 ± 4.37). Significant associations were found with marital status (p=0.024, higher in single nurses), clinical unit (p=0.006, lowest in orthopedic, highest in dialysis/management units), and a weak negative correlation with age (r= -0.132, p=0.020) and work experience (r=-0.116, p=0.041). Multiple linear regression showed that marital status was independently associated with CSR scores (β = 0.120, p = 0.032). Compared with nurses in internal–surgical units, those working in orthopedic (β = -0.223, p < 0.001), emergency (β = -0.135, p = 0.040), and neonatal units (β = -0.113, p = 0.037) had significantly lower CSR scores. The model explained 12.1% of variance (adjusted R² = 0.121)
Conclusion: Nurses in hospitals demonstrated generally positive perceptions of corporate social responsibility. These perceptions were influenced more strongly by workplace factors-particularly the type of clinical unit-than by personal demographic characteristics. Improving organizational conditions and promoting ethical leadership may further enhance CSR awareness, professional performance, and the quality of patient care.

Relationships among self-care behaviors, anxiety, depression, and religious attitudes in patients with heart failure

Kourosh Zarea

Background: Heart failure (HF) is a chronic condition requiring effective self-care to improve clinical outcomes and quality of life. Psychological factors such as anxiety and depression, as well as religious attitudes, may influence self-care behaviors, but evidence remains inconsistent. Thus, this study aimed to examine the relationships among self-care, religious attitudes, anxiety, and depression among patients with HF.
Methods: This cross-sectional study involved recruiting 114 HF patients through convenience sampling at two educational hospitals affiliated with Ahvaz Jundishapur University of Medical Sciences in Iran in 2023. Participants completed a demographic questionnaire, the European Self-Care Behavior Questionnaire (ESCBQ), the Hospital Anxiety and Depression Scale (HADS), and a Religious Attitude Questionnaire. Data were analyzed using SPSS v.22 running t-tests, one-way ANOVA, Chi-square tests, Pearson correlations, and multiple and simple regression analyses.
Results: Participants had a mean age of 55.47±13.90 years, and hypertension was the most common comorbidity (15.8%). The mean self-care score was 38.92 ± 7.86 (moderate level; higher scores indicate poorer self-care). Their anxiety (9.83±4.22) and depression (9.61±4.75) were at moderate levels, while their religious attitudes averaged 69.05 ± 10.08. Self-care behaviors were significantly negatively correlated with both anxiety and depression (p<0.05), but not with religious attitude. Multiple regression analysis revealed anxiety as the only independent predictor of self-care (β=0.50, p<0.001).
Conclusion: Anxiety is a key determinant of self-care in patients with HF, whereas depression has an indirect effect, and religious attitudes show no significant influence. Interventions focusing on anxiety reduction and psychological support may prove effective in enhancing self-care behaviors and improving clinical outcomes in this population.

Development and validation of the Persian childbearing intention questionnaire based on the Multi-Theory Model (MTM) among women with only one child

Farzan Madadizadeh

Background: Declining fertility and childbearing are significant public health concerns. The Multi-Theory Model (MTM), which addresses both the initiation and maintenance of behavior, may provide a useful framework for promoting childbearing intentions. However, no validated theory-based instrument currently exists to measure MTM constructs in this context. Therefore, this study aimed to develop and validate a Persian questionnaire based on MTM to assess childbearing intentions among women of reproductive age.
Methods: A cross-sectional descriptive survey was conducted in 2025 with 275 married women recruited from comprehensive health centers in Yazd, Iran. Women with only one child and willing to participate from the selected health centers were included in this study. An initial 37-item researcher-developed instrument based on MTM was refined through expert evaluation (CVR, CVI) and quantitative face validity (Impact score). Construct validity was assessed via confirmatory factor analysis (CFA), and reliability evaluated using via Cronbach’s alpha and test–retest ICC analyzed with SPSS 22 and AMOS21.
Results: During the psychometric validation process, four items were removed. The final questionnaire with 33-items demonstrated high reliability (Cronbach’s α = 0.93; construct-level α = 0.71-0.92; test-retest ICC =0.81 (95% CI: 0.68-0.90)) and acceptable construct validity (CFA: CFI =0.932, TLI =0.921, RMSEA = 0.06, χ²/df =1.97). Content validity was strong, with CVR ranging from 0.62-1, S-CVI/Ave =0.929, and overall CVI =0.91. All items also showed acceptable face validity (Impact score >1.5).
Conclusion: The validated MTM-based Persian childbearing intention questionnaire is a reliable and valid tool for assessing childbearing intentions among women with only one child. It can guide public health research, educational interventions, and policy planning to support informed reproductive decisions.

Pediatric intensive care nurses' perspectives on the quality of dying and death among hospitalized children: A Cross-Sectional Study

Mahnaz Shoghi

Background: Nurses are continuously present at the bedside and work closely with both children and families; therefore, their perspectives can provide a detailed understanding of end-of-life care. This study examined the quality of dying and death among hospitalized children from the perspective of Pediatric Intensive Care Unit (PICU) nurses and explored nurse-related factors associated with their evaluations.
Methods: In this cross-sectional study, 176 nurses working in the PICUs of four teaching hospitals (6 PICU wards) in Tehran, Iran, participated. Inclusion criteria were at least a bachelor's degree in nursing, at least 12 months of PICU experience, experience caring for terminally ill children, and no personal history of losing a child. A census sampling method was used. Data were collected by self-report using the PICU-QODD (Quality of dying and death) questionnaire. Independent t-tests, one-way ANOVA, Pearson correlations, and multiple linear regression were performed using SPSS version 24.
Results: The overall QODD score was 68.44 ± 15.6, suggesting a moderate to favorable perceived quality. The highest domain scores were observed for continuity and coordination of care (84.4 ± 18.1), fulfillment of the parental role (77.04 ± 21.9), emotional support for the family (76.91 ± 19.3), and pain and symptom management (76.81 ± 15.5), whereas the physical and instrumental needs of the family (49.1 ± 29.2) and spirituality and religious‑cultural issues (33.46 ± 24.1) had the lowest scores. In the multivariable analysis, only fixed work shift remained independently associated with higher QODD scores (B = 7.01, 95% CI (0.343,13.688)).
Conclusion: PICU nurses rated children's quality of dying and death as generally acceptable but identified shortcomings in spiritual and practical support for families. Promoting continuity of care and providing targeted education on holistic, family-centered end-of-life care may be beneficial.

Understanding fertility preferences: Insights from women and experts in North Khorasan, Iran

Zohreh Keshavarz

Background: Assessing fertility levels is considered one of the most critical indicators in population forecasting and reproductive health research. Therefore, this qualitative study was conducted to explore women’s and experts’ perspectives on childbearing, including the views of healthcare professionals, university faculty members, and sociologists, regarding factors influencing childbearing.
Methods: This qualitative study was conducted in 2025 in North Khorasan Province, Iran. Participants were selected through purposive sampling and included three groups: women with two or fewer children (n = 35), women with more than two children (n = 16), and experts in the field of childbearing (n = 13). Data were collected through in-depth individual interviews and analyzed using MAXQDA 10 software according to conventional content analysis procedures.
Results: Analysis of the participants’ narratives identified four main themes influencing the decision to have more than two children: “gaining power, passive social acceptance, inefficiency of educational and health approaches, and a specific lifestyle pattern.” In contrast, rethinking the value of children and reconsidering fertility emerged as key factors influencing the decision to have fewer than two children.
Conclusion: The findings indicate that fertility preferences are shaped by a complex interplay of social and personal factors. While empowerment, passive social acceptance, ineffective educational and health strategies, and lifestyle considerations tend to promote larger family sizes, reassessment of the value of children and fertility considerations support smaller family choices. These results highlight the need for tailored reproductive health policies and context-sensitive educational interventions to support informed decision-making and balanced population strategies.

Knowledge and preventive practices regarding toxoplasmosis among pregnant women attending comprehensive health centers in Gorgan, Iran

Farideh Tohidi

Background: Toxoplasmosis poses a significant risk to pregnant women because of its potential for vertical transmission to the fetus. This study aimed to evaluate the knowledge and preventive practices of pregnant women regarding toxoplasmosis.
Methods: This cross-sectional study was conducted among 506 pregnant women attending urban comprehensive health centers in Gorgan, northern Iran, between January 2023 and September 2024. Participants were selected using a stratified multistage cluster sampling method. Data were collected using a questionnaire with established validity and reliability. Statistical analyses were performed using SPSS version 25. Data were analyzed using analysis of variance (ANOVA), the independent-samples t-test, and Pearson's correlation coefficient. A p-value < 0.05 was considered statistically significant.
Results: A total of 506 pregnant women participated in the study. The mean maternal age was 26.79 ± 6.89 years, the mean gestational age was 25.88 ± 9.05 weeks, and the mean monthly household income was 8.85 ± 6.44 million Iranian rials. Overall, 41.7% of participants demonstrated poor knowledge regarding toxoplasmosis, and knowledge levels were predominantly poor to moderate, whereas 77% of participants correctly answered the questions assessing preventive practices. Statistical analysis revealed a significant positive correlation between maternal age and knowledge scores (r = 0.123, p = 0.006), as well as between household income and practice scores (r = 0.10, p = 0.02). In other words, higher household income was associated with better preventive practice scores. Multivariable regression analysis identified maternal age (B = 0.09, p = 0.005) and household income (B = 0.11, p = 0.002) as independent predictors of knowledge scores, while household income independently predicted practice scores (B = 0.06, p = 0.01).
Conclusion: The findings of this study indicate that knowledge regarding toxoplasmosis among pregnant women remains at a moderate to low level, whereas preventive practices are generally satisfactory. Integrating targeted education on toxoplasmosis into routine antenatal care services may represent an effective strategy for improving maternal and fetal health outcomes in endemic regions such as northern Iran.

Scoping review on concept analysis in nursing: Diversity of approaches and analytical pathways

Parvaneh Vasli

Background: Concept analysis is an essential process in the development of nursing science. This review aims to provide a comprehensive overview of the approaches used to conduct concept analysis in nursing.
Methods: This study was conducted as a scoping review. Google Scholar and international databases, including PubMed, Scopus, ScienceDirect, and CINAHL, as well as Iranian databases such as the Scientific Information Database (SID) and Magiran, were searched using the keywords "nursing concept analysis methods," "concept analysis methods," "nursing concept analysis approaches," and "concept analysis approaches," along with their Persian equivalents, combined with the Boolean operators AND and OR. The search was conducted without time restrictions and included studies published up to May 29, 2025.
Results: A variety of methods for concept analysis in nursing were identified, ranging from classical approaches, such as those proposed by Wilson, Walker and Avant, and Rogers, to more recent methods, including pragmatic utility, semantic, simultaneous, and systematic concept analysis. The specific applications and limitations of each method depend on the research objectives and the context in which it is applied.
Conclusion: This review contributes to nursing theory by clarifying and comparing concept analysis methods, thereby strengthening conceptual foundations and supporting nursing research through informed methodological decision-making. It also has implications for nursing practice and policy by promoting the clearer application of key concepts in clinical and educational settings.