@article{ 
author = {SalimiBani, Maliheh},  
title = {Letter to the Editor}, 
abstract ={Professor Abbas Ebadi Editor-in-Chief, Critical Care Nursing Dear Professor Ebadi, I read with interest and close attention the recent article "The effect of simulator-based blended training on the clinical competence of nurses in mechanical ventilation" by Aghal and colleagues (1), published in your journal. In this study the authors take on one of the most demanding and vital areas of nursing care, and for that their work is valuable and deserves recognition. That said, a careful look at the study's design and methodology brought a few methodological points and uncertainties to mind, and attention to them could make the results clearer and add to the scientific value of this field. I therefore offer the following for your attention and that of the authors: 1. Comparison bias and the nature of the outcome measure. According to the article, the intervention group received blended training (theory plus hands-on practice with a ventilator simulator), whereas the control group received theoretical instruction only (lecture and PowerPoint). At the same time, the outcome was measured with the Objective Structured Clinical Examination, which is by its nature a practical, skills-based test. It is plain that a group given the chance to work in practice with the device (the simulator) will perform far better on a practical examination than a group taught by theory alone. This design creates an inherent bias in favor of the intervention group. A fairer comparison would have been possible if the control group had also received some form of clinical practice equivalent in hours to the intervention group's hands-on training (for example, working with a real ventilator under supervision on the ward), so that the specific effect of the simulator as a distinct educational medium could be isolated. 2. No mention of assessor blinding. In educational studies, blinding participants and instructors is practically impossible; blinding the outcome assessors, however, is a methodological necessity for preventing detection bias. The article states that one examiner was present at each station of the Objective Structured Clinical Examination, but it says nothing about whether these examiners were blinded to the nurses' group allocation (that is, whether a given nurse belonged to the simulator group or the lecture group). A lack of assessor blinding in a test as sensitive as the Objective Structured Clinical Examination can seriously undermine the validity of the results. 3. Testing effect and the short follow-up interval. The authors carried out their assessments before the intervention and only "two weeks" afterwards. Administering the pre-test as an Objective Structured Clinical Examination itself acts as a learning and training stimulus (the testing effect). Re-assessment with the same format after such a short two-week interval reflects short-term memory and familiarity with the stations more than any lasting acquisition of clinical competence. To claim improved clinical competence in a complex skill such as mechanical ventilation, longer follow-up (for example, one to three months) seems essential. 4. No clinical trial registration number. Quasi-experimental studies that include an intervention group and a control group and that measure health-system outcomes (among them the clinical competence of care staff) require prospective registration in a clinical trial registry (such as the IRCT), in line with the CONSORT statement and the recommendations of the International Committee of Medical Journal Editors (ICMJE). This article mentions only an ethics code, and a trial registration number is notably absent. In closing, while thanking the research team once again for their valuable efforts and the editor for providing a venue for such applied work, I would be very glad if the authors could respond to these questions and methodological concerns. An exchange of views on these matters would no doubt add to scientific clarity and help guide future researchers in designing more effective educational interventions in critical care units. With renewed respect },  
Keywords = {},
volume = {18},
Number = {4}, 
pages = {1-2}, 
publisher = {دانشگاه علوم پزشکی بقیه الله (عج)},

doi = {10.30491/JCC.18.4.1},
url = {http://jccnursing.com/article-1-876-en.html},  
eprint = {http://jccnursing.com/article-1-876-en.pdf},  
journal = {Journal of Critical Care Nursing},  
issn = {2008-336X}, 
eissn = {2008-3084}, 
year = {2026}  
}

@article{ 
author = {SalehNassaj, Zohreh and KalaiMokhar, Habibeh and Garkaz, OMID and MEHRYAR, Hamid Rez},  
title = {Evaluation of Symptoms, Complications, and Prognosis of Patients with New Ischemic Stroke Symptoms (Code 724) in Hospitals Affiliated with Shahroud University of Medical Sciences During 2021–2022}, 
abstract ={Background & aim: Acute ischemic stroke is one of the most common causes of neurological deficits and occurs due to interrupted cerebral blood supply. It is considered one of the leading causes of mortality and disability worldwide. This study aimed to evaluate the clinical presentation, complications, and prognosis of patients with acute ischemic stroke (Code 724) who were presenting to the emergency departments of hospitals affiliated with Shahroud University of Medical Sciences during 2021–2022. Methods: This descriptive–analytical cross‑sectional study was conducted among all patients who presented to the emergency department of Imam Hossein Hospital in Shahroud with acute stroke symptoms from October 2021 to October 2022.  Eligible patients underwent brain CT scanning and were included regardless of whether thrombolytic therapy was administered. Demographic information, clinical and neurological symptoms, complications, and patient prognosis were collected. Results: A total of 197 patients were included, of whom 54.3% were male. The mean age of the patients was 68.95±13.7 years. The most common clinical presentations were speech impairment (35.0%), motor deficits (33.0%), dysphagia (15.7%), gastrointestinal and excretory disorders (12.7%), psychological disturbances (12.7%), cardiac complications (6.6%), and seizures (4.1%). In total, 49 patients (24.9%) received thrombolytic therapy, and 12 patients (6.4%) died during hospitalization. Data analysis showed that there was no statistically significant association between receiving or not receiving thrombolytic therapy and the occurrence of different clinical symptoms. None of the patients who received thrombolytic therapy experienced mortality, and this difference was statistically significant (P = 0.040). In addition, the mean age of patients who received thrombolytic therapy was significantly lower (P = 0.009), and limb muscle strength was higher in this group (P = 0.022). Conclusion: The results of this study suggest that thrombolytic therapy can be considered an effective treatment method for patients with acute ischemic stroke and was associated with lower mortality in the studied patients. Appropriate patient selection and timely treatment initiation are critical determinants of outcome. Further studies with larger sample sizes and more precise designs are recommended to better evaluate the short‑ and long‑term outcomes of this therapy in stroke patients.},  
Keywords = {Acute Ischemic Stroke, Complications, Prognosis, Cerebrovascular Events},
volume = {18},
Number = {4}, 
pages = {3-10}, 
publisher = {دانشگاه علوم پزشکی بقیه الله (عج)},

doi = {10.30491/JCC.18.4.3},
url = {http://jccnursing.com/article-1-853-en.html},  
eprint = {http://jccnursing.com/article-1-853-en.pdf},  
journal = {Journal of Critical Care Nursing},  
issn = {2008-336X}, 
eissn = {2008-3084}, 
year = {2026}  
}

@article{ 
author = {Zanganeh, Fatemeh and Safi, Mohammad Hadi and KeikhaeiDehdezi, Bij},  
title = {Analysis of Factors Facilitating Burden of Care in Caregivers of Children with Hemophilia}, 
abstract ={Background & aim: Hemophilia is a chronic bleeding disorder that accompanies the patient until the end of his life. Affected patients require a lot of care and support, and their caregivers bear a lot of burden of care. Therefore, this study was conducted with the purpose of investigating the factors facilitating burden of care in caregivers of children with hemophilia. Methods: The research method was a qualitative phenomenological type. The statistical population of the research included all the caregivers of children with hemophilia referred to Baghaei two hospital in city of Ahvaz, and 26 caregivers were selected by available sampling and snowball from the considered statistical population and were investigated using a semi-structured interview until reaching data saturation. Results: Data analysis led to two main themes and five sub-themes. The main theme of persistent treatment problems included subthemes (problems related to treatment follow-up and financial issues and problems related to receiving treatment), and the main theme of external stresses included (personal problems of the caregiver, communication problems with the sick child and lack of effective support). Conclusion: Caregivers of hemophiliac children, who are mainly the parents of the sick child, bear additional pressure for care and have many problems such as not having a suitable job, difficult conditions of the sick person and lack of medication and communication problems; therefore, special prevention, treatment and rehabilitation programs for these caregivers should be planned and implemented.},  
Keywords = {Burden of Care, Factors Facilitating, Caregivers of Children, Hemophilia},
volume = {18},
Number = {4}, 
pages = {11-32}, 
publisher = {دانشگاه علوم پزشکی بقیه الله (عج)},

doi = {10.30491/JCC.18.4.11},
url = {http://jccnursing.com/article-1-861-en.html},  
eprint = {http://jccnursing.com/article-1-861-en.pdf},  
journal = {Journal of Critical Care Nursing},  
issn = {2008-336X}, 
eissn = {2008-3084}, 
year = {2026}  
}

@article{ 
author = {ghasemifard, fateme and jafarioori, mehdi},  
title = {Modern approaches and emerging technologies in wound management: A narrative review study}, 
abstract ={Background & aim: Management of acute and chronic wounds remains a major healthcare challenge, exacerbated by the rising prevalence of chronic diseases and aging populations. In recent years, modern approaches and emerging technologies have played an increasingly important role in improving wound healing outcomes. This narrative review aimed to explore contemporary approaches and emerging technologies in wound management. Methods: This narrative review was conducted through a comprehensive search of PubMed, Scopus, Web of Science, Google Scholar, and Science Direct databases from 2010 to 2026. Studies addressing advanced wound care strategies, including mechanical, biological, pharmacological, and technology-based interventions, were included. Data were extracted and narratively synthesized. Results: A total of 27 studies were included. Modern wound management strategies were categorized into four main domains: mechanical therapies (including negative pressure wound therapy, compression therapy, and energy-based modalities), biological approaches (including cellular and tissue-based products, platelet-rich plasma, and stem cell therapy), pharmacological treatments (including antimicrobials and oxygen therapy), and emerging technologies (including smart dressings and artificial intelligence). Most studies focused on chronic wounds, particularly diabetic foot ulcers and pressure injuries, highlighting a shift toward personalized and technology-driven wound care. Conclusion: Future wound management appears to be moving toward integrated approaches combining biotechnology, tissue engineering, and artificial intelligence. Despite significant advances, challenges such as cost, accessibility, and limited high-quality evidence remain, underscoring the need for further clinical research.},  
Keywords = {Wound management, Chronic wound, Advanced wound dressings, Negative pressure wound therapy, Smart dressings, Artificial intelligence, Regenerative medicine, Emerging healthcare technologies, Bioactive dressings, Diabetic foot ulcer},
volume = {18},
Number = {4}, 
pages = {33-50}, 
publisher = {دانشگاه علوم پزشکی بقیه الله (عج)},

doi = {10.30491/JCC.18.4.33},
url = {http://jccnursing.com/article-1-866-en.html},  
eprint = {http://jccnursing.com/article-1-866-en.docx},  
journal = {Journal of Critical Care Nursing},  
issn = {2008-336X}, 
eissn = {2008-3084}, 
year = {2026}  
}

@article{ 
author = {hashemi, narges and SHAMSI, ATEFEH},  
title = {Strategies for Enhancing Children’s Resilience during Wartime Crises: A Qualitative Study Comparing the Perspectives of Mothers and Pediatric Intensive Care Unit (PICU) Nurses}, 
abstract ={Background & aim: Children facing war and humanitarian crises are exposed to various psychological and social stressors that can adversely affect their mental health and development.  Despite such adversity, many children maintain adaptive capacity and psychological recovery. This phenomenon, known as resilience, is shaped by a combination of individual, familial, and social factors.  This study aimed to explore and compare strategies for enhancing children's resilience during wartime crises from the perspectives of mothers and PICU nurses. Methods: This qualitative conventional content analysis study was conducted in 2026, at Imam Hussein Children’s Hospital in Isfahan, Iran. Participants included 20 mothers and 15 pediatric intensive care unit (PICU) nurses, selected through purposive sampling with maximum variation. Data were collected through semi-structured in-depth interviews and analysed using Graneheim and Lundman approach until data saturation was reached. Results: Analysis identified several main themes. The most significant themes included relational resilience and emotional co-regulation, cognitive and spiritual resilience, child agency and voice, play and creativity as trauma processing tools, social and institutional support, convergence and divergence of mothers’ and nurses’ perspectives, and ultimately, the overarching concept of “resilience as negotiated co-regulation.” Findings indicated that children’s resilience develops within the context of interactions among the child, family, and social support networks, representing a dynamic and multi-level process. Conclusion: The results of this study suggest that enhancing children’s resilience in crises necessitate a comprehensive multilevel approach that simultaneously considers family relationships, social resources, and professional interventions. The concept of negotiated co-regulation can provide a conceptual framework for designing effective supportive interventions in the field of child mental health in crisis contexts.},  
Keywords = {Resilience, Child, War, Crisis, Mother, Nurse},
volume = {18},
Number = {4}, 
pages = {51-68}, 
publisher = {دانشگاه علوم پزشکی بقیه الله (عج)},

doi = {10.30491/JCC.18.4.51},
url = {http://jccnursing.com/article-1-865-en.html},  
eprint = {http://jccnursing.com/article-1-865-en.docx},  
journal = {Journal of Critical Care Nursing},  
issn = {2008-336X}, 
eissn = {2008-3084}, 
year = {2026}  
}

@article{ 
author = {Zamani, Narges},  
title = {Barriers to School Reintegration in Students with Chronic Illnesses Following Discharge from the Intensive Care Unit}, 
abstract ={Background & aim: Recent advances in pediatric critical care have significantly improved survival rates among children with chronic illnesses. However, biological survival does not necessarily translate into successful recovery of academic and social functioning. School reintegration is considered one of the most important indicators of functional recovery in children following discharge from the Intensive Care Unit (ICU). The present study aimed to investigate barriers to school reintegration and develop a structural model of factors predicting academic adjustment among students with chronic illnesses. Methods: This cross-sectional descriptive-analytical study was conducted in 2024. The target population included all students aged 7 to 12 years old with chronic illness residing in Mashhad who had experienced ICU hospitalization during the first six months of 2024. A total of 212 students selected from three teaching hospitals and 28 elementary schools using convenience sampling. Data collection tools included the Children's Health-Related Quality of Life Questionnaire (PedsQL), Spence Children's Anxiety Scale (SCAS), and the Academic Adjustment Questionnaire. The data were analyzed using descriptive statistics, independent t-test, analysis of variance, multiple regression, and structural equation modeling. Results: The mean age of participants was 10.2 ± 1.9 years, and 53.8% were male. A total of 63.7% of students experienced substantial difficulties in school reintegration during the first six months after discharge. Multiple regression analysis identified three significant predictors of academic adjustment: chronic fatigue (β = 0.41, P<0.001), academic anxiety (β = 0.35, P<0.001), and inadequate school support (β = 0.29, P = 0.002). The regression model explained 52% of the variance in academic adjustment (R² = 0.52). Structural equation modeling indicated that physical health status exerted a significant indirect effect on academic adjustment through psychological variables (indirect effect = 0.27, P<0.01). Model fit indices indicated acceptable model fit (χ²/df = 2.14; CFI = 0.94; TLI = 0.92; RMSEA = 0.05; SRMR = 0.04). The overall model effect size was moderate to large. Conclusion: School reintegration among students with chronic illnesses following ICU discharge is a multidimensional process influenced by the interaction of physical, psychological, and institutional factors. Chronic fatigue and academic anxiety emerged as the most important individual barriers, and inadequate structured school support as the primary institutional barrier. Developing hospital-to-school transition programs, implementing individualized educational plans, and providing targeted psychological interventions may improve academic adjustment and reduce educational disruption in this population.},  
Keywords = {Chronic Illness, Intensive Care Unit, School Reintegration, Academic Adjustment, Hospitalized Children},
volume = {18},
Number = {4}, 
pages = {69-80}, 
publisher = {دانشگاه علوم پزشکی بقیه الله (عج)},

doi = {10.30491/JCC.18.4.69},
url = {http://jccnursing.com/article-1-871-en.html},  
eprint = {http://jccnursing.com/article-1-871-en.docx},  
journal = {Journal of Critical Care Nursing},  
issn = {2008-336X}, 
eissn = {2008-3084}, 
year = {2026}  
}

@article{ 
author = {Gholamzadeh, Maliheh and Amini, Fatemeh and Mohammadpour, Ali and Shareinia, Habib and Sajjadi, Moos},  
title = {Effect of Foot Reflexology on Glycated Hemoglobin in Women with Type 2 Diabetes}, 
abstract ={Background & aim: Type 2 diabetes is one of the most significant public health challenges worldwide, with rising prevalence and substantial associated complications in recent years, complementary therapies such as foot reflexology have attracted attention as non‑pharmacological approaches to blood glucose control. This study examined the effect of foot reflexology on glycated hemoglobin (HbA1c) in women with type 2 diabetes. Methods: This randomized controlled trial (RCT) was conducted with 30 women with type 2 diabetes. Participants were allocated into intervention and control groups using quadruple permuted block randomization. The intervention group received foot reflexology in 18 sessions of 30 minutes each (three sessions per week). Data were collected before and after the intervention and analyzed using the independent t-test, chi-square test, Mann-Whitney U test, and Fisher's exact test at a significance level of P<0.05. Results: At baseline, mean HbA1c and fasting blood glucose levels were comparable between groups (P = 0.78 and P = 0.19, respectively). After the intervention, a significant reduction in HbA1c was observed in the intervention group compared with the control group (P = 0.015), and fasting blood glucose levels were also significantly reduced (P = 0.01). Conclusion: These findings suggest that foot reflexology is a simple, low-cost, and safe complementary intervention that may reduce HbA1c and fasting blood glucose in women with type 2 diabetes.  Larger trials with more diverse populations are warranted to confirm these findings},  
Keywords = {Foot Reflexology, Glycated Hemoglobin (HbA1c), Type 2 Diabetes},
volume = {18},
Number = {4}, 
pages = {81-96}, 
publisher = {دانشگاه علوم پزشکی بقیه الله (عج)},

doi = {10.30491/JCC.18.4.81},
url = {http://jccnursing.com/article-1-857-en.html},  
eprint = {http://jccnursing.com/article-1-857-en.docx},  
journal = {Journal of Critical Care Nursing},  
issn = {2008-336X}, 
eissn = {2008-3084}, 
year = {2026}  
}

@article{ 
author = {Jahangiri, Aida and Valiee, Sina and Kamyari, Naser and Vatandost, Salam},  
title = {Dispatcher Performance in Telephone Triage and Instruction for Foreign Body Airway Obstruction: A Cross-Sectional Study}, 
abstract ={Background & aim: Foreign body airway obstruction (FBAO) is a time-critical medical emergency with high mortality, where patient survival depends on immediate first aid within the initial moments. Emergency dispatchers, as the first point of contact in the emergency response chain, play a vital role in providing telephone guidance to callers for performing life-saving maneuvers. Despite the significant burden of this condition in Iran and the crucial role of dispatchers in its management, no studies have examined dispatcher performance in telephone triage and guidance for FBAO cases in the country. This study aimed to determine dispatcher performance in providing telephone guidance for FBAO and its association with prehospital outcomes. Methods: In this cross-sectional study, 262 recorded telephone calls made to the Kurdistan Emergency Dispatch Center (EMS 115) between March 20, 2024, and March 20, 2025, concerning foreign body airway obstruction (94 adults, 48 children, 120 infants) were reviewed. Dispatcher performance was evaluated using a researcher-developed 13-item checklist based on the 2025 American Heart Association (AHA) guidelines and algorithms approved by the Iran Emergency Organization, separately for the three age groups. The checklist was validated for content validity (CVR = 0.82, CVI = 0.84) and inter-rater reliability (κ = 0.87). Data were analyzed at a significance level of P<0.05. Results: The overall mean performance score of dispatchers was 0.87. Complete airway obstruction was associated with a 92% reduction in the odds of clinical improvement (AOR = 0.08, 95% CI: 0.03-0.17, P<0.001), while out-of-home incidents (AOR = 4.86, 95% CI: 1.60-16.40, P = 0.007) and food-related foreign body type (AOR = 0.16, 95% CI: 0.06-0.37, P<0.001) were associated with altered odds of clinical improvement. Among dispatcher characteristics, greater clinical experience (AOR = 1.44, 95% CI: 1.05-1.98, P = 0.023) and attendance at stress management training (AOR = 0.40, 95% CI: 0.23-0.68, P = 0.001) were associated with better performance, while 10-20 hours of monthly overtime (AOR = 0.33, 95% CI: 0.16-0.68, P = 0.002) and contractual employment status (AOR = 0.37, 95% CI: 0.21-0.68, P = 0.001) were associated with poorer performance. Conclusion: Although dispatchers demonstrated generally acceptable performance in technical and critical skills, serious deficiencies were identified in communication skills and caller stress management, particularly in cases involving infant choking. Complete airway obstruction, incident location, and foreign body type were identified as the main predictors of patient outcomes. Clinical experience, stress management training, overtime hours, and employment status were significant factors affecting dispatcher performance. Protocol revision, overtime reduction, stress management training, and public awareness improvement are recommended as key strategies for enhancing patient outcomes.},  
Keywords = {Dispatch, Airway Obstruction, Foreign Body, Telephone Assistance, Medical Emergencies},
volume = {18},
Number = {4}, 
pages = {97-110}, 
publisher = {دانشگاه علوم پزشکی بقیه الله (عج)},

doi = {10.30491/JCC.18.4.97},
url = {http://jccnursing.com/article-1-854-en.html},  
eprint = {http://jccnursing.com/article-1-854-en.docx},  
journal = {Journal of Critical Care Nursing},  
issn = {2008-336X}, 
eissn = {2008-3084}, 
year = {2026}  
}