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Introduction: Breast cancer is common among women and reduces their quality of life. The current study aimed to investigate the effectiveness of mindfulness-based stress reduction group counseling in alleviating psychological responses such as anxiety, depression, stress, and regulating laboratory tests including cortisol and C-reactive protein (CRP) in women with breast cancer. Methods: This randomized clinical trial was conducted based on convenience sampling. Participants were divided into 2 groups (control and intervention groups) with block randomization. The intervention group received mindfulness-based stress reduction group counseling during 8 weeks. The participants completed the Beck anxiety inventory, Beck-II depression inventory, and perceived stress scale before and after the intervention and their blood samples were taken to check their cortisol and CRP. Results: After the intervention, the MBSR group had significantly lower anxiety compared with the control group (P < .001). No significant difference was found between the 2 groups in the reduction of perceived stress and depression (P < .05). In addition, no significant difference was found between the 2 groups in CRP and cortisol levels after the intervention (P > .05). Conclusion: The present study showed the effectiveness of mindfulness-based cognitive therapy in improving anxiety rather than the stress, depression, and inflammatory laboratory factors such as cortisol and CRP in women with breast cancer. Therefore, the psychological symptoms of these patients can be improved at different stages of treatment by providing this type of training.

ObjectivesTo examine the association between workplace sexual harassment and post-traumatic stress disorder (PTSD) symptoms among nurses in southeast Iran.DesignCross-sectional study.SettingFour teaching hospitals affiliated with Kerman University of Medical Sciences, Iran.ParticipantsA total of 283 female nurses with at least 1 year of clinical experience participated in the study.MethodsData were collected using convenience sampling and assessed using a demographic questionnaire, the Nurses’ Sexual Harassment Questionnaire, and the Impact of Event Scale-Revised (IES-R). Non-parametric tests, Spearman’s rho correlation and multivariate logistic regression were used for analysis.ResultsOverall, 39.1% of nurses reported experiencing sexual harassment sometimes to always. A total of 13.4% screened positive for PTSD. Sexual harassment was significantly associated with PTSD symptoms (OR: 1.26; 95% CI 1.164 to 1.364). Younger, single and less experienced nurses reported higher harassment levels, though sociodemographic variables were not associated with PTSD.ConclusionsWorkplace sexual harassment was significantly associated with increased PTSD symptoms among nurses. While demographic factors were related to harassment exposure, they were not linked to PTSD. Findings highlight the importance of preventive organisational strategies to mitigate harassment and protect nurses’ mental well-being.

ObjectiveStatistics suggests that patients and officials are unaware of a large number of patient safety incidents in healthcare centres. This study aimed to explore the concept of disclosure of patient safety incidents from the perspectives of Iranian nurses.DesignQualitative content analysis.SettingThe study population was nurses working in hospitals affiliated with The Hormozgan University of Medical Sciences, military hospitals and private hospitals in Bandar Abbas, Iran. Sampling was done from January 2021 to September 2021.Participants11 female and 6 male nurses aged 27–59 years with a work experience of 3–34 years were included.Primary and secondary outcome measuresThis qualitative content analysis was to explore the experiences of Iranian nurses (n=17) using purposive sampling and semistructured, in-depth interviews. Maximum variation sampling (age, sex, work experience, education level, type of hospital and type of ward) was considered to obtain rich information. Guba and Lincoln criteria were used to increase the study’s trustworthiness and rigour, and the Graneheim and Lundman method and MAXQDA 2020 were used to analyse data.ResultsWe extracted one theme, four categories and nine subcategories. The main theme was the mental schemas of disclosure of patient safety incidents with four categories: (1) misconceptions of harm to the organisation or self, (2) attributes of the disclosure process and its outcomes, (3) reactions to the disclosing incidents and (4) interpersonal conflicts.ConclusionOur study identified factors influencing the disclosure of patient safety incidents among nurses, including concerns about reputation, fear of consequences and perceptions of the disclosure process. Positive attitudes towards incident disclosure were associated with supportive organisational environments and transparent communication. Barriers to disclosure included patient and companion reactions, misinterpretation and anxiety. Healthcare organisations should foster a non-punitive reporting culture to enhance patient safety and accountability.

[This corrects the article DOI: 10.1371/journal.pone.0310434.].

Background Delirium and acute pain are common and serious problems in hospitalized older patients, often leading to adverse outcomes such as prolonged hospital stays, cognitive decline, and higher mortality rates. While pharmacological treatments can have significant side effects in older adults, non-pharmacological interventions offer safer alternatives. Objective This systematic review aimed to evaluate the effectiveness of non-pharmacological interventions in managing acute pain and delirium in hospitalized older patients. Methods A comprehensive search was conducted across PubMed, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar databases up to July 2025. The review included randomized controlled trials and quasi-experimental studies involving patients aged ≥ 65 years that used non-pharmacological interventions. Results The review included eight studies. Music therapy and hand massage consistently reduced acute pain and anxiety among older patients, while the results for delirium prevention were mixed. some interventions, like geriatric care bundles, significantly reduced delirium incidence, while others showed no effect. These findings highlight the clinical relevance of non-pharmacological interventions as safer alternatives to pharmacological management in geriatric care. Conclusion Non-pharmacological interventions are effective in reducing acute pain and anxiety among older inpatients, with some showing promise in delirium prevention. However, the variability in intervention types and study quality highlights the need for standardized protocols and further research.

Background Spiritually sensitive nurses perceive the spiritual attitudes and feelings of others. They play a positive role in providing spiritual care to patients. Spiritually sensitive nurses deal appropriately with suffering, frustration, and spiritual dysfunction. Therefore, the present study aimed to explain Iranian nurses’ experiences of spiritual sensitivity. Methods This qualitative descriptive explorative study used conventional content analysis and purposeful sampling to explain the experiences of Iranian nurses (n = 19). This study used in-depth semi-structured interviews with 19 nurses, as well as maximum variation sampling to gather rich information (age, sex, religion, work experience, level of education, marital status, type of hospital and ward) from March 2021 to January 2022. The current study also employed Guba & Lincoln criteria to increase data trustworthiness and Graneheim and Lundman approach to analyze the content. Results The research data showed 497 codes, 1 theme, 3 categories, and 6 subcategories. The theme of “Nurse’s spiritual sensitivity as a higher perception and reflection toward spiritual care” included three categories of the spiritual and professional character of the nurse, perception of the spiritual needs of patients and their families, and the nurse’s reflection on the religious beliefs of patients and their families. Conclusion Spiritual sensitivity helps a nurse to provide holistic care for patients and their families. Therefore, managers and policymakers should create guidelines to help nurses become more spiritually sensitive as well as to meet spiritual needs of patients. Further quantitative and qualitative research should confirm these results in other social and cultural contexts.

The spread of the COVID-19 epidemic, as well as its high contagiousness, increased students' anxiety and stress. Anxiety may affect individuals' functioning and undermine their self-efficacy. Therefore, the present study aimed to determine the relationship between COVID-19 anxiety and self-efficacy among adolescent students. This cross-sectional descriptive correlational study was conducted on 306 adolescent students in southern Iran. The research tools were the Corona Disease Anxiety Scale consisting of physical and psychological dimensions of anxiety and the Self-Efficacy Scale composed of three subscales: academic, social, and emotional self-efficacy. Data were analyzed using SPSS 25. Pearson correlation was used to investigate the relationship between COVID-19 anxiety and self-efficacy using the total score of both scales and their dimensions as well. T-Test and one-way ANOVA were used to see whether sociodemographic variables of participants significantly varied in self-efficacy and COVID-19 anxiety. The mean score of COVID-19 anxiety was 11.70 ± 9.25, representing mild anxiety, and the mean score of the psychological dimension was higher than that of the physical dimension. The mean self-efficacy score was 81.29 ± 12.98 indicating high level of self-efficacy. In addition, the mean score of academic self-efficacy was higher than that of social and emotional self-efficacy. There was an inverse, significant, and mild to moderate relationship between COVID-19 anxiety and the total score of self-efficacy (r = -.28, p < .001) and all its dimensions (r = -. 18, p = .002 for social and academic self-efficacy; r = -.32, p <. 001 for emotional self-efficacy). While the physical dimension of COVID-19 anxiety correlated significantly and negatively with self-efficacy total and subscale scores, the mental subscale of COVID-19 anxiety only correlated with the self-efficacy total score (r = -.20, p < .001) and emotional self-efficacy (r = -.28, p < .001). The study results revealed that the higher the COVID-19 anxiety, the lower the self-efficacy among adolescents. It is important to prioritize the enhancement of self-efficacy among adolescents to ensure their success across various life domains including managing stressors brought about by pandemics like COVID-19. This requires a collaborative effort from parents and teachers as they are a primary source of reassurance and information. Parents and teachers can also serve as role models in showcasing resilience and positive coping with the pandemic and allow adolescent students to master adaptive coping and provide positive reinforcement for effective behaviors.

Background HIV partner notification services can help people living with HIV (PLHIV) to identify, locate, and inform their sexual and injecting partners who are exposed to HIV and refer them for proper and timely counseling and testing. To what extent these services were used by PLHIV and what are the related barriers and facilitators in southeast Iran are not known. So, this study aimed to explore HIV notification and its barriers and facilitators among PLHIV in Iran. Methods In this qualitative study, the number of 23 participants were recruited from November 2022 to February 2023 including PLHIV ( N  = 12), sexual partners of PLHIV ( N  = 5), and staff members ( N  = 6) of a Voluntary Counseling and Testing (VCT) center in Kerman located in the southeast of Iran. Our data collection included purposive sampling to increase variation. The content analysis was conducted using the Graneheim and Lundman approach. The analysis yielded 221 (out of 322) related codes related to HIV notification, its barriers, and its facilitators. These codes were further categorized into one main category with three categories and nine sub-categories. Results The main category was HIV notification approaches, HIV notification barriers, and facilitators. HIV notification approaches were notification through clear, and direct conversation, notification through gradual preparation and reassurance, notification due to being with PLHIV, notification through suspicious talking of the physician, and notification due to the behavior of others. Also, the barriers were classified into individual, social, and environmental, and healthcare system barriers and the facilitators were at PLHIV, healthcare staff, and community levels. Stigma was a barrier mentioned by most participants. Also, the main facilitator of HIV notification was social support, especially from the family side. Conclusions The findings highlighted the multidimensionality of HIV notification emphasizing the importance of tailored support and education to enhance the notification process for PLHIV and their networks. Also, our results show that despite all the efforts to reduce stigma and discrimination in recent years, stigma still exists as a main obstacle to disclosing HIV status and other barriers are the product of stigma. It seems that all programs should be directed towards destigmatization.

Background The role of aesthetics in nursing care is increasingly recognized as a crucial component of high-quality practice. Professional development for nurses necessitates a thorough understanding of these aesthetic dimensions. While the Esthetics of Nursing Care Scale has previously demonstrated validity from patients’ perspectives, this study aimed to evaluate its psychometric properties from nurses’ perspectives. Therefore, we evaluated the nurse version of the Esthetics of Nursing Care Scale (ENCS) among a sample of Iranian nurses, with the goal of developing a reliable scale for assessing and enhancing aesthetic knowledge in nursing practice. Methods This cross-sectional methodological study measured the psychometric properties of the Esthetics of Nursing Care Scale through content validity (10 experts), face validity (10 nurses), a pilot study (50 nurses), construct validity [350 nurses for exploratory factor analysis (EFA) and 200 nurses for confirmatory factor analysis (CFA) and convergent validity], and reliability (internal consistency). Results The nurse version of the ENCS consists of 20 items divided into five subscales: compassionate commitment and competence (4 items), stress-free care (4 items), humanistic attention to patient (3 items), patient satisfaction and comfort (5 items), and admirable commitment and competence (4 items). These subscales explained 74.5% of the concept’s variance. The CFA sufficiently confirmed the structure extracted from EFA. Convergent validity was confirmed due to the strong correlation between the ENCS and the compassion competence scale ( r  = 0.537). Additionally, the scale had good reliability (Cronbach’s alpha coefficient = 0.956 and Omega coefficient = 0.957). Conclusion The nurse version of ENCS can be utilized in clinical settings to evaluate the esthetics and quality of nursing care from nurses’ perspectives. Further research within the nursing community is recommended to confirm these results. Clinical trial number Not applicable.

Background End-stage renal disease (ESRD) causes numerous physical and psychological problems in patients, so that they must adhere to their treatment regimen to recover their disease, alleviate these problems, and increase their lifespan. The present study aimed to determine the predictive role of spiritual health, resilience, and mental well-being in treatment adherence among hemodialysis patients. Methods This correlational cross-sectional study investigated some variables related to treatment adherence in 184 patients undergoing hemodialysis referred to two dialysis centers in Kerman, southeastern Iran. A census method was used to select the participants and data were collected using socio-demographic characteristics questionnaire, Adherence to Treatment Questionnaire (ATQ), Conner-Davidson Resilience Scale, Reef Psychological well-being Questionnaire, and Spiritual Well-Being Scale (SWBS). Results The overall treatment adherence score was 155.42 ± 27.98 and we found a positive significant correlation between spiritual health, resilience, psychological well-being, and treatment adherence ( p  < 0.001). The mean scores of resilience, spiritual health and psychological well-being were 70.59 ± 17.02, 90.09 ± 12.01, and 77.88 ± 11.72, respectively. Spiritual health, psychological well-being, resilience, gender and marital status predicted 54% of the variance of treatment adherence, with psychological well-being being the best predictor ( p  < 0.001). Conclusions Spiritual health, psychological well-being, and resilience are factors that influence treatment adherence of the patients undergoing hemodialysis, with psychological well-being having the greatest contribution to improving patient’s treatment adherence. Interventions effective in improving psychological well-being, spiritual health and resilience can improve treatment adherence of patients undergoing hemodialysis. Healthcare workers must pay more attention to the factors affecting treatment adherence of patients undergoing hemodialysis.