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In the present study, ZrB 2 nanoparticles were synthesized using sol-gel method. Zirconium alkoxide was used as the source of zirconium and boric acid as the source of boron. The size of precursor nanoparticle was controlled using the pH parameter inside the sol, and the formation of primary nuclei of ZrB 2 phase and their crystallized amount were investigated using the temperature parameter. To evaluate the mechanism of product formation during the sol-gel process, TEM, SEM, DTA/TG, RAMAN, XRD, FTIR, and DLS methods were used. DLS analysis showed that the size of precursor particle inside the sol at pH less than 5 was below 10 nm. Measurements of viscosity and zeta potential inside the sol showed that in the acidic range, the particle stability decreases with increasing pH. Mixing of precursor particles at molecular level inside the sol was one of the important reasons in reducing the synthesis temperature of ZrB 2 particles. FTIR analysis on chemical bonds showed that Zr-O-B bond was formed inside the gel powder. DTA analysis showed that the primary nuclei of ZrB 2 particles were formed at a temperature of about 1400 °C. XRD observations proved that the primary nuclei of the ZrB 2 phase crystallized and grew at a temperature of about 1500 °C. Surface research revealed that the specific surface area of the synthesized ZrB 2 particles is equivalent to 115 m 2 /g, and also the surfaces of these particles are porous, and the size of these porosities is in meso range. SEM analysis showed that the particle size of ZrB 2 having homogeneous morphology is about 50 nm. TEM microstructural analysis revealed that ZrB 2 particles were formed uniformly and orderly in very fine dimensions. Graphical abstract Highlights Synthesis of controlled ZrB 2 nanoparticle through pH-assisted sol-gel is presented. The most important goal is to achieve very high homogeneity with the appropriate chemical composition of the product. The results showed exceptional role of pH, temperature and ratio of precursors on final product characteristics.

Background Mobile applications are among effective learning tools and have a significant role in transferring information and knowledge to nurses. The current study was carried to identify the factors affecting nurses’ use of practical health related mobile applications in education and patient interaction based on the combined Technology Acceptance Model (TAM) and Diffusion of Innovation (DOI). Method The study is a descriptive-analytical study with a cross-sectional method. The research population includes nurses working at Tabriz University of Medical Sciences hospitals, 150 of which were selected as the research sample using simple and available sampling. The data collection instrument was a questionnaire, the validity and reliability of which were confirmed (α = 0.9). Data analysis was carried out using a correlation test and regression analysis by applying SPSS v16 software. Results The findings show that perceived usefulness and perceived ease of use have a direct and significant effect on the rate of using mobile applications by nurses ( P value ≤ 0.01), [(β = 0.52), (β = 0.40)]. Other findings indicate that relative advantage, compatibility, trialability and observability, have a direct and significant effect on nurses’ use of mobile applications, while complicatedness does not have a significant effect. Conclusion The current study identifies the effective factors in nurses’ use of health-related mobile applications based on an integrated model of TAM and DOI. Designers of mobile applications should consider these factors in designing and developing programs so that mobile applications can successfully fulfill their purpose in healthcare.

Background Leaders in small and medium-sized enterprises (SMEs) are exposed to increased stress as a result of a range of challenges. Moreover, they rarely have the opportunity to participate in stress management trainings. Therefore, KMU-GO (ger: Kleine und mittlere Unternehmen – Gesundheitsoffensive; en: small and medium-sized enterprises – health campaign) aims at conducting and evaluating such a stress management training. The focus of evaluation does not only lie on the effects on leaders participating but also on their employees. Methods The study is planned as a 2 × 3 mixed design with two groups (intervention and waiting control group) as a between factor and point in time (at baseline, 6 and 12 months later) as a within factor. We aim at collecting data from N  = 200 leaders. Based on the results of a preceding assessment, an already successfully implemented stress management training was adapted to SME needs and now serves as the framework of this intervention. The stress management training comprises one and a half days and is followed by two booster sessions (each 180 min) about 3 and 6 months after the training. The main focus of this intervention lies on specifying leaders stress reactivity while at the same time investigating its effects on employees’ mental health. Further dependent variables are leaders´ depression and anxiety scores, effort-reward imbalance, sick days and psychophysiological measures of heart rate variability, hair cortisol, and salivary alpha-amylase. Cost-effectiveness analyses will be conducted from a societal and employers’ point of view. Discussion Stress management is a highly relevant issue for leaders in SMEs. By providing an adequate occupational stress management training, we expect to improve leaders´ and also employees` mental health, thereby preventing economic losses for SMEs and the national economy. However, collecting data from employees about the success of a stress management training of their leader is a highly sensitive topic. It requires a carefully planned proceeding ensuring for example a high degree of transparency, anonymity, and providing team incentives. Trial registration The KMU-GO trial is registered at the German Clinical Trial Register (DRKS): DRKS00023457 (05.11.2020)

Background The COVID-19 pandemic has created a great challenge for educational systems worldwide. During this time, educational centers have been encouraged to use e-learning programs to protect the population against infection. Online teaching has the greatest effect on the process of teaching-learning for certain topics, including professional behavior and commitment, which has prompted educational systems to use creative strategies for a greater effect on learners. The present study aims to determine the effects of e-learning using educational multimedia on the ethical decision-making and professionalism of nursing students during the COVID-19 pandemic. Methods This study was conducted using a quasi-experimental design with a control group. The statistical population comprised second-semester nursing students in a first-rank nursing school in north western Iran. The samples were selected using simple random sampling and were divided into experimental ( n  = 40) and control ( n  = 40) groups. In the first stage of teaching, the conventional training method of the COVID-19 pandemic was used in both groups. In the second stage of teaching, an in-person workshop was organized for the control group and an e-learning workshop using educational multimedia for the experimental group. Data were collected by a tool with three parts: Demographic information, the Nursing Dilemma Test (NDT) by Crisham based on the Nurse Principled Thinking, and the Nursing Students Professional Behaviors Scale (NSPBS) designed by Goz. Data were analyzed in SPSS 25 software. Results There was a statistically significant increase in the post-test mean score of professionalism (125.70 ± 6.20 vs. 120.95 ± 9.28) and ethical decision-making (46.17 ± 3.81 vs. 44.02 ± 3.21) in the experimental group compared to the control group ( P  < 0.05). Conclusion The learning environment affects learning, and e-learning using educational multimedia has a greater impact than in-person workshops on improved learning outcomes with regard to ethical decision-making and professionalism.

ObjectiveThis study explored the consequences of COVID-19 on the occupational safety and health of nurses.DesignQualitative conventional content analysis.Participants14 nurses selected by purposeful sampling method.SettingFive educational and non-educational hospitals in the Northwest of Iran.Data collection and analysisSemistructured interviews were used for data collection and analysed using conventional content analysis.ResultsTwo main categories have emerged from the data: reduced quality of professional life and post-traumatic growth. Reduced quality of professional life, which has two subcategories including job dissatisfaction and burnout, has a negative nature, and has had many negative effects on the physical, mental and well-being of nursing personnel during the coronavirus era. On the other hand, post-traumatic growth, with two subcategories that include promoting safe behaviour and gaining a positive self-concept, has a positive nature.ConclusionsMaintaining the occupational health and safety of nurses plays an important role in providing quality services to patients. Therefore, it is necessary for managers and policymakers to use the experiences related to the COVID-19 crisis, to prevent negative factors and strengthen positive factors, to maintain the safety and occupational health of nurses, and increase the quality of care.

ObjectivesHospitals are psychologically demanding workplaces with a need for context-specific stress-preventive leadership interventions. A stress-preventive interprofessional leadership intervention for middle management has been developed. This phase-II study investigates its feasibility and outcomes, including work-related stress, well-being and transformational leadership.DesignThis is a mixed-methods study with three measure points (T0: baseline, T1: after the last training session, T2: 3-month follow-up). Additionally, focus groups were conducted to assess participants’ change in everyday work.SettingA tertiary hospital in Germany.ParticipantsN=93 leaders of different professions.InterventionAn interactive group setting intervention divided in five separate sessions ((1) self-care as a leader, (2) leadership attitudes and behaviour, (3) motives, needs and stressors of employees, (4) strengthen the resource ‘team’, (5) reflection and focus groups). The intervention was conducted between June 2018 and March 2020 in k=5 runs of the intervention.Outcome measuresFeasibility and acceptance were measured with a self-developed intervention specific questionnaire. Psychological outcomes were assessed with the following scales: work-related strain with the Irritation Scale, well-being with the WHO-5 Well-being Index and transformational leadership with the Questionnaire of Integrative Leadership.ResultsAfter the intervention at T2, over 90% of participants reported that they would recommend the intervention to another coworker (92.1%, n=59) and all participants (n=64) were satisfied with the intervention and rated the intervention as practical relevant for their everyday work. Participants’ self-rated cognitive irritation was reduced, whereas their well-being and transformational leadership behaviour were improved over time. Focus group discussions revealed that participants implemented intervention contents successfully in their everyday work.ConclusionsThis intervention was feasible and showed first promising intraindividual changes in psychological outcomes. Participants confirmed its practical relevance. As a next step, the intervention will be evaluated as part of a multicentre—randomised controlled trial within the project SEEGEN (SEElische GEsundheit am Arbeitsplatz KrankeNhaus).

ObjectivesThe transition back to work after cancer is a significant milestone for many survivors, affecting their financial stability, psychological well-being and overall quality of life. Return-to-work (RTW) process is often complicated by lingering physical and cognitive impairments, changes in self-identity and workplace dynamics. Understanding how cancer survivors navigate this process is crucial for the development of effective support systems. This study aimed to explore strategies employed by cancer survivors in managing the RTW process.DesignThis study employed a qualitative content analysis approach to explore RTW strategies used by cancer survivors.SettingThe study was conducted at a referral cancer centre and the workplaces of cancer survivors located in East Azerbaijan, Iran.ParticipantsA total of 22 cancer survivors were selected using purposive sampling. These participants had completed primary cancer treatment and had rich and diverse RTW-related experiences. Data were collected through semi-structured, face-to-face interviews and then analysed using the inductive content analysis approach described by Graneheim and Lundman (2004).Results‘Active Strategies for Returning to Work’ constituted the main theme and consisted of three categories, including assessing the situation, self-accommodation and impressing the workplace.ConclusionsCancer survivors actively engaged in RTW. They evaluate their situations before returning to work, seek to accommodate themselves to their circumstances and impress their workplaces to gain the necessary support. Healthcare providers, employers and families, as the most influential parties in the RTW process of cancer survivors, should recognise survivors’ positive strategies and provide informational, financial, emotional and occupational support.

IntroductionThe primary caregivers of patients with cancer, especially in advanced stages, experience significant physical and emotional strain and require comprehensive support. Respite care has been acknowledged as an effective strategy to aid primary caregivers, and different models have been established in Western nations. However, implementing these models poses challenges due to notable cultural, social and healthcare system variances between Western and non-Western regions like Iran and other Middle Eastern countries. It is crucial to develop a model tailored to the country’s specific needs, culture and resources to systematically support caregivers and ensure care continuity. Hence, this study aims to develop and validate a respite care model for adult patients with cancer in Iran.Methods and analysisThis study will use a multimethod approach across three stages. In the first phase, a scoping review will be conducted to identify, describe, conceptualise and implement the respite care system based on available documents and evidence. Then, a directed content analysis will be carried out to clarify care requirements and system establishment needs from stakeholders’ perspectives. Data from the scoping review and directed content analysis will be integrated to identify the crucial components of the model using the Delphi method in the second phase. In the third phase, another Delphi study will be conducted to assess the importance, scientific credibility and feasibility of the model, with the aim of finalising it.Ethics and disseminationThis research project has received the code of ethics (IR.TBZMED.REC.1402.720) from Ethics Committee of Tabriz University of Medical Sciences. The findings of this study will be published in reputable journals and disseminated in accessible formats through various media channels.

Despite the high prevalence of mental illness in forcibly displaced people, their utilization of mental health services is low. Major barriers to seeking mental health services include mental health self-stigma. To address this issue, the psychoeducational short film 'Coping with Flight and Trauma' was developed as a brief online intervention. The present study aims to evaluate the feasibility and acceptance of the newly developed 10 min film, and to assess changes in self-stigma and help seeking. The evaluation of the film was conducted using a mixed-methods design with an online survey including the Self-Stigma of Mental Illness Scale, help seeking, and mental health variables at baseline, postintervention, and 3 month follow-up, in addition to telephone interviews postintervention with a randomly selected volunteer subsample. A total of 134 participants with a forced displacement history within the past 8 years took part in the study, of whom 66% scored as having probable post-traumatic stress disorder (PTSD), depression, and/or anxiety. The results revealed emotional, cognitive, and behavioural changes postintervention. Directly after watching the film, participants reported reduced self-stigma and increased openness towards accessing mental health services. At follow-up, precisely 3.8 months later, these changes were no longer significant, yet 11% of participants reported having started psychotherapy since watching the film. Probable PTSD was associated with higher self-stigma at all three time-points. The majority (90%) would recommend watching the film to other forcibly displaced people. Self-stigma was shown to be a robust and persistent issue, which tends to be underestimated by individuals not affected by mental illness. Low-threshold psychoeducational online interventions may be a promising tool to reduce barriers to accessing mental health services for forcibly displaced people, e.g. by being implemented in stepped-care models. Mental health self-stigma was shown to be a persistent and underestimated burden in forcibly displaced people. Psychoeducational online interventions are promising for addressing the burden of self-stigma and reducing barriers to seeking mental health services.

Background Prehospital emergency care is a vital pillar of the health system and serves as the first point of contact for patients. It plays an important role in providing timely care to emergency patients. The expectations of patients and their companions from these services, especially in critical situations, have the capacity to exert a significant influence on their experience and the quality of services. The aim of this study is to identify and investigate the needs and expectations of patients and their companions regarding prehospital emergency services. Methods In this descriptive-cross-sectional study, 1100 patients and their companions were selected. The collection of data was facilitated by means of a questionnaire on expectations of pre-hospital emergency services, which was administered via telephone interviews following the determination of validity and reliability. The collected data were then analyzed using SPSS21 statistical software, and the results were interpreted through the use of descriptive and inferential statistics. Results In this study, the average score of interviewees’ expectations was high (80.01 ± 8.9) and the level of expectations was reported to be higher in women than in men. The results showed that the highest expectations of patients and their companions were related to the presence of a doctor in the ambulance, sufficient skills of medical personnel, respectful treatment combined with gaining trust and providing rapid emergency services. A significant relationship was observed between expectations and marital status, age, occupation and level of education ( P  < 0.001). Conclusion The conclusion drawn from this study indicates that patients and their companions, particularly female members, hold elevated expectations of pre-hospital emergency services. The findings of this study indicate that patients and their companions, especially women, have elevated expectations of pre-hospital emergency services. These expectations encompass the presence of a medical professional in the ambulance, competent staff, respectful treatment, and expeditious service delivery. A notable correlation was identified between these expectations and socio-economic variables. These results underscore the importance of addressing patients’ needs and expectations to enhance the quality of emergency services. Specifically, enhancing staff skills and improving service delivery processes have the potential to increase patient and companion satisfaction.