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When Caregivers Need Care: The Hidden Challenges of Nurses in the Workplace
Mir Amirhossein Seyednazari, Amir Mohammad Dorosti,
Volume 28, Issue 4 (10-2025)
Abstract
Nurses, as one of the main pillars of the healthcare system, have always been at the forefront of delivering medical services. However, recent studies reveal that this professional group is facing serious challenges in terms of mental health and job satisfaction, largely due to structural and systemic failures in the workplace (1). Data from the COVID-19 pandemic underscore the severity of this issue, revealing high rates of burnout among nurses. 34.1% experienced emotional exhaustion, and 12.6% reported a loss of professional identity. These figures reflect not only a transient crisis but also chronic deficiencies within the healthcare system (2).
Key factors exacerbating nurse burnout include workforce shortages, inadequate resources, and workplace violence
(3, 4). The global shortage of nurses is estimated at around 5.9 million, placing excessive pressure on the remaining staff. Additionally, lack of resources and specialized training, particularly during crises, significantly contribute to burnout risk. Workplace violence, particularly in emergency departments and psychiatric units, is on the rise, and many reports suggest that the actual number of incidents is much higher than what is officially recorded (2, 5).
The consequences of these conditions extend beyond individual nurse wellbeing, directly compromising patient care quality and safety. Meta-analyses have shown significant associations between nurse burnout and reduced patient safety, increased hospital-acquired infections, and medication errors (5). Furthermore, only 50% of nurses in 2021 felt that their organizations prioritized their health and safety (1).
The mental health crisis among nurses is also alarming. Rates of anxiety, depression, post-traumatic stress disorder (PTSD), and insomnia are considerably higher in this group compared to other professions. Predictive factors include understaffing, excessive workload, workplace violence, and lack of organizational support. In addition, the stigma surrounding mental health services acts as a major barrier for nurses seeking professional help (6).
Effective solutions include adjusting nurse-to-patient ratios, banning mandatory overtime, enforcing zero-tolerance policies against workplace violence, and strengthening managerial support. For example, California’s implementation of minimum nurse-to-patient ratio laws has led to increased direct care time, better patient outcomes, and higher nurse retention. Emphasis must shift from merely increasing nurse numbers to retaining the current workforce—a crucial step in healthcare reform.
In conclusion, considering the critical importance of nurse wellbeing and its direct impact on patient care, structural and supportive reforms must be prioritized by health policymakers and administrators.
Psychometrics of healthy lifestyle questionnaire in elderly people with Item-Response Theory
Mitra Rahimzadeh, Noushin Ghavidel, Behrooz Kavehie,
Volume 28, Issue 5 (12-2025)
Abstract
Introduction: The age structure of the population has changed due to a decrease in mortality rates. With the increase in the number of elderly individuals, addressing their physical, mental, and social needs has become essential. It is necessary to have a reliable and valid tool for assessing the health status of this group for developing future policies and planning health interventions. This study aimed to evaluate the psychometric properties of Lali’s Healthy Lifestyle Questionnaire using Item Response Theory (IRT) among the elderly in Karaj City.
Methods: Data collection was done through the distribution of questionnaires and interviews with patients in the health centers of Karaj city. In addition to demographic information, Lali's Healthy Lifestyle Questionnaire (2012) was used to collect data.
Results: The mean (standard deviation) age of the participants in the study was 66.82 (6.59) years. Based on the Akaike Information Criterion (AIC), the Nominal Response Model (NRM) demonstrated a better fit to the data among the common IRT models for Likert-scale questionnaires. Based on this model, out of the 54 items used, 6 items did not meet the acceptable criteria for the discrimination parameter and were excluded from the questionnaire. Based on the total information function, the questionnaire can appropriately differentiate individuals within the ability range of -1.5 to 2.5.
Conclusions: Using Item Response Theory in questionnaire psychometrics helps to reduce the number of unrelated items and increase the accuracy of the measurement tools.
 
The Relationship between Nurses’ Moral Courage and Spiritual Health in Amirul Mominin Hospital, Gerash, Iran
Atefeh Sadeghi, Hadi Hasani, Mobina Kaviani, Ramin Mohammadi,
Volume 28, Issue 5 (12-2025)
Abstract
Introduction: With the advancement of science and knowledge worldwide, ethical challenges are increasing, and nurses' inability to face these challenges significantly impacts the quality of healthcare. Moral courage in nurses helps overcome fear and unethical values. The complexity of nursing work affects spiritual health and prevents nurses from adapting well to nursing challenges.
Methods: This was a correlational study using a convenience sampling method. In 2024-2025, nurses working at Amirul Mominin Hospital were selected, with a calculated sample size of 221. The instruments used were Sekerka's Moral Courage Questionnaire and Ellison and Paloutzian's Spiritual Well-being Scale.
Results: A total of 186 nurses participated in the study, including 119 women and 67 men. The mean scores of moral courage indicated that the moral courage score was higher among women and those with higher educational qualifications. Also, age and existential health were important factors in predicting moral courage, while religious health had no significant effect.
Conclusions: The study's results showed that moral courage and spiritual health, especially in existential dimensions, play important roles in moral decision-making. Gender and age are also factors that can affect the level of moral courage.
The Ethical and Legal Imperative in the Age of AI: Safeguarding Patient Data and Privacy in Healthcare
Miramirhossein Seyednazari, Hamed Gholizad Gougjehyaran, Amin Sohaili, Amirmohammad Drosti, Rasul Asghari,
Volume 28, Issue 5 (12-2025)
Abstract
The rapid integration of Artificial Intelligence (AI) into medical sciences, while promising transformative breakthroughs in early diagnosis and personalized treatments (1), introduces a profound ethical and legal challenge: the management of the vast, sensitive, and unprecedented volume of health data and the preservation of patient privacy. The nature of this data, which includes clinical records, radiological images, genetic data, and even data from wearable health devices 2, extends beyond traditional identifiable information. It possesses the capability to reconstruct a comprehensive profile of an individual, rendering complete and permanent de-identification virtually impossible (1).
This massive volume of information has become the main fuel for deep learning algorithms, but any breach or disclosure could lead to serious discrimination in access to insurance, employment, and even judicial decision-making (2). The lack of Transparency regarding how these data are processed and analyzed by the algorithms, which often function as a "black box," erodes the trust of both patients and physicians (3). Healthcare providers cannot understand the AI's decision-making process, which not only hinders clinical adoption but also creates a legal gray area concerning accountability in the event of diagnostic or therapeutic error (4).
The current legal challenge stems from the fact that existing privacy laws were not designed to address advanced algorithms and real-time data collection (1, 4). AI constantly outpaces existing legal frameworks by creating novel methods of knowledge extraction from raw data. Furthermore, due to their reliance on large data networks, AI tools are exposed to advanced cyberattacks, which could lead to the mass disclosure of confidential data (5). Consequently, in the absence of a robust and up-to-date data governance framework, AI's potential to improve public health is accompanied by the risk of undermining human dignity and violating fundamental patient rights (6).
To ensure that AI innovations advance with ethical and legal compliance, urgent measures must be taken to establish a comprehensive regulatory framework. This requires formulating a new, dynamic model of informed consent that goes beyond a one-time agreement, allowing patients continuous and informed control over how their data is used at different stages of AI training and deployment. Concurrently, developers must be mandated to embed privacy protection at the core design of every AI tool, which means utilizing advanced privacy-preserving techniques such as differential privacy and federated learning for on-premise data processing. Additionally, a multi-disciplinary oversight body composed of ethics, legal, computer science, and clinical experts must be established, ensuring that every AI tool undergoes a rigorous and transparent ethical and technical assessment and approval process before entering the clinical environment, thereby preventing potential biases and algorithmic errors. These measures will not only protect patients against misuse but also provide the necessary trust for the sustainable and safe advancement of this vital technology in society
Identifying and Explaining the Challenges of Health System Planning in Iran: A Qualitative Study
Nahid Chezani Sharahi, Seyed Mojtaba Hosseini, Khalil Alimohammadzadeh, Ali Hassan Shaban Khamseh, Mohammadkarim Bahadori,
Volume 28, Issue 6 (1-2026)
Abstract
Introduction: Health system planning, as a core function of health governance, plays a crucial role in resource allocation, performance improvement, and equity promotion. Despite recent reforms, evidence suggests that planning processes in Iran’s health system still face significant structural, managerial, and implementation challenges. This study aimed to identify and explain the key challenges of health system planning in Iran.
Methods: qualitative study was conducted using a thematic analysis approach. Seventeen participants—including senior and middle managers, faculty members, and health planning experts at national and university levels—were selected through purposive sampling with maximum variation. Data were collected via semi-structured interviews over eight months and analyzed using MAXQDA version 20. Credibility, transferability, dependability, and confirmability were ensured to strengthen the trustworthiness of the findings.
Results: Thematic analysis led to the identification of 160 initial codes, 36 organized themes, and 9 overarching themes. The main categories of challenges included: human resources, leadership and governance, processes and regulations, inter- and intra-sectoral coordination, budgeting and financing, physical infrastructure and equipment, health information and technology, service delivery, and sociopolitical–cultural–economic factors. Major issues were found in managerial transparency, cross-sectoral collaboration, financial constraints, and the lack of systematic monitoring and evaluation mechanisms.
Conclusions: The Iranian health planning system suffers from centralization, structural ambiguities, limited stakeholder participation, and weak information systems. Strengthening evidence-informed policymaking, enhancing transparency and accountability, and reforming governance structures are essential for improving the effectiveness and efficiency of health system planning.
 
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