Humanistic Studies and Social Researches

Abstract Introduction: The global healthcare workforce shortage is a critical issue impacting patient care, economic stability, and healthcare access, particularly in specialties like orthopedics, anesthesiology, and nursing. In Iran, this crisis is worsened by economic sanctions, limited training opportunities, and unequal distribution of healthcare workers. This review examines the causes, impacts, and potential solutions to workforce shortages, with a focus on Iran.

Methods: A narrative review was conducted to analyze existing literature on workforce shortages in orthopedics, anesthesiology, and nursing. Sources included peer-reviewed articles, WHO reports, and national surveys. Data were synthesized to identify trends, impacts on patient care, and strategies for addressing these gaps.

Results: The shortage of orthopedic surgeons and anesthesiologists has led to delays in surgeries and worse patient outcomes, especially in underserved regions. Nursing shortages are driven by low wages, poor working conditions, and gender disparities. In Iran, sanctions restrict access to medical equipment, worsening the crisis. Additionally, healthcare workers are concentrated in urban areas, deepening the gap in rural settings. These shortages contribute to higher mortality rates, reduced care quality, and escalating healthcare costs.

Conclusion: The healthcare workforce shortage, particularly in orthopedics, anesthesiology, and nursing, presents a significant global challenge. Solutions include expanding training programs, improving working conditions, providing incentives for rural placements, and fostering international collaboration. These efforts are especially vital in countries like Iran, where external economic pressures exacerbate the issue.

Abstract Background: Parkinson's disease (PD) is a neurodegenerative disorder that affects both motor and non-motor functions, with communication impairments playing a significant role in patients' quality of life and mental health. While motor symptoms are widely addressed, difficulties in speech, language comprehension, and cognitive processing are also critical challenges. This review explores the communication difficulties faced by PD patients, the impact on daily life, and strategies to improve communication, with a particular focus on how medical treatments, including anesthesiology, influence these outcomes.
Methods: A narrative review of studies published through October 2024 was conducted using digital repositories such as PubMed, Scopus, and Web of Science. The focus was on research related to speech, language, cognitive functions, and social support for PD patients.
Results: PD patients frequently experience challenges in speech production, language comprehension, and cognitive processing, leading to diminished social interactions, isolation, and psychological distress. Medical treatments such as deep brain stimulation (DBS) and anesthesia during surgeries can further impact cognitive function and postoperative communication, necessitating careful anesthetic management. Effective strategies like augmentative and alternative communication (AAC) devices, patient-centered care, and information communication technologies (ICTs) have shown potential in improving communication. Strong social support systems and improved health literacy are also essential for enhancing well-being and treatment adherence.
Conclusion: A holistic, multidisciplinary approach that integrates personalized communication strategies, robust social support, and specialized anesthetic management can significantly improve communication abilities and the overall quality of life for individuals with Parkinson’s disease.

Abstract Introduction: Thyroid surgery has evolved significantly, with ongoing debates surrounding indications, techniques, and postoperative outcomes. Historically, total thyroidectomy was the standard approach for both benign and malignant thyroid diseases. However, more conservative methods, like thyroid lobectomy, have gained traction, especially for well-differentiated thyroid cancer (WDTC). Additionally, minimally invasive and transoral techniques are emerging as potential alternatives to improve patient outcomes and reduce scarring. This review explores these developments and examines the challenges associated with thyroid surgery, particularly postoperative complications.
Methods: This narrative review synthesizes recent literature on thyroid surgery, focusing on total thyroidectomy, thyroid lobectomy, and hemi-thyroidectomy for benign and malignant thyroid conditions. It also evaluates the impact of minimally invasive and transoral approaches, along with common postoperative complications such as recurrent nerve palsy, hypocalcemia, and hematoma, and their management strategies.
Results: Thyroid lobectomy has shown to be a safe and effective alternative to total thyroidectomy for low-risk WDTC, offering similar outcomes. Minimally invasive and transoral techniques have improved cosmetic results and reduced recovery times, though they require specialized skills. Postoperative complications, including recurrent nerve injury and hypocalcemia, remain significant but manageable with proper monitoring and early intervention.
Conclusion: Thyroid surgery has shifted toward more conservative approaches, such as thyroid lobectomy, and newer minimally invasive techniques. While these advancements offer improved patient outcomes, the management of complications remains crucial. Continued research and collaboration are key to refining surgical practices and enhancing patient care.

Abstract Background: The social determinants of health (SDOH) significantly shape the prevalence, incidence, and management of diabetes. This review examines the complex relationship between SDOH and diabetes, focusing on economic factors, education, insurance coverage, community context, physical environment, healthcare access, lifestyle factors, and key considerations in orthopedic and anesthesiology care.
Methods: A review of peer-reviewed articles and studies published over the past decade was conducted to explore how SDOH impact diabetes outcomes. The review also addresses orthopedic and anesthesiology concerns, especially related to musculoskeletal complications and anesthesia management for diabetic patients.
Results: Lower economic status, limited education, and insufficient insurance coverage are strongly linked to worse diabetes outcomes. Social and community support, including mental health resources and community programs, is crucial for diabetes self-management. The physical environment—such as access to nutritious food and safe spaces for physical activity—also influences diabetes risk. Additionally, orthopedic issues, such as diabetic neuropathy and musculoskeletal complications, and anesthesiology challenges, such as blood glucose control and cardiovascular concerns during surgery, are vital factors in the care of diabetic individuals.
Conclusion: Addressing diabetes requires a holistic, multidisciplinary approach that incorporates economic, educational, and healthcare factors, along with specialized care for orthopedic and anesthesiology needs. Policy interventions, community-based programs, and healthcare reforms are essential to improving outcomes and reducing disparities. Future research should focus on integrated strategies that incorporate SDOH into diabetes care, particularly for underserved populations.

Abstract Academic procrastination is a prevalent issue among university students, particularly those in high-stress programs like medical studies. This behavior is often associated with negative consequences such as lower academic performance, heightened stress, and a decline in psychological well-being. One promising solution to this problem involves teaching self-regulated learning (SRL) strategies, with a focus on metacognition, which encourages students to monitor, evaluate, and adjust their learning processes. This review synthesizes the body of research on the effectiveness of SRL and metacognitive strategies in reducing academic procrastination and enhancing key outcomes, including psychological well-being, academic self-efficacy, and overall academic satisfaction, particularly among medical students. The review finds that SRL and metacognitive interventions significantly improve both academic performance and mental health by helping students better manage their time, reduce procrastination, and increase motivation. By promoting greater awareness and control over their learning habits, students can overcome procrastination tendencies, leading to improved academic outcomes and greater satisfaction in their studies. The findings of this review suggest that SRL and metacognitive approaches are valuable tools in addressing procrastination and fostering more successful, well-rounded students, particularly in demanding academic environments such as medical education.

Abstract Chronic low back pain and sciatica caused by intervertebral disc herniation are among the leading causes of disability and healthcare utilization worldwide. Effective management of lumbar disc herniation is crucial, encompassing medical therapy, physiotherapy, and interventional procedures. Nucleotomy, the gold standard for decades, directly removes herniated disc material but carries risks such as infection and adjacent segment disease. Recently, percutaneous laser disc decompression (PLDD), a minimally invasive technique, has gained prominence due to its favorable safety profile, reduced recovery times, and efficacy in selected cases. PLDD employs laser energy to vaporize the nucleus pulposus, reducing intradiscal pressure and alleviating nerve compression. This review critically compares nucleotomy and PLDD, focusing on their techniques, indications, outcomes, and complications. While nucleotomy is preferred for complex herniations, PLDD is effective for smaller, contained cases, with success heavily reliant on patient selection. The integration of nutraceuticals with PLDD represents a promising innovation, enhancing neuroprotection and pain management. With a growing emphasis on minimally invasive solutions, PLDD offers a cost-effective alternative for patients seeking less invasive options. This discussion aims to guide clinicians and patients in selecting the most appropriate treatment while exploring advancements shaping the future of spinal care.

Abstract Objectives: this narrative review, empirical findings from multiple sources are brought together with the aim of examining the relational competencies that nurses assess in themselves as well as the caring behaviors they display when engaging with patients, while also pointing out factors that predict these elements, methods used for measurement, and the broader consequences for education in nursing.

Methods: A narrative literature review was carried out in a systematic manner, involving searches for peer-reviewed studies that were published from 1997 through to 2025 and drawn from a range of databases.

Results: When evidence from a variety of international settings was synthesized, it became clear that both nursing students and those already working as practitioners tend to regard their relationships with patients as supportive and helpful provided that there is enough time for contact, a sense of personal capability, increasing age, and accumulated experience. At the same time, the caring behaviors that nurses exhibit often place greater emphasis on completing technical procedures rather than on showing expressive qualities such as compassion and emotional support.

Conclusions: Both the education provided to nurses and the practices they follow in clinical settings need to incorporate structured forms of self-evaluation so that technical abilities can be developed alongside relational skills in a balanced way, with attention paid to influences from the surrounding context and from demographic factors in order to foster genuine interactions with patients and to support ongoing growth in the profession.

Abstract Aim: This review aims to discover the ways burnout and JS influence OCB among nurses.

Methods: Drawing on both quantitative and qualitative research till 2025, this narrative review brings together evidence from PubMed and comparable databases, centering on studies involving registered nurses.

Results: Higher JS consistently showed up as a reliable predictor of stronger OCB, sometimes explaining a surprisingly large share of its variance. These effects often worked through mechanisms like organizational justice, social connectivity, or nurses’ own growing sense of professional capability. Meanwhile, burnout, especially its more corrosive elements such as depersonalization and emotional exhaustion, was strongly linked to declines in OCB, whereas a solid sense of personal accomplishment seemed to act like a buffer. Structural empowerment helped soften exhaustion and indirectly lifted OCB, and supportive supervisors increased nurses’ commitment as well as their willingness to engage in citizenship acts. When woven together, these threads formed an integrated model accounting for about 45% of variation in OCB, with ethical climate and workload standing out as meaningful contributors.

Conclusion: If JS is the fuel for OCB, burnout is the slow leak that drains it. Empowerment strategies, stronger supervisory support, and ethical organizational climates appear capable of preserving OCB while simultaneously holding burnout at bay, changes that ripple outward into patient care and retention.

Abstract Objectives: To determine the prevalence of psychoactive drug and alcohol use and their association with demographic factors such as age and gender, as well as accident characteristics among trauma patients presenting to the emergency department of Imam Khomeini Hospital in Sari, Iran.

Methods: This cross-sectional study was conducted over two years and included all eligible patients (aged 18 and above) who presented to the emergency department due to traffic accidents. Urine samples were collected for biochemical screening using multi drug assesing techniques. Demographic data, accident details, and medical history were also recorded and analyzed. Chi-square and independent t-tests were used to assess statistical associations.

Results: The most commonly detected substances were cannabis (48.5%), methamphetamine (18.2%), and benzodiazepines (19.2%). Although substance use was observed across different age groups and patient roles (pedestrian, driver, passenger, etc.), most cases showed no statistically significant association between substance use and demographic variables. Specifically, no significant associations were found for methadone (p=0.382), cannabis (p=0.212), methamphetamine (p=0.292), amphetamine (p=0.232), benzodiazepines (p=0.134), tramadol (p=0.815), morphine (p>0.05), or tricyclic antidepressants (TCA) (p>0.05) with age, gender, or the patient's role in the accident. The only statistically significant findings were the association between alcohol use and accident occurrence (p=0.035), as well as gender differences in alcohol consumption (p=0.027).

Conclusion: The findings highlight the need for continuous and comprehensive monitoring of drug use among trauma patients, with particular attention to alcohol consumption. The study underscores the importance of developing targeted interventions at both local and national levels to prevent substance-related traffic accidents.

Abstract Objective:

This review sought to weave together evidence on breast cancer knowledge, attitudes, and screening practices across Asian and global populations.

Methods:

A structured literature review was carried out, drawing on systematic reviews, meta-analyses, and observational studies that documented women’s knowledge, beliefs, and preventive actions such as breast self-examination (BSE), clinical breast examination (CBE), and mammography.

Results:

Across countries, breast cancer knowledge and screening practices varied not just statistically but culturally and emotionally. Indian women showed comparatively higher awareness (~63%) and practice (~79%), whereas Iranian, Pakistani, Middle Eastern, and emigrant Asian communities often exhibited low-to-moderate knowledge combined with erratic screening habits. Widespread barriers, fear of diagnosis, financial constraints, social expectations, and limited flow of reliable health information, recurred across studies. Yet, whenever structured and culturally grounded interventions were introduced, from community-based education to navigator programs or train-the-trainer workshops, screening uptake almost always improved. Urban residence, a personal history of breast problems, and easier access to health facilities emerged as consistent predictors of engagement.

Conclusion:

In many Asian settings awareness and screening remain far from where they need to be. Still, the accumulated evidence makes one thing abundantly clear: thoughtful, culturally sensitive health education paired with improved access to care can meaningfully shift outcomes, enhance early detection, and reduce mortality. Prioritizing these strategies is essential if breast cancer control efforts are to be equitable and effective.

Abstract Objective

This review aimed to bring together findings on main factors that drive nurse job satisfaction and to show gender differences in satisfaction levels, stressors, and work outcomes in different nursing settings.

Methods

Narrative review of selected studies found through focused literature search.

Results

Studies showed that high workload, not enough staff, weak supervisor support, and low pay reduced satisfaction. Research indicated that autonomy from task delegation, respectful communication, strong ethical focus on patient-centred care, and good talent management practices increased satisfaction. Gender differences appeared clearly. Data showed that most nurse practitioners were women. Findings indicated that male nurses experienced more workplace bullying yet showed lower intent to leave, and structural empowerment explained part of this effect. Results showed that men had higher burnout depersonalization scores, while women working in emergency departments presented more PTSD symptoms. Evidence indicated that gender equity in nursing education raised esteem and pride among male nurses.



Conclusion

Nurse job satisfaction decreases when resources and support are missing, but it rises with autonomy and ethical patient care. Gender changes how nurses experience work, which shows that men face more bullying and burnout and bullying, while women appear more vulnerable to PTSD and loss of motivation. More research on combined gender effects is needed.

Abstract Objective

This review put together evidence on MS levels, factors linked to it, predictors and interventions in nursing groups, mostly from Asia.

Methods

A narrative review of studies on nursing staff was done with thematic synthesis of evidence.

Results

The review looked at studies from 2010 to 2023, mainly from Asian countries and one study that compared Japan and Finland, which showed moderate levels of moral sensitivity in many nursing groups. These groups included students, ICU nurses, critical care nurses, midwives, mental health nurses and nurses who care for older people. Data from quantitative studies indicated that moral sensitivity had positive links with ethical decision-making which indicated professional values played a mediating role, emotional intelligence, moral awareness, moral self-concept, person-centered care and positive attitudes toward care of older people. The same data showed an inverse link with perceived quality of nursing care that included psychosocial and physical parts. Moral sensitivity appeared as a strong predictor of person-centered care and of compassion fatigue, especially during the COVID-19 period. Results were mixed for links with moral distress because some studies indicated no connection while others showed it existed.

Conclusions

Moral sensitivity is a clear predictor of ethical nursing practice and care quality which indicates it can also make nurses more open to distress and fatigue when conditions are hard. Targeted interventions and supportive ethical climates are needed that show how to keep moral sensitivity strong and reduce bad outcomes.

Abstract Objective:to explore how different forms of digital use, including social media scrolling, generalized internet immersion, and habitual smartphone engagement, intersect with dietary choices, movement patterns, sleep routines, and broader mental health outcomes among varied demographic groups.

Methods:

The review synthesizes findings from peer-reviewed studies that focus on social media or internet addiction alongside research on physical activity, eating behaviors, and sleep quality, that shows how these behaviors converge.

Results:

A growing body of evidence points to excessive digital involvement as a notable contributor to disordered eating behaviors, nighttime eating episodes, orthorexic traits, and a heightened intake of sugar-sweetened or ultra-processed foods that shows the subtle ways digital patterns seep into daily habits. Physical activity frequently declines when social media addiction intensifies, although structured interventions and fitness-focused applications appear capable of buffering some negative outcomes. Sleep quality tends to erode under heavy screen exposure, social media fatigue, and gaming addiction, and this decline becomes more pronounced when poor impulse regulation or late-evening device use is present. Adolescents show striking vulnerability given their developmental stage and social pressures, though adults also encounter addiction-like symptoms including compulsive engagement and nomophobia. Cultural norms and socioeconomic conditions further shape how these factors interact.

Conclusion:

Digital engagement carries substantial influence over lifestyle behaviors and psychological well-being, which indicates urgent need for interventions that promote digital literacy, regular movement, balanced nutrition, and supportive sleep habits. These strategies must remain culturally adaptable in order to prevent harmful patterns of digital dependence and sustain holistic health across age groups.

Abstract Background: Ovarian cancer kills more women than any other gynaecological cancer. Culture plays a big role: many patients show stoicism, follow Confucian rules, and believe in fate, which changes how they see stress, how they cope and how confident they feel.

Objective: This review brings together studies that show how perceived stress, coping methods, health locus of control, and self-efficacy work together in Asian women with ovarian cancer.

Methods: We looked at quantitative, qualitative, and mixed-method studies that were written in English and came mostly from East, Southeast, and South Asia.

Results: Studies repeatedly showed that high perceived stress strongly indicated more anxiety, more depression, and worse quality of life that was clearly worse. Task-oriented coping together with family support showed lower distress again and again, while emotion-focused or avoidance coping indicated higher distress every time. In Asian patients, both internal health locus of control and powerful-others locus of control indicated better self-efficacy and better adherence, but chance locus of control showed helplessness and passive behaviour. Self-efficacy often worked as the link that explained how stress, coping, and locus of control finally affected quality of life. Exercise and good nursing care indicated clear increases in self-efficacy.

Conclusion: Mental suffering in Asian women with ovarian cancer is deeply shaped by collectivist thinking, trust in doctors and family, and beliefs about fate. Regular screening with tools that fit the culture and family-based psychological help are necessary so that patients gain self-efficacy, learn active coping, and reach better quality of life.

Abstract Objective: This narrative review aims to synthesize and examine the interrelationships between critical care nurses' exhaustion, job burnout, work conditions, task volume, and their perceptions of the patient safety climate.

Methods: A narrative review of the extant literature was conducted. Databases and relevant journals were searched for studies focusing on ICU nurses, burnout, work environment, workload, and patient safety climate. Key findings were synthesized to identify themes and evidence-based relationships.

Results: The evidence consistently demonstrates a strong negative correlation between burnout components (emotional exhaustion and depersonalization) and positive perceptions of patient safety culture. Conversely, a sense of personal accomplishment and a supportive work environment are positively associated with a robust safety climate. While the direct link between task volume and safety perceptions is sometimes attenuated, high workload is a significant driver of exhaustion and burnout, thereby indirectly eroding the safety climate. Fatigue is identified as a critical precursor that impairs cognitive function and diminishes safety performance.

Conclusion: The well-being of the critical care nurse is inextricably linked to the safety of the patient. Burnout, poor work conditions, and excessive task volume collectively threaten a positive safety climate. Healthcare organizations must implement multifaceted, systemic strategies that address burnout, optimize the work environment, manage fatigue, and empower nurses to foster a culture of safety. Proactive leadership is required to safeguard both caregiver well-being and patient outcomes.

Abstract Background: The COVID-19 pandemic forced nursing education and practice into an unprecedented crisis that is constantly shifting most teaching online overnight and intensifying already high levels of stress among nurses.

Objective: This review examines how nursing students and professional nurses around the world experienced and managed heightened psychological pressure during the pandemic, highlighting both adaptive and maladaptive ways of coping.

Methods: A narrative synthesis of international studies conducted between 2020 and 2025 explored common stressors, preferred coping approaches, and factors that supported or hindered resilience in diverse settings.

Results: Academic workload, fear of infection, isolation from peers and family, financial strain, and limited hands-on training emerged as universal sources of distress. Many turned to helpful strategies such as planning ahead, seeking emotional support from colleagues, reframing difficult situations positively, and using humor or structured reflection techniques. These approaches consistently reduced anxiety, lowered burnout, and helped people stay in school or remain at work. In contrast, avoidance, denial, or emotional detachment often worsened mental health and increased dropout intentions. Strong social networks, institutional mental health programs, resilience training, and clear communication tools proved especially protective.

Conclusion: The pandemic exposed serious gaps in mental health support for nursing students and nurses, yet it also revealed remarkable adaptability worldwide. Moving forward, nursing programs and healthcare organizations should routinely teach evidence-based stress management, build peer-support systems, and provide accessible counseling. Embedding these practices into everyday training will better equip the next generation of nurses to handle future crises while protecting their own well-being.

Abstract Objective

This review aims to consolidate current knowledge on the effectiveness of CBT and related therapeutic approaches for addressing anxiety and depression in people with advanced cancer.

Methods

A narrative review method was adopted to integrate findings from various sources, including systematic reviews, randomized trials, pilot studies, and research protocols, all examining CBT, mindfulness-based practices, and other forms of psychotherapy within advanced cancer populations.

Results

Findings suggest that CBT and similar interventions can provide meaningful relief from anxiety and depressive symptoms, though the degree of benefit varies. Mindfulness-based approaches appear particularly helpful in promoting a sense of existential well-being and supporting caregivers. Some structured CBT programs have not demonstrated consistent benefits across all patient groups, with improvements often observed in specific subpopulations. Overall, broader psychotherapeutic approaches indicate the potential for moderate symptom reduction, but evidence remains limited. Newer approaches, such as behavioural activation, are currently under study and may offer alternative options.

Conclusion

Psychological therapies, including CBT, show important but variable effects in managing anxiety and depression in individuals with advanced cancer. Interventions that are tailored to individual patient characteristics, levels of distress, and situational needs may be more effective. Continued research through well-designed, focused trials is essential to better understand how these therapies can be optimized in this population.

Abstract aim: This review explores the effectiveness of anxiety prevention education for adolescent service recipients in healthcare centers.

Methods: A comprehensive literature review was conducted, synthesizing evidence from systematic reviews, meta-analyses, and randomized controlled trials (RCTs) focusing on anxiety prevention education. Studies were retrieved from databases such as PubMed, PsycINFO, Scopus, and Google Scholar using relevant keywords. Selected studies assessed the effectiveness of psychoeducational interventions, cognitive-behavioral techniques (CBT), and stress management strategies in reducing adolescent anxiety.

Results: Evidence indicates that structured anxiety prevention programs, particularly those integrating psychoeducation and CBT, effectively reduce anxiety symptoms and enhance coping skills among adolescents. School-based interventions have shown significant short-term benefits, with some effects persisting for up to a year. However, research on healthcare-based interventions remains limited. Primary healthcare centers, as accessible and community-trusted institutions, have the potential to provide a structured and sustainable approach to anxiety prevention. Challenges such as mental health stigma, resource constraints, and limited training of healthcare professionals must be addressed to optimize program implementation.

Conclusion: Integrating anxiety prevention education into healthcare centers in Sari County presents a promising strategy for reducing adolescent anxiety and promoting mental well-being. By leveraging existing healthcare infrastructure and adopting evidence-based interventions, these programs can offer scalable and cost-effective solutions. Policy support, professional training, and community engagement are essential for ensuring the long-term success of such initiatives. Future research should focus on assessing the sustained impact of healthcare-based interventions and developing culturally adapted models tailored to the needs of Iranian adolescents.

Abstract Background: This review explores how such interventions can enhance the quality of life for children undergoing cancer treatment and support their social integration.

Materials and Methods: This review draws on a wide range of studies and clinical trials concerning family interventions for children with ASD undergoing cancer radiotherapy. The research materials include both domestic and international literature on various family-centered approaches, such as psychoeducational programs, behavioral interventions, and parent training.

Results: The review identifies several key family interventions that are effective in improving the treatment process for children with ASD undergoing cancer radiotherapy. These include structured parent training, psychoeducational support, and behavioral interventions tailored to the unique needs of children with ASD. Family interventions were found to enhance the children’s ability to cope with the stresses of cancer treatment, improve their emotional regulation, and promote better social integration. Furthermore, active family participation in the treatment process led to improved adherence to medical protocols and greater emotional well-being during radiotherapy.

Conclusion: Family intervention plays a critical role in improving the outcomes for children with autism spectrum disorder undergoing cancer radiotherapy. By actively engaging families, providing appropriate support, and integrating psychoeducational and behavioral strategies, children with ASD can experience better treatment outcomes, enhanced social integration, and improved quality of life. Future research should continue to focus on refining family-based interventions and exploring innovative approaches to support children with ASD in challenging medical situations such as cancer treatment.

Abstract Objective: To evaluate the impact of key lifestyle factors on liver function in patients with liver cancer receiving radiotherapy, integrating both conventional clinical evidence and Traditional Chinese Medicine (TCM) perspectives.

Methods: A systematic review of literature published between January 2000 and March 2024 was conducted using PubMed, CNKI, Wanfang, Web of Science, and Scopus. Inclusion criteria focused on studies assessing the effect of lifestyle factors such as stress, diet, sleep, and exercise on liver function in the context of liver cancer and radiotherapy.

Results: A total of 47 studies were included (18 RCTs, 22 observational studies, 7 systematic reviews). Emotional stress was significantly associated with worsened liver function during radiotherapy (OR = 2.87; 95% CI: 2.14–3.84; p < 0.001). High-fat diets increased the risk of hepatic steatosis and impaired liver function (RR = 1.94; 95% CI: 1.67–2.25; p < 0.001), while plant-based diets were protective (OR = 0.68; 95% CI: 0.57–0.81; p < 0.001). Poor sleep quality correlated with liver enzyme elevation (r = 0.62; 95% CI: 0.54–0.69; p < 0.001). Moderate exercise, including TCM-based practices like Tai Chi, was linked to improved liver function and reduced radiation-induced toxicity (SMD = 0.82; 95% CI: 0.67–0.97; p < 0.001).

Conclusion: Lifestyle factors significantly influence liver function in liver cancer patients undergoing radiotherapy. Interventions targeting emotional regulation, diet optimization, sleep hygiene, and physical activity—especially when aligned with TCM principles—may enhance hepatic resilience and therapeutic outcomes. These insights support integrative, lifestyle-centered care in oncology settings.

Abstract Background: Performance anxiety is a prevalent issue among nursing students during clinical simulations, potentially hindering learning and skill acquisition. Music intervention has emerged as a potential non-pharmacological approach to mitigate anxiety and enhance performance. This review synthesizes current evidence on the role of music in alleviating anxiety and boosting performance in nursing simulations, with a specific focus on findings from an Asian educational context.

Methods: A comprehensive review of the literature was conducted, focusing on experimental and observational studies that examined the effects of music on nursing students' anxiety levels, physiological stress indicators, self-efficacy, and simulation performance. The review critically appraises a key randomized controlled trial conducted in an Asian setting and integrates its findings with the broader evidence base.

Results: The reviewed evidence consistently demonstrates that music intervention significantly reduces both self-reported anxiety and physiological indicators of stress, including heart rate and mean arterial pressure, during nursing simulations. Furthermore, music exposure is associated with improved performance as evaluated by instructors. However, the impact of music on self-efficacy appears inconsistent across studies. The low-cost, non-invasive nature of music intervention enhances its practical applicability in nursing education.

Conclusion: Music serves as an effective, accessible tool for creating a more supportive learning environment in nursing simulation education. Its implementation can reduce anxiety and improve performance, thereby potentially enhancing clinical competence. Future research should explore optimal music genres, timing, and duration of exposure, as well as the long-term effects of music intervention on clinical practice transitions.

Abstract Background: Cardiopulmonary resuscitation (CPR) is a critical life-saving intervention in cases of cardiac and respiratory arrest. Nurses, as front-line healthcare providers in hospital settings, play a vital role in initiating and performing effective CPR. This study aimed to assess the knowledge and practical skills of nurses at Imam Khomeini Teaching Hospital in Sari regarding the basic principles of CPR.

Methods: This descriptive-analytical and cross-sectional study was conducted in 1403. The research population included 149 nurses working in different departments of Imam Khomeini Center in Sari who were included in the study by census method. The data collection tool was a standard checklist prepared based on the guidelines of the Heart Association. To examine the normality of the scores obtained from the total nurses' knowledge and skills questionnaire, two statistical tests, Kolmogorov-Smirnov, were used.

Results: Most participants were female (65.1%) and held a bachelor’s degree in nursing (96.6%). Although all nurses reported prior theoretical familiarity with CPR, deficiencies were noted in critical areas of practical skills, including proper AED usage, correct depth and frequency of chest compressions, and effective artificial ventilation. No statistically significant differences were found in knowledge and skill scores based on age, gender, education level, work experience, or ward of employment (P>0.05).

Conclusion: Despite theoretical awareness, the nurses’ practical CPR skills, especially in high-stakes interventions, were suboptimal. This highlights the necessity of regular hands-on training, simulation-based learning, and continuous professional development programs to enhance CPR competencies in clinical settings.

Abstract Objective: This review aims to synthesize and critically evaluate existing research on the relationship between personality types and learning styles among nursing students, with a specific focus on implications for English as a Second Language (ESL) acquisition. The goal is to consolidate findings to inform the development of more personalized, effective, and inclusive educational strategies in nursing programs.

Methods: A literature review was conducted, drawing on key studies that investigate personality typologies, particularly the Myers-Briggs Type Indicator (MBTI), and learning style models. The review synthesizes evidence from quantitative and qualitative research to explore the correlations between these psychological constructs and their practical applications in nursing education.

Results: The synthesized evidence consistently indicates a strong correlation between personality types and preferred learning styles. Introverted nursing students (e.g., INFP, ISFJ) show a marked preference for private, self-directed, and solitary learning environments. In contrast, extroverted students (e.g., ESTJ, ENTP) thrive in collaborative, group-oriented, and interactive settings. These preferences profoundly impact engagement, motivation, and academic success, particularly in the challenging context of second language acquisition.

Conclusion: Nursing education must proactively move beyond standardized teaching methodologies. Acknowledging and accommodating the diversity of learning styles rooted in personality is crucial for optimizing student outcomes. Implementing a multimodal teaching strategy that incorporates self-directed modules, collaborative activities, and reflective practices can create more inclusive and effective learning environments. This approach not only enhances academic and language skills but also fosters the development of well-rounded, adaptable nursing professionals prepared for the collaborative yet often autonomous nature of modern healthcare.

Abstract Objective: This review aims to synthesize and critically evaluate the current literature on experiential empathy training programs for nursing students, focusing on their implementation, efficacy, and methodological approaches, with specific attention to studies within the Asian context.

Methods: A narrative synthesis of the literature was conducted. Studies were included that investigated structured empathy interventions for nursing students, utilizing methodologies such as simulation, role-playing, and flipped classrooms. Outcomes of interest included changes in self-reported empathy, observed empathic behavior, and skill retention.

Findings: The evidence consistently demonstrates that well-designed, experiential training programs lead to statistically significant improvements in nursing students' empathy levels. These gains are documented using validated tools like the Jefferson Scale of Empathy (JSE) and the Consultation and Relational Empathy (CARE) Measure. Key effective pedagogical components include simulated patient interactions, reflective practice, and blended learning models. However, the field is limited by a predominance of quasi-experimental designs, small sample sizes, and a lack of long-term follow-up data.

Conclusion: Experiential empathy training is a highly effective and necessary component of undergraduate nursing education. To advance the field, future work should prioritize longitudinal studies, the development of culturally adapted interventions for diverse Asian populations, and more rigorous randomized controlled trials to strengthen the evidence base and ensure the sustained integration of empathy into clinical practice.