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Mechanically ventilated patients experience a high level of anxiety due to their therapeutic condition. Anxiety is one of the strongest emotions that patients under mechanical ventilation experience due to their inability to communicate with others. The aim of this study was to investigate the effect of using a communication board on these patients' by assessing serum cortisol level and vital signs.This randomized clinical trial study was conducted in 2020. This study included 60 ventilated patients, who had been randomly assigned into two intervention and control groups. After blood sampling and evaluation of cortisol and physiological parameters, patients in the control group received routine communication by nurses, whereas those in the intervention group received communication using a communication board. Subsequently, the serum cortisol level and physiological parameters were measured again.No significant difference was observed between the two groups in terms of demographic characteristics. There was a significant difference in blood cortisol levels before and after in the intervention group (Communication through a communication board in mechanically ventilated patients leads to decreased cortisol levels and physiological parameters. It is recommended to do more studies about communication boards' content and use this tool for more prolonged periods.

Home care service is considered as comprehensive care for children with chronic disease or COVID-19. This study aimed to investigate the factors affecting the implementation of a home care nursing program for such children in 2019-2020.A descriptive-analytical study was conducted with 198 nurses working in pediatric wards of selective hospitals of Isfahan University of Medical Sciences. The data were collected through an author-administered questionnaire with 44 questions. The questionnaire was designed in two parts. Part one involved gathering the demographic data of the participants. Facilitating and barrier factors of the implementation of the care were prioritized and examined in part two by using the Likert scale in both the individual and the organizational domains. The data were analyzed using the mean frequency and pairedThe mean (SD) score of individual and organizational facilitating factors were 65.65 (16.24) and 65.98 (11.29), respectively, and the mean (SD) score of the organizational barriers was 82.04 (14.36), which was significantly higher than the mean score (SD) of the individual barriers of 57.94 (14.82) (Organizational factors were the most significant barriers. Therefore, the findings of this study will help policymakers in the program implementation.

Early detection of postpartum problems can help reduce maternal mortality in Indonesia. Early detection can be achieved by monitoring postpartum mothers using a guidance system. The purpose of this study was to describe the development of a guidance system, namely, Smart Postpartum Care (SMAP CARE) and present its functional and acceptance tests.This study was a development study conducted in 2019 using a mixed-method approach. Data were collected through Focus Group Discussions (FGDs) and a literature study. The FGD participants consisted of six doctors, six nurses, and midwives from six community health Public health center in Semarang City, Indonesia. The collected data were analyzed using the Colaizzi method. The content of the postpartum mentoring application was based on input from the experts in health education and health services. Before widely applied, a feasibility study on the application was carried out in community health centers involving postpartum mothers and health care teams.Five themes were generated from FGDs: (1) postpartum monitoring facilities; (2) monitoring postpartum mothers through visits to health centers and home care; (3) problems with postpartum mothers (including problems with mothers, babies, and the environment); (4) management of high-risk postpartum mothers; and (5) the risk of postpartum mothers, which could cause death. The SMAP CARE provides some features to educate postpartum mothers, for example (a) changes in the physiological aspects of postpartum mothers, (b) breast milk, (c) newborn care, (d) signs of danger in newborns, (e) problems with babies, (f) problems with postpartum mothers, and (g) signs of danger in postpartum mothers.The application developed in this research, SMAP CARE, helps to facilitate mentoring for postpartum mothers and can be extended to community health centers in Indonesia.

Hidden Curriculum (HC) plays an essential role in nursing education and professionalism. However, its positive consequences have been overlooked. Thus, this study aimed to explore and discuss the positive consequences of HC in nursing undergraduate education.A comprehensive literature search was conducted to investigate articles published between January 2010 and December 2020. Furthermore, Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was used to select articles, and Consolidated criteria for Reporting Qualitative research (COREQ) and Strengthening the Reporting of Observational studies in Epidemiology (STROBE) tools were employed to appraise qualitative and quantitative studies, respectively. The applied search strategy resulted in a final list of 16 articles out of a total of 132 articles. Next, the data were integrated and categorized using the Whittemore and Knafl methodology.Three categories were identified: Individual Consequences; involving increased self-confidence, self-esteem, assertiveness, adaptation, autonomy, and lifelong learning. Social Consequences; involving enhanced socialization, cultural consciousness, and social interactions. Professional Consequences; involving professional socialization, professional identity, professional ethics, link theory and practice, and professional dignity.Altogether, we concluded that the emergence of HC and its positive and remarkable consequences in nursing knowledge helps the personal, social, and professional development in nursing.

The prevalence of persons with hypertension remains high, especially in Southeast Asia, such as in Indonesia. Therefore, an effort to control blood pressure is needed. This study aimed to examine the effect of a self-management program on blood pressure among persons with hypertension in Indonesia.A quasi-experimental study with pre-test post-test with control group design was used. Seventy-seven participants were selected using convenience sampling in Belitung, Indonesia. A digital sphygmomanometer was used to measure blood pressure. PairedThere was a significant effect of the eight-week self-management program on systolic blood pressure (Brisk walking with a duration of at least 30 minutes per day, dietary modification program specifically focusing on weight loss and anti-hypertensive food, monitoring program, and health education for eight weeks, are considered effective to control blood pressure among patients with hypertension, and these interventions should be a part of nursing interventions and sustainable health development programs in the community.

What has been less considered in the literature of the sex work research, especially in Iran, is to look at the causes of sex work from the perspective of women. The present study sought to understand the causes of the problem and the experience of female sex workers.The present study was conducted by using qualitative method. Twenty-eight sex workers participated in the study voluntarily and with informed consent. The researcher conducted deep semistructured interviews. Purposive sampling continued until data saturation was reached. Conventional content analysis of the transcribed interviews and field notes were performed to identify key themes, first by each of researchers separately and then in joint discussions.The main theme of the study, according to the participants, was the sense of "what pushed me into sex worker" which included the five main categories of "despair, psychic restlessness, getting drunk by alcohol and drug, incomplete families, not to be left behind by the sudden social changes."Social and health consequences, especially reproductive health of female sex, workers are affected by several factors. However, to deal with this social and health problems, specific attention should be paid to social factors affecting health. Accordingly, each of the influential variables known in this study could be a target for the country's intervention programs, especially in public health centers and even charities related to the healthcare counseling of sex workers.

Rheumatoid Arthritis (RA) is a chronic inflammatory disease that affects various systems of the body. The present study was conducted with the aim to explain the lived experiences of Iranian patients with RA.According to the research question, the phenomenological research approach was used. The participants were selected through purposive sampling, and sampling was continued until data saturation was achieved. The data was collected by conducting unstructured interviews and using an audio recorder. To interpret the data, an interpretive/hermeneutic approach was implemented using Van Manen's method. In addition, Lincoln and Guba's criteria were used to evaluate data robustness.A total of 24 participants participated in the study. Overall, 145 basic concept codes were extracted which were classified into the four main themes of self-management with the participation of the family, spiritual resilience in the face of existing problems, the tendency to hide the disease, and the fear of an uncertain future.It is recommended that care providers use the findings of this study to develop care plans in the various aspects of the physical, mental, social, and spiritual needs of patients with RA based on their concerns and deep experiences. It is also suggested that other qualitative research approach methodologies such as grounded theory for explaining the process of patient care and providing an appropriate model, or action research for solving the problems of hospitalized patients through suitable care at home be implemented.

Background: Internet dependency has become one of the 21st century dilemmas affecting different aspects of married life such as sexual relationships. Considering the importance of family in the Iranian society, this study aimed to determine how internet dependency is related to sexual desires and satisfaction among married clients of healthcare centers. Materials and Methods: This cross-sectional study was conducted on 326 married clients referred to healthcare centers in Tabriz City, Iran, between February and August 2019. Proportionate stratified random sampling was used based on the health complexes and the healthcare centers covered by them. One of the healthcare centers covered by each complex was selected randomly. The data collection tools included a demographic characteristics checklist, the Internet Addiction Test (IAT), the Index of Sexual Satisfaction (ISS), and the Hurlbert Index of Sexual Desire (HISD). The collected data were analyzed using the Pearson correlation coefficient test and multiple linear regression model. Results: The mean (SD) was 37.33 (15.37) for of internet dependency, 59.20 (17.27) for sexual desire, and 104.45 (22.81) for sexual satisfaction. There was a negative correlation between internet dependency and sexual satisfaction (r = -0.47, p < 0.001). This correlation remained significant (B = -0.41, df = 9, p < 0.001,) even when occupation (B = 3.66, p = 0.01), satisfaction with married life (B = 15.34, p < 0.001), and sexual desire (B = 0.60, p < 0.001) were adjusted as potential confounding factors. Conclusions: Internet dependency can cause a reduction in sexual desire and sexual satisfaction. Designing educational interventions in healthcare centers is recommended to manage the use of internet and to inform clients about the effects that internet dependency may have.

Background: Sexual self-disclosure is one of the factors that affect sexual satisfaction. The aim of this study was to assess the efficacy of individual therapy using the Bring up, Explain, Tell, Timing, Educate, and Record (BETTER model) in comparison to individual therapy using the Permission, Limited Information, Specific Suggestions, and Intensive Therapy (PLISSIT model) in terms of increasing sexual self-disclosure in women with sexual problems after childbirth. Materials and Methods: This randomized trial was conducted in 2017 in Mashhad, Iran. 80 women with sexual problems within 4 weeks to 6 months after childbirth were randomized into two equal groups and received the interventions in 2 sessions of 60–90 minutes. The research instruments included a demographic questionnaire, the Female Sexual Function Index (FSFI) and Hulbert sexual self-disclosure index. Changes in mean (SD) scores of sexual self-disclosures between groups were assessed before and 4 weeks after the intervention and the results (mean changes) were compared between groups. The data analysis was conducted using independent t-test, paired t-test, Chi-square, analysis of covariance (ANOVA), and Mann-Whitney U test in SPSS (p < 0.05). Results: In the PLISSIT group, the mean (SD) sexual self-disclosure score at baseline was 43.80 (9.50) and after 4 weeks was 51.60 (8.30). In the BETTER group, at baseline and after 4 weeks the mean (SD) sexual self-disclosure score was, respectively, 44.10 (10.30) and 55.60 (8.20) (Z = -2.5, p = 0.013). Conclusions: The findings confirm the effectiveness of the BETTER counseling model in increasing sexual self-disclosure after childbirth.

Background: Diagnosing congenital fetal anomalies before birth is considered an emotionally devastating experience. To facilitate the process of compatibility with this event, healthcare providers should determine various needs of these women. The present study was conducted to explore the informational and educational needs of women who have experienced pregnancy termination because of fetal anomalies. Materials and Methods: The present study was a qualitative content analysis. Forty participants (women, their spouses, and healthcare providers) in Rasht city, Iran, were selected using purposive sampling method with maximum variety and their data were gathered using in-depth interviews and field notes. Data were analyzed using conventional qualitative content analysis with Graneheim and Lundman approach. Results: After analyzing the text of the interviews, the informational and educational needs of women who have experienced pregnancy termination because of fetal anomalies were categorized in three main categories of “receiving information tailored to the client's circumstances,” “learning life skills to cope,” and “getting prepared for the next pregnancy.” Conclusions: The results, by exploring and magnifying the informational and educational needs of these women, could present an appropriate context for providing principal care and cultural-based interventions with an emphasis on comprehensive education and counseling. Also, proper implementation of the process of obtaining informed consent from the women to terminate the pregnancy is essential. These could facilitate the conditions for their return to normal life and ultimately promote their health.

Background: Respectful relationship among nurses is an important influencing factor of positive work environment and nursing outcomes. Disrespectful interpersonal behaviors set the scene for an unpleasant and unhealthy workplace in nursing. This can be harmful to persons and their organization and affect health care outcomes. This study was designed in order to search for contextual barriers to respectful behaviors in the context of nursing. Materials and Methods: This study was a focused ethnography that was carried out in medical-surgical wards of Shahid Chamran Hospital in Isfahan in 2018-2019. The data collection method consisted of 140 h of participant observation and semi-structured interviews with 34 informants. The nformants comprised 29 nurses, 2 assistant nurses, a physician, and 2 patients who were selected by purposive sampling. The first author of the study made direct observations as an outsider. The data were analyzed by Spradley's method. Results: Three main categories and eight subcategories were obtained from data analysis that are as follows: 1) Personal self: challenges of perceived respect (negative self-concept, unpleasant feelings, and ineffective communication), 2) Organizational-based perceived disrespect (poor organizational climate, inadequate job condition, restrictive organizational structure), 3) Social self: challenges of showed respect (implicit social norms, cultural gap). Conclusions: Individual and social attitudes, interactive communication, and organizational factors are the contextual determinants of a respectful workplace in nursing. Consequently, improving self-concept and effective communication skills as well as adjust organizational conditions and value conceptualization in society may effect a respectful workplace in nursing.

Background: Patients undergoing orthopedics surgery experience the most severe postoperative pain. The fasting time is a factor that affects this complication. The aim of this study was to investigate the impact of fasting time reduction by using oral carbohydrate on postoperative pain and analgesic consumption in orthopedic patients. Materials and Methods: This randomized control trial was conducted between November 2017 and December 2018. Sixty‑four patients were randomly assigned into the intervention (which consumed 200 mL of the 12.50% carbohydrate, 2 h before the surgery) and the control group (which was fasted from midnight). Postoperative pain was measured by visual analog scale; the amount of the consumed analgesics was also recorded. The data were analyzed by using Chi‑square and t‑test. Results: The mean (SD) of the pain scores in the control group immediately and 2, 4, 6, 12 and 24 h after consciousness were 7.19 (2.64), 6.69 (2.17), 6.31 (2.05), 6.16 (2.08), 6.06 (2.24), and 5.38 (1.86), respectively. These scores for the intervention group were 7.44 (1.48), 6.31 (1.25), 5.72 (1.17), 5.59 (1.43), 5.25 (1.13), and 4.97 (1.57). The mean of the pain scores between two groups was not different ( p > 0.05). The amount of the consumed morphine (t61 = ‑2.10, p = 0.039), pethidine (t62 = ‑2.25, p = 0.028), and diclofenac (t62 = ‑2.51, p = 0.015) were significantly different between the two groups. Conclusions: The pain intensity in the patients with shortened fasting time was lower, but it was not statistically significant. Moreover, reducing fasting time by using carbohydrate significantly reduced the use of analgesics.

Background: The use of analgesics and sedatives to provide sedation for Patients in Intensive Care Unit (ICU) is inevitable. The present study aimed to determine the effect of sedation protocol using the Richmond Agitation‑ Sedation Scale on sedation level and amount of pharmacological and non‑pharmacological interventions on patients under mechanical ventilation. Materials and Methods: This randomized clinical trial was conducted on 79 patients under mechanical ventilation in Zanjan. The patients were recruited using the blocking randomized sampling method. In the experiment group, the sedation was provided hourly, using the Richmond sedation Protocol, during the mechanical ventilation period. The level of sedation and pharmacological and nonpharmacological interventions were compared in the two groups using Fisher exact test. Results: Totally, 40 patients in the experiment and 39 patients in the control groups were evaluated. No significant difference was found between the two groups in terms of confounding variables (age, sex, level of consciousness, Acute Physiologic and Chronic Health Evaluation (APACHE) II criterion, underlying disease, and cause of hospitalization). The level of sedation in the experiment group was significantly closer to the ideal score of the Richmond Scale compared to the control group ( p < 0.001). The experimental group received significantly more non‑pharmacological interventions and fewer pharmacological interventions compared to the control group ( P < 0.001). Conclusions: Using a sedation protocol could provide better sedation levels in patients under mechanical ventilation, and reduce the use of sedative medications, and consequently, the cost of hospitalization. Further research is suggested.

Background: Fear of hypoglycemia is a medical emergency which leads to disrupt individuals' normal lives. Peers support is a hopeful approach to improve diabetes self-care behaviors. This study was conducted to assess the effect of peers support on the fear of hypoglycemia in patients with type 1 diabetes. Materials and Methods: This randomized clinical trial study was performed among 60 patients with type 1 diabetes in Qazvin city from September 2019 to October 2020. Patients were assigned to control and intervention groups using a random method. The data collection tools included demographic characteristics and a standard questionnaire for Hypoglycemia Fear Survey (HFS). Patients in the intervention group were trained by skilled peers for 2 months, but those of the control group only received routine hospital training. The data were analyzed by SPSS version 16 and paired and independent t-test. Results: The scores of the fear of hypoglycemia in diabetic patients in the two groups had no significant statistical difference before intervention (t53 = 0.93, p = 0.94). But after the intervention, the independent t-test showed that there was a significant difference between the scores of the fear of hypoglycemia in both groups (t53 = -2.13, p = 0.03). Conclusions: Considering the results of the current study, peer support for diabetic patients is an effective way to reduce the fear of hypoglycemia. Therefore, it is recommended using this training method to train diabetic patients.

Background: Reproductive Life Planning (RLP) is a person-centered approach that investigates the reproductive needs, values, and priorities of each person and not only reduces the risk of unwanted pregnancies but also improves pregnancy outcomes and childbirth by investigating the health behaviors and underlying diseases of each individual. Therefore, the present study was conducted to assess RLP in pregnant women. Materials and Methods: This descriptive cross-sectional study was carried out on 1019 pregnant women who were referred to outpatient clinics of teaching hospitals in Mashhad, Iran, during May–August 2019. The participants were selected using a convenience sampling method. The data collection tool used was a questionnaire. Data analysis was performed in SPSS software. Results: The results of this study showed that about two-thirds of the participants had a plan for their reproductive years. The age range of the participants was 13–47 years. Among the women, 38.60' had experienced failure of contraceptive method, and 32.20' had an unmet need for family planning-Ž. Moreover, only one-third of the women had been referred for preconception care, but 88.70' of the pregnant women had their initial prenatal care visit in their first trimester. Conclusions: Given the considerable number of unwanted pregnancies and unmet needs for family planning in the present study, the modification of family planning policies seems necessary. Various strategies have been proposed to prevent unintended pregnancies such as RLP. The long-term goals of RLP are to plan pregnancies and improve maternal and infant outcomes.

Background: Hospitalization of a premature neonate in the Neonatal Intensive Care Unit (NICU) is stressful for mothers. They show symptoms of Post-Traumatic Stress Disorder (PTSD). It is important to use the proper strategy to manage PTSD. This study was designed to investigate the effect of non-verbal music on the PTSD in mothers of premature neonates hospitalized in NICU. Materials and Methods: In this clinical trial study, the convenience sampling method was applied and 45 mothers of premature neonates were selected and categorized randomly into the intervention (N = 23) and control (N = 22) groups in 2018. The babies were hospitalized in one of the NICUs in Yazd (Iran). The intervention group were supposed to listen to the non-verbal music for 20 minutes daily for two weeks using MP3 player and headphones. All participants completed the Perinatal PTSD Questionnaire (PPQ). The data were analyzed by SPSS 21 using paired t-test, independent t-test, and Chi-square test. Results: The PTSD mean (SD) scores before and after the intervention was 9.39 (1.67) and 4.39 (1.49), respectively, in experimental group. It was 8.54 (1.59) and 5.31 (1.71) in control group. The severity of PTSD decreased in the intervention (p = 0.003) and control (p < 0.001) groups after the intervention. The difference between the two groups was significant (F1,07 = 1058, p < 0.03), which confirmed the significant effect of the non-verbal music on decreasing the PTSD severity (0.92). Conclusions: Non-verbal music can be used as an effective and low-cost intervention for managing PTSD in mothers of premature neonates hospitalized in the NICU.

Background: Men's involvement in perinatal care has benefits including reduced preterm childbirth, and better development of children. This study was conducted with the aim to determine the attitude and participation of men in prenatal, childbirth, and postpartum care. Materials and Methods: This cross-sectional study was performed on 280 men in industrial units in Kashan city, Iran (November 2014–March 2015). The participants were selected using cluster sampling method. They completed a researcher-made three-part questionnaire. The data were analyzed using independent-samples t test and analysis of variance (ANOVA). Results: The mean (SD) score of men's attitude and practice regarding perinatal care were 40.12 (5.00) and 61.65 (6.87), respectively. A significant difference was observed between the practice of men with different education levels (F2,75 = 3.63, p = 0.001). Conclusions: The participation of men in perinatal care was low. It is recommended that healthcare providers make visits in the presence of husbands and simultaneously provide training for the couples during the perinatal period.

Background: Social stigma is the most common and challenging burden of care on the family of people with Borderline Personality Disorder (BPD) In Iran, despite the cultural and social influences, this issue has been less studied. Therefore, present study was conducted to determine the lived experiences of caregivers of patients with BPD of social stigma. Materials and Methods: This qualitative study was performed at Ibn Sina hospital in Mashhad, Iran from 2017 to 2019. Participants were selected by purposive and snowball sampling method. Data were collected through semi-structured interviews. Data saturation was achieved after 16 interviews. Finally, the data were analyzed by the method proposed by Diekelmann (1989). Results: In data analysis, one main theme and two sub-themes emerged. The main themes include Black shadow. Two sub-themes consisted of society dagger and secrecy. The sub-theme of society dagger included the two common meanings (inner turmoil in response to the stigma of others and weakening of family status among relatives and acquaintances). The sub-theme of secrecy comprised of the three common meanings (concealment of disease, hide hospitalization, and seclusion). Conclusions: An understanding of the experience of family stigma can lead to the development of supportive strategies to manage this problem among caregivers of patients with BPD. Nurses can support caregivers by offering them opportunities to discuss how stigma is disrupting their caregiving roles. They can also support the caregivers in negotiating the experienced social and emotional distress and when necessary, refer them to the other members of healthcare teams.

Background: Neurofibromatosis Type 1 (NF1) is a common autosomal disorder; the criteria for the diagnosis of NF1 includes café au lait spots, freckling, and Neurofibromas (NF). Skin symptoms have a major impact on patients' Quality of Life (QOL) but little is known about the burden of the disease on patients. The aim of this study was to explore the experiences of patients with NF. Materials and Methods: Using purposive sampling, 20 participants were enrolled in this qualitative content analysis study. The study was carried out between 2019 and 2020. Unstructured interviews and field notes were used to gather data. Data collection was stopped when data saturation was achieved. Results: Data analysis revealed 14 subcategories and 4 categories including “failing and falling behind in life”, “deprivation and restriction”, “social isolation”, and “ineffective adaptation to the disease”, which indicate the perception of patients with NF. Conclusions: In addition to the physical burden due to physical complications and problems, NF imposes a high degree of psychological and social burden on patients causing mental conflicts, which in turn results in them failing and falling behind in life. These findings illustrate the need to develop strategies and use multidisciplinary approaches to support patients, and thus to reduce the burden of NF.

Background: Dietary and medication regimen adherence in patients with history of Acute Coronary Syndrome (ACS) is very important in preventing readmission and reducing the complications of the disease. The objective of the present study was to investigate the effect of the family‑centered self‑care program based on home visits dietary and medication regimen adherence in patients with ACS discharged from Shahid Chamran Hospital during 2017‑2018. Materials and Methods: This clinical trial was conducted on 80 ACS patients. The samples by using the random numbers table, were randomly divided into control and experimental groups. The routine interventions were administered for the control group, and family‑centered self‑care was conducted on patients of the experiment group. In order to obtain the quantitative data of this study, three questionnaires were used including demographic characteristics, Morisky questionnaire, and dietary adherence. Results: The difference between the mean score of medication and diet regimen adherence in both groups before the intervention was not significant ( p > 0.05). data was demonstrated that scores of medication and diet regimen adherence were significantly higher immediately and 6 weeks after the intervention; (f = 64.06, p < 0.001). Conclusions: Family‑centered self‑care program based on home visits can be used as an effective method to increase the dietary and medication regimen adherence in ACS patients.

Background: Parent–adolescent dialog on sexual issues reduces high‑risk sexual behavior in adolescents. However, many adolescents are deprived of such training. Several factors may affect the sexual dialog between parents and adolescents. This study aimed to investigate the factors associated with mother–adolescent daughter dialog on sexual health matters in Iran. Materials and Methods: This cross‑sectional study was carried out on 363 female adolescents aged 14‑18 years in Ahvaz‑Iran, between June 2015 and January 2016. Data collection was conducted utilizing multi‑stage cluster sampling in high schools using the Parent–adolescent sexual dialog questionnaire and the parent–adolescent general dialogue questionnaire. The validity of the questionnaires was confirmed using content and face validity and their reliability was confirmed through internal consistency. The data were analyzed using descriptive statistics, Pearson’s correlation coefficient, independent one‑sample and two‑sample t ‑tests, one‑way ANOVA, and Post‑HOC (Duncan) test. Results: The mean score of mother–daughter sexual dialog had a significant relationship with mother’s education ( F = 4.03, p > 0.003), adolescent’s major ( F = 4.48, p < 0.004), mother–daughter general communication ( p < 0.001), and emotional relationship with parents ( F = 6.47, p < 0.002). The more is the mother–daughter general communication, the more will be their sexual communication ( p < 0.001). There was no relationship between the score of mother–daughter sexual communication and the age of mother or adolescent, parents’ job, parents’ marital status, and having sisters ( p = 0.86). Conclusions: Some demographic characteristics of parents and adolescents, and the parent–adolescent emotional relationship can affect the communication between them about sexual issues. So efforts to enhance this communication should consider these factors as mediator variables.

Background: Adolescent women’s reproductive health is often neglected despite the high prevalence of early marriage. Since no appropriate scales were found to assess the health status of adolescent women, this study aimed to develop a reproductive health scale in married adolescent women in Iran and investigate its psychometric properties. Materials and Methods: An exploratory mixed‑methods study was conducted in Ardabil healthcare centers (Ardabil City, Iran) between May 2017 and December 2018. In the qualitative phase, 14 semi‑structured in‑depth interviews were conducted with married adolescent women, and two focus group discussions were held with 12 key informants. In the quantitative phase, the initial scales were validated using face, content, and construct validities. In a cross‑sectional study among 300 women, Exploratory Factor Analysis (EFA) was used to assess the construct validity. Internal consistency and test‑retest methods were used to review. The initial scale was designed with 45 items, but only 30 items reached the construct validity stage. EFA revealed five factors that explained 50.96% of the variance. Cronbach’s alpha coefficient of 0.75 estimates the reliability of the scale. Results: The qualitative study identified 76 items that reached 88 items through literature confirmed its reliability, and test‑retest with a two‑week interval confirmed its consistency (ICC = 0.99, p < 0.001). Finally, the scale was approved with 27 items and four domains: sexual, pregnancy and childbirth, psychosocial, and family planning. Conclusions: This valid and reliable scale with cultural sensitivity can be used to help health professionals to improve the reproductive health of married adolescent women.

Background: Abortion and loss of pregnancy in the first trimester may affect maternal mortality and morbidity. This study aimed to determine the severity of post-abortion stress in spontaneous abortion, induced abortion, and Forensic Medical Center (FMC) referral abortions immediately after abortion and after 1 month of follow-up in Shiraz, Iran, in 2018. Materials and Methods: This cross-sectional study was conducted on 104 mothers selected through convenience sampling method in 2018. The data collection tools included a demographic characteristics questionnaire and the Mississippi Post-Traumatic Stress Disorder (M-PTSD) Scale that were filled out by mothers immediately and 1 month after the abortion. Data were analyzed using one-way ANOVA and post-hoc LSD test in SPSS software. Moreover, p < 0.05 was considered as statistically significant. Results: The mean (SD) of post-traumatic stress scores was 83.87 (18.35) and 77.40 (9.88) in spontaneous abortion, 82.28 (13.27) and 75.71 (14.73) in FMC permitted abortions, and 86.66 (10.10) and 74.98 (12.99) in induced abortions immediately and 1 month after abortion, respectively. Stress was reduced in the three groups of mothers, after one month of severe value. The score for frequency of stress was 3.10% in FMC-permitted abortions and 5.10% in induced abortions; moreover, no stress was observed in the spontaneous abortion cases. Conclusions: Stress was gradually reduced over time. The level of PTSD was lower after 1 month in women who had experienced spontaneous abortion. Given that 1 month after abortion, women are still often moderately stressed, follow-up care, and appropriate counseling for these women are necessary.

Background: Procrastination in the general population is a prevalent phenomenon. Procrastination in midwives, who are responsible for health care services, can have serious consequences and reduce health care productivity. Cognitive Behavioral Group Therapy (CBGT) is believed to reduce procrastination, but few studies have investigated its effectiveness. The aim of the present study was to determine the effect of CBGT on the workplace and decisional procrastination of midwives. Materials and Methods: This randomized, controlled trial was conducted on 47 participants who were eligible to participate in the study. The participants were randomly assigned to the CBGT (n = 24) and control (n = 23) groups. The intervention group received 7 sessions of CBGT and the control group received no intervention. Decisional and workplace procrastination were assessed at the pre-treatment, post-treatment, and 2-month follow-up phases. Repeated measures Analysis of Variance (ANOVA) and Analysis of Covariance (ANCOVA) were used for data analysis. Results: At the posttest and follow-up phases, workplace procrastination (Post-test: F1,40= 11.78, p = 0.001; Follow-up: F1,40= 11.12, p = 0.002), soldiering (Post-test: F1,40= 13.77, p = 0.001; Follow-up: F1,40= 4.15, p = 0.049), cyberslacking (Post-test: F1,40= 4.20, p = 0.047; Follow-up: F1,40= 13.34, p = 0.001), and decisional procrastination (Post-test: F1,40= 6.66, p = 0.014; Follow-up: F1,40= 6.12, p = 0.018) significantly decreased in the CBGT group compared to the control group. CBGT explained 23% of the changes in the total workplace procrastination score and 22% of the changes in the component of soldiering (p < 0.05). Conclusions: CBGT significantly reduced workplace and decisional procrastination in midwives.

Background: Moral distress and moral courage among healthcare professionals have received considerable attention in recent years. However, there is a paucity of studies investigating these topics among nurses. Thus, the present study aimed to evaluate the association between moral distress and moral courage among nurses in an Iranian sample population. Materials and Methods: The present cross-sectional study was conducted during February–December 2018. Corley's Moral Distress (MDS-R) and Sekerka's moral courage scales were used to collect the data. MDS-R is a 21-items scale which includes frequency and intensity ranges from 0 (never) to 4 (very frequently) and 0 (none) to 4 (great extent), respectively. In addition, the moral courage scale contains 15 items ranging from “never true” (1 point) to “always true” (7 points). In total, 225 eligible nurses were entered into this study. Finally, SPSS-16 was used for statistical analysis at the α = 0.05 level. Results: The mean scores of the frequency and intensity of moral distress and moral courage were 45.41 (95% CI = 43.37-47.45), 44.24 (95% CI = 42.98-45.42), and 59.63 (95% CI = 58.50-60.87), respectively. Eventually, a significant relationship was found between the moral courage and frequency of moral distress (r = 0.46, p < 0.001) and the intensity of moral distress (r = 0.73, p < 0.001). Conclusions: In general, encouraging healthcare managers and administrators is considered as crucial for developing supportive structures and highly sensitive management which promotes moral courage while reducing moral distress in nurses' work setting.

Background: Autonomy is the main element of professional practice in nursing. However, despite the many studies conducted on nursing autonomy, this concept is not fully understood and a comprehensive explanation of this concept in nursing is necessary. Meta-synthesis offers a way to increase the understanding of this concept using existing research findings. Thus, the present study aimed to explain the concept of professional nursing autonomy. Materials and Methods: This qualitative meta-synthesis was conducted based on a modified version of Noblit and Hare's meta-ethnography approach and qualitative studies on the concept of nursing autonomy published in databases such as PubMed, Scopus, Web of Science, Cochrane, SID, IranMedex, Magiran, and ScienceDirect in the past 15 years (2003–2018). Results: Thirteen articles that reported the experiences of nurses regarding professional autonomy were included in the research. Based on the meta-synthesis of findings, the final interpretation of the professional autonomy of clinical nurses was presented in the three themes of professional competence, professional decision making, and professional interactions. Conclusions: According to the results, the concept of professional autonomy is a developmental achievement based on patient-based professional competence along with self-reliance to provide the best care plan for the promotion of patients' health through the professional decision making and professional interactions with other professional team members.

Background: Midwives have a major role in the improvement of health indicators in every country. In order for midwives to be able to play their role well, they must have sufficient updated knowledge. For this purpose, it is necessary to review their educational needs. The aim of the present research was to review Iranian studies that have investigated midwives’ educational needs. Materials and Methods: In this narrative review, PubMed, Scopus, Web of Science, Google Scholar, ProQuest, Ovid, SID, and Magiran databases were searched for the full texts of Iranian studies published in Persian and English languages in the period of 2000–2018. Review, descriptive, and interventional articles consistent with the research aim were included in this study. Results: Of the 53 found articles, 23 articles that were relevant to midwives’ educational needs in Iran were investigated. The findings of the studies showed that the educational needs of the midwives can be categorized into the four groups of knowledge and performance, communication skills, occupational rules/regulations, and religious rules. Conclusions: The results showed that midwives in Iran have different educational needs. Because the midwifery practice leads to the promotion of public health, it is imperative that midwives have comprehensive knowledge and the skills necessary for providing optimal care. In order to achieve this, short-term and long-term training programs tailored to the needs of midwives are recommended.

Background: There are standard guidelines for the provision of health care for pregnant women in prisons. There is no single guide to meet all the specific needs of imprisoned women. In this study, the related international guidelines were reviewed to reveal the existing gaps. Materials and Methods: In this narrative review, studies published from May 2010 to January 2019 were reviewed through investigating databases including PubMed, Scopus, the Cochrane Library database as well as Science Direct Google Scholar using keywords: Guideline AND Prison AND Pregnancy AND Prenatal Care. The contents of the guidelines were subjected to analogy comparison. Results: 13 guidelines were included in the study. Of these, 10 guidelines were related to the organizations deployed in the USA, two guidelines to the United Nations and the World Health Organization, and one guideline to the United Kingdom. The most comprehensive care coverage of pregnant women was suggested, at the first level, by Birth Champion and in the second level by the Federal Bureau of Prisons. The care recommended in the guidelines was classified into four general categories of health care, safety and security, education and counseling, as well as miscellaneous issues. Most of the care items mentioned in the guidelines were related to the issue of safety and security of pregnant women. Conclusions: There are currently gaps in the guidelines in many aspects including maternal and fetal health assessments, mental health care, and also ethical and communication issues. It is essential to upgrade the guidelines provided for imprisoned women to promote their health.

Background: The use of mobile health has a pivotal role in the prevention and treatment of many diseases. This study aimed at determining the affecting factors in acceptance of mobile health by using a modified acceptance model, among medical sciences students in the south-west of Iran. Materials and Methods: This cross-sectional, analytical study was conducted in 2017. The research population included all the students of Lorestan University of Medical Sciences (LUMS). The 352 of students selected as the samples of study through a stratified sampling method. Data gathering was done through a valid and reliable questionnaire. The data was analyzed using Linear Structural Relations (LISREL) and Statistical Package for the Social Sciences (SPSS) software. Results: The findings showed that perceived usefulness (t 7, 38 = 2.16, p = 0.03), performance expectancy (t 7, 70 = 3.18, p = 0.01), facilitating conditions (t10, 61 = 4.17, p < 0.001), and attitude to use (t 7, 14 = 5.49, p < 0.001) were effective in the behavior intention of mobile health. Moreover, the results showed that the behavior intention of mobile health applications (t 10, 77 = 8.10, p < 0.001) is effective on its user behavior. Conclusions: The results of our study showed that perceived usefulness, performance expectancy, facilitating conditions, and attitude to use of technology were the affecting factors in the acceptance of mobile health by the students. It is suggested that the policymakers and authorities comprehensively consider these important factors when introducing new technologies.

Background: Strengthening of midwives' position and support for freestanding birth centers, frequently referred to as Freestanding Midwife-led Units (FMUs), raise hopes for a return to humanized labor. Our study aimed to review published evidence regarding FMUs to systematize the knowledge of their functioning and to identify potential gaps in this matter. Materials and Methods: A structured integrative review of theoretical papers and empirical studies was conducted. The literature search included MEDLINE, Cochrane, Scopus, and Embase databases. The analysis included papers published in 1977–2017. Relevant documents were identified using various combinations of search terms and standard Boolean operators. The search included titles, abstracts, and keywords. Additional records were found through a manual search of reference lists from extracted papers. Results: Overall, 56 out of 107 originally found articles were identified as eligible for the review. Based on the critical analysis of published data, six groups of research problems were identified and discussed, namely, 1) specifics of FMUs, 2) costs of perinatal care at FMUs, 3) FMUs as a place for midwife education, 4) FMUs from midwives' perspective, 5) perinatal, maternal, and neonatal outcomes, and 6) FMUs from the perspective of a pregnant woman. Conclusions: FMUs offers a home-like environment and complex midwifery support for women with uncomplicated pregnancies. Although emergency equipment is available as needed, FMU birth is considered a natural spontaneous process. Midwives' supervision over low-risk labors may provide many benefits, primarily related to lower medicalization and fewer medical interventions than in a hospital setting.

Background: Painful care procedures are the most common cause of stress in patients admitted to Intensive Care Units (ICUs). Tracheal suctioning is the most painful experience for ICU patients. The present study was conducted to compare open and closed endotracheal suctioning in terms of their effect in pain in mechanically ventilated patients. Materials and Methods: The present clinical trial recruited 70 mechanically ventilated patients with tracheostomy in 2019. The eligible patients were randomly divided into open and closed suctioning groups. The pain was measured in the patients using the Critical Pain Observational Tool (CPOT) before and during suctioning as well as 10 and 30 min later. The data were analyzed using the repeated measures Analysis Of Variance (ANOVA), paired t‑test, and Chi‑squared test. Results: The pain score was significantly higher in the open suctioning group during ( t = 2.59, p = 0.01) and 10 min after suctioning ( t = 3.02, p = 0.004). No significant differences were observed in the pain score between the two groups 30 min after suctioning ( t = 0.32, p = 0.75). The post hoc Least Significant Difference (LSD) test showed that the CPOT scores 10 min after suctioning was significantly higher than that before suctioning and significantly lower than that during suctioning ( p = 0.001). The CPOT score 30 min after suctioning was also significantly lower than that 10 min after suctioning ( p < 0.001). Conclusions: The present findings suggested a lower pain in the patients with closed suctioning compared to those with open suctioning.

Background: Approximately half of mothers give birth by cesarean section in Iran and two-thirds of them are repeated cesareans. Repeated cesarean is threatening for the mothers and newborns and not compatible with fertility policies in Iran. Vaginal Birth After Cesarean (VBAC) is a reasonable strategy but its prevalence is very low due to some barriers. The aim of this study was to explore barriers to VBAC in health care system. Materials and Methods: In this qualitative study, 26 semi-structured individual interviews with maternity care providers and mothers with prior cesarean section as well as one focus group discussion with maternity care providers were conducted. Interviews and focus group discussions were tape-recorded, transcribed verbatim and analyzed with conventional content analysis developed by Graneheim and Lundman using MXQDA10 software. Results: Barriers to VBAC in health care system identified in the main category of “the climate of restriction, fear and discourage” and eight subcategories including: “defective access to specialized services,” “insufficient encouragement system,” “modeling in cesarean section,” “physician-centeredness in VBAC,” “fear of legal responsibilities,” “imposed policies,” “marginalization of midwives,” and “unsupportive birth team.” Conclusions: To remove barriers of VBAC in health care system, appropriate strategies including establishment of specialized VBAC counseling centers, performance-based incentive policies, cultural development and promotion of natural childbirth, promoting of teamwork culture, shared decision making, improvement of knowledge and skills of maternal care providers and implementation of clinical guidelines, should be considered. Future research could be focused on the effect of implementing these strategies to decrease repeat cesarean section rate.

Background: Since endothelial dysfunction is related to atherosclerosis, this study was planned to determine the effect of type of delivery on Nitric Oxide (NO) metabolites and endothelial function. Materials and Methods: This Cohort study was conducted in 2015 in selected hospitals of Isfahan. 88 nulliparous women with gestational age of 39 weeks and above were enrolled in this study using convenience sampling method and finally, after giving birth, 51 mothers with vaginal delivery, 21 with urgent C-section and 13 with elective C-section were considered for data analysis. The serum levels of NO metabolites were measured in the laboratory with standard kits and data was analyzed using student and paired t-test, one-way ANOVA, and Chi-square test. The significance level was considered less than 0.05 for all tests. Results: The NO metabolites levels in mothers who had vaginal delivery or urgent C-section showed a significant difference before and after delivery (normal vaginal delivery (NVD): t50 = 5.61, p < 0.001, Urgent C-section: t23 = 5.38, p < 0.001). But those with elective C-section showed no significant difference in the nitrate and total nitrite levels before and after delivery (p > 0.05). Conclusions: Since reduction in serum levels of NO metabolites may possibly indicate endothelial dysfunction and predict cardiovascular disease, especially atherosclerosis in the future, it could be concluded that, childbirth, regardless of the type of delivery, could damage the endothelial cells but C-section (urgent or elective) could cause more disruption than vaginal delivery.

Background: Awareness of the experiences of students and educators in the educational process plays an important role in facilitating and improving this process. This study aimed to explain and investigate the experiences of nursing educators and students about the presence of students with practical nursing diplomas in the process of undergraduate education. Materials and Methods: In this qualitative study conducted from 2016 to 2018, which adopted a content analysis approach, 24 nursing students and educators of Lorestan University of Medical Sciences were selected using the purposive sampling method and were interviewed in depth. The data were manually recorded and analyzed using the Graneheim and Lundman method. Results: The three main themes of “from contrast to alignment with professional competence,” “peaceful coexistence in the educational process,” and “reflection of the perceived reality of the clinical environment,” along with six categories and 30 subcategories were extracted from the interviews. Conclusions: It seems that monitoring and managing undergraduate courses more thoroughly, as well as raising the awareness of educators about the positive and negative dimensions of the presence of nursing students with practical nursing diplomas in undergraduate nursing courses can make it possible to optimize and improve students' learning process.

Background: Emergency department is among the most crowded hospital units. The function of this department considerably affects the functions of other hospital units as well as patient satisfaction. The Stabilization Model is a strategy with potential effectiveness in managing overcrowding in emergency department. This study aimed to determine the effects of overcrowding management based on the stabilization model on patient safety in emergency department. Materials and Methods: This pretest‑posttest quasi‑experimental was conducted in 2015 in the emergency department of a teaching hospital located in Tehran, Iran. Primarily, the perceived safety of 35 patients was assessed using the Patient Safety Assessment Questionnaire. Then, an overcrowding management intervention was implemented based on the stabilization model. Finally, the perceived safety of 35 newly recruited patients was assessed after the intervention. The SPSS software (v. 16.0) was employed for data analysis through the Chi‑square, the Kolmogorov‑Smirnov, and the independent‑sample t tests. Results: The mean (SD) score of patient safety was 27.45 (8.43) in the control group and 34.45 (4.04) in the intervention group and the between‑group difference was statistically significant ( t 34 = 50.37, p < 0.001). The rate of patient safety increased from 65% at baseline to 82% after the intervention. Conclusions: Overcrowding management based on the stabilization model can significantly enhance patients’ perceived safety. Therefore, this strategy can be used to ease emergency department overcrowding and enhance patient safety and care quality.