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   Table of Contents - Current issue
Coverpage
October-December 2019
Volume 8 | Issue 4
Page Nos. 169-218

Online since Monday, October 14, 2019

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REVIEW ARTICLE  

Prevalence of self-medication among pregnant Women: A systematic review and meta-analysis Highly accessed article p. 169
Azam Rahmani, Suren Akram Hamanajm, Arezoo Fallahi, Reza Ghanei Gheshlagh, Sahar Dalvand
DOI:10.4103/nms.nms_77_18  
Background: Self-medication is prevalent among pregnant women. It can cause adverse effects such as fetal anomalies. Objectives: This study aimed to estimate the prevalence of self-medication among Iranian pregnant women. Methods: This was a systematic review and meta-analysis study. Online national and international databases (namely, Scientific Information Database, MagIran, Web of Science, PubMed, Scopus, and Google Scholar) were searched using the following keywords: “pregnancy,” “gravidity,” “self-treatment,” “self-medication,” “non-prescription,” “over-the-counter,” “self-administered,” “self-reported,” “Iran,” “prevalence,” “occurrence,” “frequency,” and “epidemiology.” In total, 128 studies were retrieved. Only 13 studies fulfilled eligibility criteria, i.e. cross-sectional design and publication in Persian or English. Methodological quality of the studies was assessed using a tool with four items, namely design, sample description, sample size, and methods. Meta-analysis was performed using the random-effects model and heterogeneity among the studies was assessed using the I2 index. Results: The total number of samples in the 13 analyzed studies was 4874. The overall self-medication prevalence was 38.46% (95% confidence interval: 27.42–49.49). Meta-regression analysis revealed no significant relationships between self-medication prevalence and methodological quality score (P = 0.409), participants' mean age (P = 0.400), sample size (P = 0.248), and publication year (P = 0.704). Conclusion: The overall prevalence of self-medication among Iranian pregnant women is 38.46%. Study findings can be used to design and implement interventions to reduce self-medication among pregnant women. Educational interventions are needed to improve the knowledge of pregnant women and health-care providers about the effects of self-medication, particularly herbal self-medication.
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ORIGINAL ARTICLES Top

The effects of stress inoculation training on coping strategies among midwives in primary health-care centers p. 176
Maryam Navaee, Hadis Kaykha
DOI:10.4103/nms.nms_71_18  
Background: Effective coping with stress is the main component of interpersonal communication. It helps people overcome their conflicts and problems in their interpersonal and social relations. Objectives: This study sought to examine the effects of stress inoculation training (SIT) on coping strategies among midwives in primary health-care centers. Methods: In this two-group, quasi-experimental study, eighty midwives were randomly selected from health-care centers in Zahedan, Iran, and were randomly allocated to an intervention and a control group. The study intervention was an SIT program offered in two 4-h workshops weekly held in 2 consecutive weeks. Participants in both groups responded to the Coping Responses Inventory (CRI) before, immediately after, and 1 month after the intervention. Data were analyzed using the independent-sample t and the Chi-square tests as well as the repeated-measures analysis of variance. Results: The mean score of coping strategies statistically significantly increased in the intervention group from 36.20 ± 7.50 at pretest to 47.22 ± 9.97 1 month after the intervention (P < 0.001). One month after the intervention, there were significant between-group differences in the CRI respecting the mean scores of coping strategies and all its subscales (P < 0.05), except for the problem-focused coping subscale (P = 0.06). Conclusion: SIT can be used to improve midwives' coping with stress.
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The effects of video podcast on learning among midwifery students: A randomized controlled trial p. 183
Firoozeh Firoozehchian, Morvarid Ghasab Shirazi, Zahra Atrkarroushan,
DOI:10.4103/nms.nms_96_18  
Background: Although some studies examined the challenges of using podcasts, there is limited information about the effects of video podcasting on learning outcomes. Objectives: The purpose of this study was to compare the effects of video podcasting and lecture on learning among midwifery students and to assess their satisfaction with podcasting. Methods: This was a randomized controlled crossover trial. Five-semester baccalaureate midwifery students of a class were randomized into two seventeen-person groups to receive education about gynecological diseases in two sessions. In the first session, students in Group A received educational materials through lecture, while their counterparts in Group B received the same materials through video podcasting. In the second session, held 1 week after the first session, students in Group A received educational materials through video podcasting, while their counterparts in Group B received the same materials through lecture. Students' learning and satisfaction were measured via multiple choice questions and a satisfaction questionnaire, respectively. The paired- and the independent-sample t-tests were used for within- and between-group comparisons, respectively. Results: Both lecture and video podcasting significantly increased the mean score of students' knowledge. However, between-group difference respecting the posttest mean score of knowledge was not statistically significant (15.3 ± 2.3 vs. 14.5 ± 2.7; P = 0.35). Students were satisfied with video podcasting though they believed that it cannot completely replace traditional lecture. Conclusion: Video podcasting has the same effects as lecture on learning outcomes among midwifery students. It can be used as a complement to lecture.
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The effects of multidisciplinary education for nurses and physicians on the management of patients with multiple trauma p. 189
Farhad Heydari, Shahla Mohamadirizi, Mohammad Nasr-Esfahani
DOI:10.4103/nms.nms_26_18  
Background: Trauma is a leading cause of death and disability in developing countries. In-service training is a strategy for improving health-care providers' trauma-related knowledge and skills. Objectives: The purpose of this study was to evaluate the effects of multidisciplinary education for nurses and physicians on the management of patients with multiple trauma. Methods: This quasi-experimental study was conducted in 2017–2018 in Al Zahra hospital, Isfahan, Iran. Initially, the triage-related characteristics of 200 patients with multiple trauma were documented using specific checklist. Then, a multidisciplinary education program on the Emergency Service Index (ESI) triage and advanced trauma life support (ATLS)-based trauma management was implemented for emergency department (ED) staff, including 80 emergency nurses and 82 medical residents. After the intervention, the triage-related characteristics of another sample of 200 patients with multiple trauma were documented similarly. Data analyses were conducted using the Chi-square, Mann–Whitney and Wilcoxon tests. Results: The mean of waiting time for the first visit by emergency medicine specialists, the relative frequency of endotracheal intubation, and the length of stay in the ED significantly decreased from 19.45 ± 13.41 min, 12%, and 7.55 ± 1.59 h at pretest to, respectively, 14.01 ± 1.81 min, 3%, and 3.91 ± 0.71 h at posttest. Moreover, the relative frequency of patients who were transferred directly from the ED to the operating room significantly increased from 13% at pretest to 27% at posttest. Conclusion: Multidisciplinary education based on the ESI triage and ATLS can reduce the waiting time for specialized care services, facilitate patient transfer from the ED to the operating room, and shorten patient stay in the ED. It is also partially effective in alleviating overcrowding in the ED.
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Factors behind moral distress among Iranian emergency medical services staff: A qualitative study into their experiences p. 195
Mojtaba Jafari, Mohammadali Hosseini, Sadat Seyed Bagher Maddah, Hamidreza Khankeh, Abbas Ebadi
DOI:10.4103/nms.nms_69_18  
Background: The unique characteristics of each emergency situation and the necessity to make prompt decisions cause emergency medical services (EMS) staff's ethical conflicts and moral distress. Objectives: This study aimed to explore EMS staff's experiences of the factors behind their moral distress. Methods: This qualitative study was conducted on 14 EMS staff using the conventional content analysis. Data were collected through unstructured and semi-structured interviews. Each interview was started using general questions about moral issues at workplace and barriers to professional practice. The five-step content analysis approach proposed by Graneheim and Lundman was used for data analysis. Results: The factors behind EMS staff's moral distress were categorized into 13 subcategories and 5 main categories. The main categories were staff's lack of knowledge and competence, inability to adhere to EMS protocols, restraints on care provision, ineffective interprofessional communications, and conflicts in value systems. The subcategories were, respectively, inadequate knowledge and experience, working with incompetent colleagues, artificial services, working in unpredictable situations, lay people's interference in care provision, resource and equipment shortages, barriers to early arrival at the scene, obligatory obedience to the system, poor interprofessional interactions, inadequate interprofessional trust, refusal of care, challenges in obtaining consent, and challenges in telling the truth. Conclusion: EMS staff experience moral distress at work due to a wide range of factors. Given the negative effects of moral distress on EMS staff's physical and mental health and the quality of their care services, strategies are needed to prevent or reduce it through managing its contributing factors.
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Nurses' experiences of workplace violence in Kashan/Iran: A qualitative content analysis p. 203
Tayebeh Hashemi-Dermaneh, Negin Masoudi-Alavi, Masoumeh Abedzadeh-Kalahroudi
DOI:10.4103/nms.nms_53_18  
Background: Nurses are at a high risk of workplace violence (WPV). This phenomenon is largely dependent on the sociocultural conditions. Objectives: This study explained the experiences of nurses about the WPV in medical, surgical, and emergency departments of a general hospital in Kashan, Iran, in 2017. Methods: In a qualitative content analysis, 13 nurses who had the experience of WPV were invited to participate in semi-structured interviews. The interviews were analyzed through conventional qualitative content analysis using the method suggested by Graneheim and Lundman. Results: Four themes were extracted from the interviews. The themes were: “violent behaviors,” “antecedents of violence,” “violence management,” and “violence outcomes”. Conclusion: WPV had many forms, antecedents, and consequences. Training the personnel and developing a committee for evaluating the incidents can prevent the occurrence of the violence.
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Development and psychometric evaluation of the menopausal self-care questionnaire in a sample of Iranian postmenopausal women p. 210
Mahboobeh Kafaei-Atrian, Mahnaz Solhi, Farbod Ebadi Fard Azar, Fatemeh Atoof
DOI:10.4103/nms.nms_9_18  
Background: Self-care assessment is a prerequisite to self-care promotion interventions. However, there is no specific measurement instrument for self-care assessment among postmenopausal women. Objectives: The aim of this study was to develop the menopausal self-care questionnaire and evaluate its psychometric properties in a sample of Iranian postmenopausal women. Methods: This methodological study was conducted in 2017 based on Waltz's method for instrument development. Questionnaire items were generated based on a literature review, and then, face, content, and construct validity of the questionnaire were assessed. For construct validity assessment, a sample of 357 women aged 45–60 years were selected through cluster and stratified sampling from health-care centers in Kashan, Iran. Then, exploratory factor analysis was conducted to determine the factor structure of the questionnaire. Moreover, reliability was assessed through calculating Cronbach's alpha and test-retest intraclass correlation coefficient (ICC). Results: The primary version of the questionnaire contained 36 items. Two items were deleted due to their limited content validity. The impact scores, content validity ratios, and content validity indices of the remaining 34 items were at least 2.84, 0.70, and 0.70, respectively. During factor analysis for construct validity assessment, one item was deleted and the questionnaire was found to have a seven-factor structure, accounting for 54.87% of the total variance. The factors were general health care, screening, nutrition, memory, hot flashes and night sweats, sexuality, and social communication. The ICC and Cronbach's alpha value for the questionnaire were 0.76 (P < 0.001) and 0.88, respectively. Conclusion: The menopausal self-care questionnaire is a valid and reliable instrument for self-care assessment among postmenopausal women. It can be used in health monitoring programs for middle-aged and elderly women.
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LETTER TO EDITOR Top

The relationship between self-esteem and academic achievement of Iranian nursing and medical sciences students: A meta-analysis letter p. 217
Kourosh Sayehmiri, Reza Valizadeh, Hamed Tavan
DOI:10.4103/nms.nms_38_19  
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