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DISCUSSION
Nurse–patient relationship based on the imogene king's theory of goal attainment
Mohsen Adib-Hajbaghery, Mahsa Tahmouresi
July-September 2018, 7(3):141-144
DOI:10.4103/2322-1488.235636  
There are many nursing theories about nurse–patient relationship, one of the most important of which is Imogene King's Theory of Goal Attainment. However, it is unknown why this theory is not used in everyday nursing practice. The aim of this study was to assess the use of King's theory in nurse–patient relationship.
  13,364 1,242 -
ORIGINAL ARTICLES
The effects of inhalation aromatherapy with Boswellia carterii essential oil on the intensity of labor pain among nulliparous women
Sara Esmaelzadeh-Saeieh, Mitra Rahimzadeh, Nafiseh Khosravi-Dehaghi, Shokufeh Torkashvand
April-June 2018, 7(2):45-49
DOI:10.4103/nms.nms_70_17  
Background: Labor pain is a major reason behind preferring cesarean section over normal vaginal delivery. Aromatherapy is among the most common nonpharmacological therapies for pain. Objectives: The objective of this study aimed to evaluate the effects of inhalation aromatherapy with Boswellia carterii (BC) essential oil on the intensity of labor pain among nulliparous women. Methods: This randomized controlled trial was carried out on 126 nulliparous women. Women were randomly allocated to an aromatherapy (n = 63) and a placebo (n = 63) group. For each woman in the aromatherapy group, a piece of gauze was soaked with 0.2 ml of 0.2% BC essential oil diluted in 2 ml of normal saline, and then, it was attached to the collar of each woman. The intervention was repeated for each woman every 30 min up to a cervical dilation of 10 cm. The intervention in the placebo group was the same as the aromatherapy group except that the gauze was soaked only with 2 ml of normal saline. A numeric pain rating scale was used to assess the labor pain intensity before the intervention and at cervical dilations of 3–4, 5–7, and 8–10 cm. Statistical analyses were performed using descriptive and inferential statistics such as the Chi-square, the independent sample t- test, and paired t-test. Results: Between-group comparisons revealed that labor pain intensity in the aromatherapy group was significantly lower than the control group at cervical dilations of 3–4 (4.98 ± 0.93 vs. 6.68 ± 1.28, P < 0.001), 5–7 (5.79 ± 1.13 vs. 7.23 ± 1.54, <0.001), and 8–10 cm (6.35 ± 1.63 vs. 7.71 ± 1.38, P < 0.05). However, there were no significant between-group differences regarding 1 and 5 min Apgar scores (P > 0.05). Conclusion: Inhalation aromatherapy with BC essential oil has positive effects on labor pain. Therefore, it can be used for relieving labor pain in the first stage of labor.
  2,191 370 -
Job stress, job satisfaction, and related factors in a sample of Iranian nurses
Zahra Gadirzadeh, Mohsen Adib-Hajbaghery, Mohammad Javad Arabi Matin Abadi
July-September 2017, 6(3):125-131
DOI:10.4103/nms.nms_26_17  
Background: A number of studies on Iranian nurses' job stress or job satisfaction are available. However, studies on the relationship between these two variables among Iranian nurses are rare. Objectives: This study aimed to investigate job stress and job satisfaction among nurses working in Kashan Shahid-Beheshti Hospital, and the relationship between these two variables. Methods: A cross-sectional study was conducted on 260 nurses with 1 year experience in nursing who worked in Shahid Beheshti Hospital in Kashan, Iran, during 2015. A three-part questionnaire was used including questions on demographic variable, the organization's performance satisfaction scale, and the 35 items hospital stress scale. Descriptive and inferential statistics were used to analyze the data. Results: Among the respondents, 65.7% were female, 82.7% were staff nurse, 68.9% had a bachelor degree, and 72.8% of the respondents worked in rotating shifts. The mean overall job stress and job satisfaction scores were 109.06 ± 16.22 and 129.03 ± 17.63, respectively. A significant correlation was found between job stress and job satisfaction scores (r = 0.30, P < 0.001). Married and unmarried nurses were not significantly different in job satisfaction or in job stress scores. However, the mean job stress score was significantly higher in female nurses than in males (P = 0.042). The mean job satisfaction scores and the mean job stress scores were significantly different in nurses with various degrees (P < 0.001 and P = 0.002). The mean job satisfaction scores were significantly different in nurses with different job positions (P = 0.042). Conclusion: Nurses showed a moderate job stress score and a moderate job satisfaction. A significant correlation was found between nurses' job stress and job satisfaction. Steps should be taken by the authorities to improve the nurses' working conditions and to decrease their job stress.
  1,717 269 -
REVIEW ARTICLE
The prevalence of job stress among nurses in Iran: A meta-analysis study
Reza Ghanei Gheshlagh, Naser Parizad, Sahar Dalvand, Mozhdeh Zarei, Mohammad Farajzadeh, Maryam Karami, Kourosh Sayehmiri
October-December 2017, 6(4):143-148
DOI:10.4103/nms.nms_33_17  
Background: Many nurses experience job stress in their workplace. Given the wide range of differences in the statistics about job stress among nurses, the question that arises is what is the general prevalence of job stress among Iranian nurses? Objective: The present study aimed to evaluate the prevalence of job stress among Iranian nurses through meta-analysis. Persian and English databases including SID, MagIran, IranMedex, Google Scholar, Sciencedirect, and PubMed were searched by using the keywords such as “job stress, occupational stress, work-related stress, job related stress” and their combinations and 30 articles were finally selected. All the observational research articles that had information regarding the prevalence of job-related stress, sample size, and job stress instruments were entered into the meta-analysis. The form used to extract information included variables such as the first author's name, publication year, the place where the study had been carried out, type of the study, sample size, data collection instruments, and the most important findings. Results: The general prevalence of job stress was estimated to be 69% (confidence interval [CI] 95%: 0.58–0.79) based on the report of 30 papers with sample size of 4630. By region, type of hospital and the type of study, the highest prevalence of nurses' job stress was 90% (CI 95%: 0.85–0.96) in region one (Provinces of Alborz, Tehran, Qazvin, Mazandaran, Semnan, Golestan, and Qom), 70% (CI 95%: 0.60–0.80) in public and private hospitals, and 79% (CI 95%: 0.58–1.01) in studies where the type of study had not been mentioned. Conclusion: Given the high prevalence of job stress among nurses, developing programs to reduce nurses' job-related stress seems to be essential.
  1,611 319 -
ORIGINAL ARTICLE
The effect of melatonin on the sexual function among postmenopausal women: A randomized placebo-controlled trial
Nehle Parandavar, Khadijeh Abdali, Sara Keshtgar, Masoumeh Emamghoreishi, Seddegheh Amooee, Leili Mosalanejad
October-December 2017, 6(4):149-155
DOI:10.4103/nms.nms_47_17  
Background: Menopause is associated with alterations in women's behaviors and sexual function. Altered sexual function can in turn causes serious health problems for women and negatively affect their marital relationships. Objective: This study aimed to investigate the effects of melatonin on the sexual function of postmenopausal women. Methods: This randomized double-blind placebo-controlled clinical trial was made in 2012–2013 on 240 postmenopausal women who aged 40–60 and referred to public obstetrics and gynecology clinics affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Participants were randomly divided into a melatonin and placebo group. Women in the melatonin and the placebo groups, respectively, received melatonin (3-mg tablets) and placebo for 3 consecutive months. Before and every 1 month during the intervention, participants' sexual function was assessed using Female Sexual Function Index. The repeated measures analysis of variance, the least significant difference, the independent sample t test, the Chi-square, and Fisher's exact tests were done for data analysis. Results: Sexual function mean score in the melatonin and placebo groups significantly increased from 12.49 ± 7.07 to 20.72 ± 8.57 and from 12.11 ± 7.82 to 15.55 ± 9.06, respectively. Yet, the amount of increase in the melatonin group was significantly higher than the placebo group. Moreover, there were significant differences between the groups regarding the variations of sexual function mean score across the four assessment points (P < 0.001). In addition, except for the baseline assessment point, the mean score of sexual function in the melatonin group was significantly greater than the control group at all other assessment points (P < 0.05). Conclusion: Melatonin significantly improves sexual function among postmenopausal women.
  1,797 117 -
ORIGINAL ARTICLES
Prevalence of timely introduction of complementary feeding and its related factors in children 6–24 months of age in Hyderabad, Pakistan
Saadat Khokhar, Hashmat Ali Jatoi, Zohra S Lassi
July-September 2017, 6(3):115-120
DOI:10.4103/nms.nms_19_17  
Background: A child at the age of 6 months requires an additional and improved nutrition, besides mother's milk for better growth and immunity, to protect them from many diseases. Lack of timely initiation of complementary feeding (CF) is an important cause of undernutrition in children under 5 years of age which is an underlying cause of more than 40% of morbidity and mortality. Objectives: The study aimed to estimate the prevalence of and factors related to timely introduction of CF in children 6–24 months of age. Methods: This was a mixed-method study. This study was conducted in a rural area of Hyderabad, Pakistan. A sample of 106 households was selected through multistage sampling technique. Mothers of children between 6 and 24 months of age were interviewed through questionnaire and in-depth interview guide for quantitative and qualitative parts, respectively. Results: The prevalence of early initiation of CF in the study area was found out to be 48%, those who started in time believed that children were old enough (42%) or the child was crying excessively (33%), and hence, they had to introduce complementary foods for children. In total, around 63% of mothers were empowered to decide about their children feeding. Factors such as mothers' education, living in cemented house, and watching television were significantly associated with their children given CF at the age of 6 months. Qualitative data suggested that mothers commonly weaned their infants with animal milk, tea, and biscuits, and they lacked in correct knowledge about CF practices. Conclusion: A significant proportion of mothers in rural areas of Pakistan delay CF. We found that maternal education, residence in cemented houses, and exposure to media play a part in timely introduction of CF to children aged 6–24 months.
  1,274 202 -
The impact of cognitive behavioral therapy on self-esteem and quality of life of hospitalized amputee elderly patients
Mousa Alavi, Houshang Molavi, Razieh Molavi
October-December 2017, 6(4):162-167
DOI:10.4103/nms.nms_46_17  
Background: No study is available on the effect of cognitive behavioral therapy (CBT) on self-esteem and quality of life (QOL) of amputee elderly patients. Objectives: This study aimed to examine the effects of CBT on self-esteem and QOL of hospitalized amputee elderly patients. Methods: A randomized controlled trial was carried out on a sample of 64 amputee elderly patients. The subjects were selected consecutively and then were randomly assigned into either the experimental or the control groups (32 patients in each group). The data collection instrument consisted of a demographic data form, the Rosenberg self-esteem scale, and the short form of the World Health Organization QOL Questionnaire (WHOQOL). Patients in the intervention group participated in six sessions of CBT and the control group received routine care. At the start and after the 3rd week, all patients answered the Rosenberg self-esteem scale and the WHOQOL-short form. Descriptive statistics, Chi-square, Fisher's exact, and t- tests were used to analyze the data. Results: No significant differences were found between the intervention and the control groups regarding their baseline mean scores of self-esteem and QOL. The observed changes in the QOL and self-esteem of the control group were not statistically significant. However, significant statistical differences were observed between all mean differences in the two groups that indicate the positive effect of the intervention. Conclusion: The CBT employed in the present study could significantly improve the self-esteem and QOL in amputee elderly patients. The same protocol is suggested to be added into the rehabilitation process for amputee elderly patients.
  1,196 164 -
The effects of home-based nursing care on metabolic control among patients with type ii diabetes mellitus: A randomized clinical trial
Masoud Khodaveisi, Farzaneh Miri, Afsar Omidi, Manouchehr Karami, Ali Esmaili Vardanjani, Nahid Mohammadi
January-March 2018, 7(1):1-5
DOI:10.4103/nms.nms_61_17  
Background: Diabetes mellitus (DM) management is challenging, particularly for people in developing countries. Objective: This study aimed to examine the effects of a home-based nursing care (HBNC) program on metabolic control among patients with type II DM. Methods: This single-blind randomized controlled trial was conducted in Hamadan, Iran, in 2014. Sixty patients with type II DM were consecutively recruited from a public diabetes care clinic in Hamadan, Iran, and randomly allocated to an experimental and a control group. Patients in the control group received usual discharge services, while their counterparts in the experimental group received HBNC services in addition to usual discharge services. The levels of fasting blood glucose, hemoglobin A1C, total cholesterol, triglycerides, high- and low-density lipoprotein cholesterols, and systolic and diastolic blood pressures were measured before and 3 months after the intervention. Data analysis was performed through the Chi-square, the paired-sample and the independent-sample t-tests. Results: HBNC program significantly decreased the levels of fasting blood glucose (from 206.60 ± 84.93 to 141.40 ± 48.75; P < 0.001), hemoglobin A1C(from 9.25 ± 2.19 to 7.55 ± 1.54; P < 0.001), and triglycerides (from 165.80 ± 78.96 to 126.63 ± 45.21; P < 0.01). However, it had no significant effects on total cholesterol, high- and low-density lipoproteins, and systolic and diastolic blood pressures (P > 0.05). Conclusion: HBNC is an effective strategy for managing type II DM and decreasing the risk of its complications.
  1,117 240 -
Comparing the effects of aerobic and anaerobic exercise on sleep quality among male nonathlete students
Toktam Kianian, Ali Navidia, Fahimeh Aghamohamadi, Saman Saber
October-December 2017, 6(4):168-173
DOI:10.4103/nms.nms_56_17  
Background: Physical activity is among the most significant factors behind sleep quality. However, there are limited data on the effects of different types of physical activity on sleep quality. Objectives: This study aimed to compare the effects of aerobic and anaerobic exercise on sleep quality among male nonathlete students. Methods: As a three-group randomized controlled trial, this study was done on ninety male nonathlete nursing students of Zahedan Islamic Azad University, Zahedan, Iran. Students were randomly assigned to an aerobic exercise, an anaerobic exercise, and a control group. For 10 consecutive weeks, students in the aerobic and the anaerobic groups respectively attended aerobic and anaerobic exercise programs thrice a week. Data were collected using a demographic questionnaire and the Pittsburgh Sleep Quality Index and were analyzed using the one-way analysis of variance, the Tukey's post hoc, the Chi-square, and the paired-sample t-tests. Results: At baseline, the mean scores of sleep quality in the aerobic exercise, anaerobic exercise, and control groups were 4.06 ± 3.62, 4.56 ± 4.93, and 4.50 ± 4.01, respectively (P = 0.98). However, after the intervention, these values significantly changed to 2.03 ± 2.96, 1.96 ± 3.60, and 4.66 ± 4.16, respectively (P = 0.008). Pairwise between-group comparisons showed that the mean scores of sleep quality in both intervention groups were significantly lower than the control group (P < 0.05) while the difference between the intervention groups was not statistically significant (P > 0.05). Conclusion: Exercise, either aerobic or anaerobic, significantly improves sleep quality among male nonathlete students.
  1,140 135 -
Comparing the effect of nurse-led and peer-led training on stress of mothers of children with chronic diseases
Maliheh Asadollahi, Hussein Namdar, Afsaneh Arzani, Sorayya Khafri, Iraj Mohamadzadeh, Fatemeh Korddaronkolaii
July-September 2017, 6(3):103-108
DOI:10.4103/nms.nms_28_17  
Background: For children and their families, the diagnosis of a chronic disease can come as a mental and psychological shock. Objective: The present study was undertaken to compare the effect of nurse-led and peer-led training methods on the stress of mothers of children with chronic illness. Methods: A two-group, pre-test and post-test design, clinical trial was conducted on sixty mothers of children with chronic diseases. Using a permuted-blocked randomized sampling method, the subjects were equally assigned into two groups of 30 to receive either peer-led or nurse-led training. All of the mothers in the two intervention groups were responded the parenting stress index within 48–72 h after the diagnosis and hospitalization of their child and then again after the end of the training program. The mothers in each intervention group were divided into small subgroups of 2–3 and each subgroup participated in three 30 min training sessions held either by a trained peer or by a nurse. Data analysis was performed using t-test, Chi-square test, Mann-Whitney, and paired t-test. Results: No statistically significant difference was observed between the stress scores of peer-led group (320.29 ± 44.38) and nurse-led group (319.60 ± 41.12) before the intervention. After the implementation of the intervention programs, a greater decrease was observed in the mean stress score of the nurse group (314.48 ± 19.67), as compared to the peer group (320.5 ± 22.92). However, the difference was not statistically significant (P > 0.05). Conclusion: Peer- and nurse-led training methods did not yield much different results. Therefore, it is recommended to substitute peer-led training method for nurse-led training method, due to the nurses' huge workload.
  981 233 -
The effects of the continuous care model on sleep quality, pain, fatigue and nausea among breast cancer patients receiving chemotherapy: A clinical trial
Nasrin Elahi, Mahsa Imanian
October-December 2018, 7(4):145-150
DOI:10.4103/nms.nms_34_17  
Background: Patients with breast cancer (BC) suffer from sleep disorders, pain, fatigue, and nausea after receiving chemotherapy. Objectives: The objective of this study was to assess the effects of the continuous care model (CCM) on sleep quality, pain, fatigue, and nausea among patients with BC who were receiving chemotherapy. Methods: This randomized clinical trial was conducted on 78 patients with BC who referred in April–June 2013 to the chemotherapy clinic of Ahvaz University of Medical Sciences, Ahvaz, Iran. Initially, patients were paired with each other respecting their age, type of surgery, and educational level, and then through tossing a coin, one patient in each pair was randomly allocated to the intervention and the other to the control group. The CCM was used for care provision to patients in the intervention group, while care services were provided to patients in the control group through routine methods. Data were collected 4 days after chemotherapy onset and 2 months after the intervention using a demographic questionnaire, a visual analog scale for nausea assessment, the Pittsburgh Sleep Quality Index, the Brief Fatigue Inventory, and a 10-cm ruler for pain assessment. For data analysis, the independent-sample t and the Chi-square tests were used. Results: Before the intervention, the groups did not significantly differ from each other concerning the scores of sleep quality, fatigue, pain, and nausea (P > 0.05). However, after the intervention, between-group differences of the intervention group and the controls were statistically significant for sleep quality (7.81 ± 4.50 vs. 16.80 ± 4.32, P < 0.0001), fatigue (36.23 ± 15.60 vs. 61.00 ± 12.32, P < 0.0001), pain (2.90 ± 2.82 vs. 6.81 ± 2.31, P < 0.0001), and nausea (2.16 ± 2.90 vs. 5.2 ± 2.93, P < 0.0001). Conclusion: This study proves the positive effects of the CCM on sleep quality, pain, fatigue, and nausea among patients with BC. Nurses can use this model to improve the patient outcomes.
  889 311 -
The effects of tai chi and walking on fasting blood glucose among patients with type II diabetes mellitus
Forough Rafii, Daryadokht Masroor, Hamid Haghani, Hamideh Azimi
April-June 2018, 7(2):56-61
DOI:10.4103/nms.nms_77_17  
Background: Effective diabetes mellitus (DM) prevention and management necessitate blood glucose monitoring, health education, and professional nursing care. Objectives: The aim of this study was to compare the effects of Tai Chi and walking on fasting blood glucose (FBG) among patients with type II DM. Methods: In this randomized controlled trial study, 100 patients with type II DM were randomly allocated to a Tai Chi, a walking, and a control group. Patients in the control group performed no regular physical exercise. However, patients in the Tai Chi and the walking groups, respectively, did Tai Chi and walking in three 30-min sessions a week for eight successive weeks. FBG was assessed before and after the interventions. The data were analyzed through the one-way analysis of variance paired-sample t, and Scheffe's tests. Results: Posttest values of FBG in the Tai Chi and the walking groups were significantly lower than the corresponding pretest values (P = 0.013 and 0.004, respectively). Moreover, after the intervention, FBG level in the control group was significantly higher than the Tai Chi (P < 0.001) and the walking (P < 0.0001) groups while the difference between the Tai Chi and the walking groups was not statistically significant (P = 0.571). Conclusion: Eight-week Tia Chi and walking are effective in lowering blood glucose among patients with type II DM. These exercises are recommended for patients with type II DM.
  952 215 -
Comparing the impacts of topical chlorhexidine and dry cord care on umbilical cord separation time among neonates
Fatemeh Abbaszadeh, Zeynab Hajizadeh, Parisa Seraji, Zohreh Sadat
April-June 2018, 7(2):62-66
DOI:10.4103/nms.nms_53_17  
Background: Delayed umbilical cord separation (UCS) can increase the risk of infection. Therefore, cord care is of great importance. Objectives: This study aimed to compare the impacts of topical chlorhexidine and dry cord care on UCS time. Methods: In this quasi-experimental study, 174 neonates were recruited from two teaching hospitals affiliated to Kashan University of Medical Sciences, Kashan, Iran. They were assigned to chlorhexidine and dry cord care groups. In the first group, 4% chlorhexidine solution was applied to the cord stump 3 h after birth and then every 12 h until 2 days after cord separation. The mothers of neonates in the dry cord care group were recommended to avoid using any material on the cord stump. The signs of cord stump infection were assessed by mothers on a daily basis and also by the second author at four-time points, namely, 3 h after birth (in hospital), 3 and 7 days after birth (through home visits), and 2 days after cord separation (through home visits). UCS time was documented by mothers. The Chi-square and the independent-samples t-tests were used to analyze the data. Results: UCS time in the chlorhexidine group was significantly longer than the dry cord care group (13.28 ± 6.79 vs. 7.85 ± 2.51 days; P < 0.001). The longest separation time in these groups was 53 and 17 days, respectively. There were no significant differences between the groups with regard to infection signs, namely, discharge, redness, foul odor, inflammation, and swelling (P > 0.05). Conclusion: Dry cord care not only is as effective as topical use of chlorhexidine in preventing cord stump infection but also is associated with shorter cord separation time.
  934 192 -
Medicinal plants use by elderly people in Kashan, Iran
Mohsen Adib-Hajbaghery, Saeedeh Rafiee
April-June 2018, 7(2):67-73
DOI:10.4103/nms.nms_109_17  
Background: There is limited information about the use of medicinal plants (MPs) by older adults in Middle East countries, including Iran. Objective: This study aimed to assess the MP use by older adults in Kashan, Iran. Methods: A cross-sectional study was conducted on 770 older adults who were randomly selected from different areas of Kashan, Iran. A questionnaire was used to gather the data. The data were described using the measures of descriptive statistics and analyzed via the Chi-square and the Fisher's exact tests. Results: Totally, 67.8% of participants used MPs. MPs were used, respectively, for abdominal pain, temperament modification, tranquilization, constipation, and common cold. Significant statistical relationships were found between MP use and variables such as gender, having hyperlipidemia, employment status, belief in the effectiveness of the MPs, and the level of knowledge about them. Conclusion: Older adults widely use MPs. Public education programs should be implemented to inform people, particularly elderly people, about the risks associated with the over-the-counter use of MPs and their interactions with conventional medications.
  968 155 -
Needs of critically ill patients' relatives in emergency departments
Tulay Yildirim, Zeynep Karaman Özlü
January-March 2018, 7(1):33-38
DOI:10.4103/nms.nms_100_17  
Background: Illnesses influence patients as well as patients' relatives and cause emotional problems, such as anger, fear, and anxiety. Determining the needs of patients' relatives increases satisfaction of patients and relatives and enhances health-care goal achievement. Objective: The objective of this study was to examine the needs of critically ill patients' relatives in emergency departments and the state of meeting these needs. Methods: This descriptive study was conducted on 202 critically ill patients' relatives at emergency department of Atatürk University Research Hospital. The data were collected using the Critical Care Family Needs Inventory for Emergency Departments (CCFNIED) and a form for meeting the needs of critically ill patients' relatives. Data were analyzed using percentage distribution, mean, analysis of variance, Mann–Whitney U test, and Kruskal–Wallis test. Results: The needs of patients' relatives according to the order of importance included communication with family members (3.88 ± 0.28), being supported (3.40 ± 0.42), being involved in care in the emergency department (3.27 ± 0.34), and comfort (3.20 ± 0.51). Using CCFNIED, the total mean score was 3.52 ± 0.31. Conclusion: Related studies are recommended to consider patients' relatives in the emergency department as a part of care, enable them to be involved in patient care, provide support for them, and enhance their comfort.
  981 141 -
The effects of stress-coping strategies and life skills trainings on the mental health and academic progress of adolescent cancer patients: A quasi-experimental study
Mohammad Mehdi Mohammadi, Roghayeh Poursaberi
January-March 2018, 7(1):12-17
DOI:10.4103/nms.nms_38_17  
Background: Cancer is a serious illness which can cause significant complications such as mental disorders. Objective: This study aimed to investigate the effects of stress-coping strategies (SCS) and life skills (LS) trainings on mental health and academic progress among adolescent cancer patients. Methods: This quasi-experimental study was conducted on 120 Iranian adolescent cancer patients. Participants were randomly allocated to a control (n = 60) and an experimental group (n = 60). A demographic questionnaire and the General Health Questionnaire were used to collect data on adolescents' mental health and grade point average (GPA) both before and after study intervention. A SCS and an LS training programs were held for the adolescents in the experimental group. However, adolescents in the control group received no training about the strategies and skills. The Chi-square, the Fisher's exact, as well as the independent- and the paired-sample t-tests were used for data analysis. Results: In the experimental group, the mean scores of the somatic symptoms, anxiety/insomnia, depression, and social dysfunction subscales of mental health were 8.91 ± 6.17, 10.33 ± 5.43, 15.33 ± 7.34, and 16.23 ± 3.61 at baseline and significantly decreased to 4.71 ± 2.51, 6.61 ± 2.62, 11.05 ± 2.84, and 12.31 ± 5.45, respectively (P < 0.05), while the mean GPA significantly increased after the study (P < 0.05). However, in the control group, neither mental health nor GPA changed significantly (P > 0.05). Conclusion: SCS and LS trainings can promote mental health and academic achievement among adolescent cancer patients.
  952 166 -
Effects of nature sounds on sleep quality among patients hospitalized in coronary care units: A randomized controlled clinical trial
Maryam Nasari, Tahereh Najafi Ghezeljeh, Hamid Haghani
January-March 2018, 7(1):18-23
DOI:10.4103/nms.nms_39_17  
Background: Sleep disorders are a source of stress for patients hospitalized in coronary care units (CCUs). Objective: The aim of this study was to investigate the effects of nature sounds on sleep quality among patients in CCUs. Methods: This randomized controlled trial was conducted on 93 patients hospitalized in the CCUs of three teaching hospitals in Tehran, Iran. Patients were randomly allocated into three groups, namely, nature sounds, silence, and control groups. Patients in the nature sounds group listened to nature sounds for 30 min in two consecutive nights while their counterparts in the silence group only wore mute headphones. Patients in the control group neither listened to nature sounds nor wore headphones. The Richards–Campbell sleep questionnaire was used for the evaluation of the patients' sleep quality two days before and during the intervention. The mean scores of sleep quality at the first two and the last two nights, respectively, were considered as the pretest and the posttest sleep quality. Cohen's d, one-way analysis of variance, paired-sample t, Chi-square, Fisher's exact, and the Scheffe post hoc tests were used to analyze the data. Results: Posttest-pretest mean differences of the sleep depth, the number of awakenings, and the returning to sleep domains of sleep quality in the control group were significantly less than nature sounds group (P < 0.001). Moreover, the posttest-pretest mean differences of the total sleep quality and its sleep latency and subjective sleep quality domains in the control group were significantly lower than both the nature sounds and the silence groups (P < 0.001). On the other hand, none of the differences between the nature sounds and the silence groups were statistically significant (P > 0.05). Conclusion: Both nature sounds and silence can significantly improve sleep quality among patients in CCUs. Nurses can use these strategies to improve the sleep quality of a patient in these units.
  956 138 -
A path analysis of the effects of nurses' perceived organizational justice, organizational commitment, and job satisfaction on their turnover intention
Mozhgan Fardid, Nahid Hatam, Zahra Kavosi
October-December 2018, 7(4):157-162
DOI:10.4103/nms.nms_13_18  
Background: Staff turnover, particularly nursing staff turnover, is one of the most common reasons behind loss of productivity in health-care organizations. A basic requirement for reducing staff turnover is to determine its causes. Objectives: This study evaluated the relationships of perceived organizational justice, organizational commitment, and job satisfaction with turnover intention among a group of Iranian hospital nurses. Methods: This cross-sectional study was conducted on nursing staff and auxiliary nurses who were working in 15 teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. A random sample of nurses, who had an associate or higher degrees in nursing and had a work experience of >1 year, was recruited through stratified random sampling. Data were collected using a demographic questionnaire, the Organizational Justice Questionnaire, the Job Satisfaction Questionnaire, the Organizational Commitment Questionnaire, and the Questionnaire of Turnover and were analyzed through the confirmatory factor analysis, path analysis, Pearson's correlation analysis, and squared multiple correlation analysis. Results: Organizational justice had significant direct relationships with job satisfaction (r = 0.73) and organizational commitment (r = 0.61) and inverse relationship with turnover intention (r = −0.41). Path analysis revealed that organizational justice had no direct effects on turnover intention, while it had indirect effects on turnover intention through the paths of organizational commitment and turnover intention. Conclusion: Nurses' turnover intention is directly affected by organizational commitment and job satisfaction and indirectly affected by organizational justice through the paths of organizational commitment and turnover intention.
  876 185 -
BRIEF REPORTS
Nurses' perspectives on the reasons behind medication errors and the barriers to error reporting
Mohammad Amrollahi, Narges Khanjani, Mehdi Raadabadi, Majid Bagheri Hosseinabadi, Maryam Mostafaee, Seyed Ehsan Samaei
July-September 2017, 6(3):132-136
DOI:10.4103/nms.nms_31_17  
Background: Medication errors may happen in any hospital setting. Medication error reporting can enhance patient safety and provide valuable information about reasons behind errors. Objectives: The present study aimed to determine nurses' perspectives on the reasons behind medication errors and the barriers to error reporting. Methods: This cross-sectional study was conducted in 2015 on 213 hospital nurses working in three hospitals in Kerman, Iran. Nurses working in different inpatient wards were selected through random sampling. Data were collected using a three-part questionnaire on nurses' demographic characteristics, reasons behind medication errors, and reasons for not reporting them. Data analysis was done through the independent sample t-test and the one-way analysis of variance. Results: The most and the least important reasons behind medication errors were nurses' insufficient attention to patients' medical records (3.63 ± 1.29) and the high number of tasks (2.01 ± 0.99), respectively. Moreover, the most and the least important reasons for not reporting medication errors included forgetting to report (2.80 ± 1.20) and fear over being blamed by doctors (2.03 ± 0.98), respectively. Conclusion: Nurse- and management-related factors were the most important reasons behind medication errors and not reporting them, respectively. Designing an efficient system for medication error reporting and a systematic approach for evaluating and managing error risk factors is recommended.
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ORIGINAL ARTICLES
The nursing challenges of caring for brain-dead patients: A qualitative study
Hamideh Yazdi Moghaddam, Zahra-Sadat Manzari, Abbas Heydari, Eesa Mohammadi, Ibrahim Khaleghi
July-September 2018, 7(3):116-121
DOI:10.4103/2322-1488.235638  
Background: Caring for brain-dead patients is one of the hardest duties for nurses, particularly in Intensive Care Units (ICUs). Objective: This study aimed to explore the nursing challenges of caring for patients diagnosed with brain death. Methods: The present study was conducted as a qualitative conventional content analysis, and data collection was carried out by field notes and 15 semi-structured and in-depth interviews with nurses working in the ICUs. Data analysis co-occurred simultaneously with data collection. Results: Seven themes were extracted from the data: uncertainties and conflicts between physicians and nurses, tensions in breaking the news of patient's brain death to families, stressful experience of caring for the first time, nurses' physical and psychological afflictions due to complex care tensions, stress of being blamed by patients' family, difficulty in tackling the emotions of patients' family, and finally, a sense of lack of support and protection in care. Finally, the main theme of turbulent confrontation with successive chains of tension in caring brain-dead patients was abstracted. Conclusions: Since nurses confront chain of tensions while caring for a brain-dead patient, this can affect the quality of this vital role to keep the transplantable organs viable; furthermore, authorities should implement special support programs for nurses.
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The effects of dry cupping on primary dysmenorrhea: A randomized clinical trial
Maryam Taherpour, Maryam Momeni, Azam Kazemi, Fatemeh Ranjkesh, Hamidreza Salimi, Maryam Shakiba
October-December 2018, 7(4):151-156
DOI:10.4103/nms.nms_4_17  
Background: Primary dysmenorrhea (PD) is one of the most common gynecologic problems. Objectives: The objective of this study was to determine the effects of dry cupping on PD severity and dysmenorrhea-associated systemic symptoms. Methods: In this randomized clinical trial, 150 young single students with PD were randomly allocated to either an intervention (n = 75) or a control (n = 75) group. Data collection tools were a demographic and menstrual characteristics checklist, Andersch and Milsom's Verbal Multidimensional Dysmenorrhea Severity Scoring System, and a Dysmenorrhea-associated Systemic Symptom Scale. In the intervention group, students were provided with daily sliding dry cupping therapy from 3 days before to 3 days after the onset of menstruation for three successive menstrual cycles. In each cupping therapy session, two cups were placed on the lower back on each side of the spine and another on the suprapubic area for 10–15 min. Students in the control group did not receive cupping therapy. Data were analyzed through the Chi-square and the independent-samples Student's t-tests, the repeated measures analysis of variance, and generalized estimating equation. Results: The mean scores of dysmenorrhea severity and systemic symptoms in the intervention group significantly decreased over time, while they did not significantly change in the control group. Thus, there were significant between-group differences respecting the variations of dysmenorrhea severity and systemic symptoms over time (P = 0.03). The odds of severe dysmenorrhea and the odds of severe dysmenorrhea-associated systemic symptoms in the intervention group were, respectively, 52% (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.27–0.85) and 78% (OR: 0.22; 95% CI: 0.05–0.98) less than the control group. Conclusion: Dry cupping can significantly reduce the severity and the systemic symptoms of PD. Therefore, it can be used as an effective, inexpensive, and safe therapy for PD management.
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Effect of problem-solving therapy and relaxation on the severity of postpartum depressive symptoms: A randomized controlled trial
Saeideh Nasiri, Masoumeh Kordi, Morteza Modares Gharavi, Masoud Kashani Lotfabadi
January-March 2018, 7(1):6-11
DOI:10.4103/nms.nms_35_17  
Background: Postpartum depression with high prevalence and unpleasant complications needs to be identified and treated. Objective: This study aimed to compare the effect of problem-solving therapy (PST) and relaxation on the severity of postpartum depressive symptoms. Methods: This randomized controlled trial was performed in health-care centers of Mashhad city, Iran, in women on the 3rd postpartum week. A total of 120 women were selected conveniently and randomly assigned to three groups (i.e., PST, relaxation, and control groups). The women completed Edinburgh Depression Scale and Beck Depression Inventory (BDI). Problem-solving skills were educated during six weekly sessions. Progressive muscle relaxation exercises and guided imagery were performed daily and once a week during 6 weeks, respectively. In the control group, women received usual postpartum care. All groups completed a daily checklist for recording depression symptoms. The three groups completed the BDI once again a week after the end of the intervention. Data analysis was conducted using Chi-square, paired t-test, analysis of variance (ANOVA), and repeated measures ANOVA. Results: The mean difference of severity of depressive symptoms was significantly different between the three groups at 9 weeks after delivery (−14.86 ± 6.15 in PST group, −10.71 ± 5.23 in relaxation group, and −4.72 ± 4.51 in the control group, P < 0.001). The frequency of mild depression decreased from 57.1% to 3.8% in PST group, from 65.4% to 23.1% in the relaxation group, and from 60.7% to 33.3% in the control group. Conclusion: Both PST and relaxation can reduce the severity of depressive symptoms. However, the effects of PST were more than those of relaxation.
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The image of nursing as perceived by nurses: A phenomenological study
Joko Gunawan, Yupin Aungsuroch, Ade Sukarna, Nazliansyah , Ferry Efendi
October-December 2018, 7(4):180-185
DOI:10.4103/nms.nms_24_18  
Background: Image remains crucial for nursing profession. How nurses view professional self-image has an impact on their professional self-esteem. Objectives: This study explored the image of nursing as perceived by Indonesian nurses. Methods: This was a phenomenological study with a purposeful sample of 19 clinical nurses participated in in-depth interviews. The interviews were audio-recorded, transcribed verbatim, and validated by relistening to the recording by researchers. The analysis was thematic. Results: Five themes emerged (a) Islamic culture, (b) job definition, (c) role of nurses, (d) self-confidence, and (e) relationship between multigenerations of nurses. Conclusion: This study addressed positive and negative images of nursing in Belitung, Indonesia. The findings may be used for nurse managers to improve nursing image through the improvement of nurse competence and continuing professional development.
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Medication adherence and its predictors among patients with heart failure
Seyedeh Somayeh Amininasab, Hamideh Azimi Lolaty, Mahmood Moosazadeh, Vida Shafipour
April-June 2018, 7(2):81-86
DOI:10.4103/nms.nms_9_17  
Background: Medication adherence is a complex behavioral pattern affecting treatment success. A stepping stone to improve medication adherence is to determine its contributing factors. Objectives: This study intended to evaluate medication adherence and its predictors among patients with heart failure in Mazandaran Heart Center, Sari, Iran. Methods: This cross-sectional study was conducted on 300 patients with heart failure who were hospitalized from January to March 2015. Sampling was done through the census method. Data were collected using the Morisky Medication Adherence Scale and were analyzed using the Chi-square test and logistic regression analysis. Results: The mean score of treatment adherence was 5.82 ± 2.54. Medication adherence had a significant correlation with education level (P = 0.012), number of children (P = 0.013), comorbidity (P = 0.002), ejection fraction (P = 0.046), and the number of tablets used per day (P = 0.001). However, it was not significantly correlated with age, gender, employment status, place of residence, income level, and the number of hospitalizations for heart failure (P > 0.05). Logistic regression analysis showed that none of the demographic and clinical characteristics was a significant predictor of medication adherence. Conclusion: Medication adherence is affected by different factors such as education level, number of children, comorbidity, disease severity, and the number of tablets used per day. Nurses need to take these factors into account when developing care plans and patient education programs.
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The effects of continuous positive airway pressure mask on hemodynamic parameters after open heart surgery: a randomized controlled trial
Mohammad Reza Afazel, Fatemeh Nadi, Mohammad Sadegh Pour-Abbasi, Ismail Azizi-Fini, Mehdi Rajabi
July-September 2017, 6(3):109-114
DOI:10.4103/nms.nms_20_17  
Background: Controversies exist regarding the effects of continuous positive airway pressure (CPAP) mask on hemodynamic parameters after open heart surgeries. Objectives: This study aimed to investigate the effects of CPAP mask on hemodynamic parameters after open heart surgery. Methods: This randomized controlled trial was conducted in 2015 on 72 patients who were to undergoing open heart surgery in Kashan, Iran. Patients were randomly assigned to an intervention (n = 36) and a control (n = 36) group. After postoperative extubation, a CPAP mask (with a pressure of 5 cmH2O) used for patients in the intervention group (30 min every 8 h for five times). A checklist was used to document hemodynamic parameters 10 min before and after each phase of the intervention. Data analysis was performed using the repeated measures analysis of variance and the Chi-square, Fisher's exact, and the independent-sample t-tests. Results: Results showed that CPAP mask had no significant effects on systolic blood pressure (P = 0.12), heart rate (P = 0.34), and mean arterial pressure (P = 0.12). However, it significantly affected diastolic blood pressure (P < 0.001) and central venous pressure (P < 0.01). Conclusion: CPAP mask has no negative effects on hemodynamic parameters. Thus, it can be safely used for patients who undergo open heart surgeries.
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