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.

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Background: Parents of children with autism need to have unique competencies which are different from the competencies of parents with healthy children. Nurses and other health-care providers should know these competencies to be able to provide these parents with quality care and education. Objectives: This study aimed to define the concept of parental competence from the perspectives of parents with autistic children. The main question of the study was, “What does parental competence mean?” Methods: This qualitative study was done in 2016 on 20 parents (12 mothers and eight fathers) of 20 autistic children. Parents were purposively recruited from the Autism Association of Shiraz University of Medical Sciences, Shiraz, Iran. Data collection was done through 16 semi-structured interviews and two focus group discussions. Interviews and focus group discussions were digitally recorded, transcribed verbatim, and analyzed using conventional content analysis. Results: Data analysis led to the development of 13 subcategories, five main categories, and two main themes, namely, “restoration of family stability” and “excellence in child care.” The three main categories of the first theme were adaptation to the current situation, organization of family affairs, and improvement of satisfaction in the family. The second main theme also had two main categories, namely, self-confidence in child care and stability on the difficult path of child care. Conclusion: Parental competence among parents with autistic children is defined as “the ability to restore family stability and achieve excellence in child care.” Appropriate strategies are needed to evaluate and improve parental competence among parents with autistic children.

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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.

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Background: Measurement of nursing activities is used for workload assessment, performance evaluation, and workforce management. Objectives: This study aimed to measure care and noncare-related activities among critical care nurses and to determine their contributing factors. Methods: This cross-sectional observational study was conducted from July to September 2017. All care and noncare-related activities of 70 critical care nurses in a public university hospital in Kashan, Iran, were assessed through the time and motion technique. Each nurse was observed throughout a 6-h morning shift. Data were collected using a nurse and patient characteristics questionnaire and care and noncare-related activities checklist. The paired and the independent-samples t-test, Mann–Whitney U-test, Kruskal–Wallis tests, and the one-way analysis of variance were used for data analysis. Results: The duration of nurses' care-related activities (249.10 ± 65.00 min, i.e., 69.2% of a 6-h shift) was significantly more than the duration of their noncare-related activities (111.00 ± 48.30 min, i.e., 30.8% of a 6-h shift). Respecting care-related activities, participants spent 53.5% of their time on direct care and the rest 46.5% on indirect care; whereas respecting noncare-related activities, they spent 76.5% of their time on personal activities (such as making personal calls) and the rest 23.5% on unit related tasks. The duration of nurses' activities had significant relationships with their unit, nurse–patient ratio, and patients' age, gender, and diagnosis. Conclusion: Critical care nurses spend their time mostly on care-related than noncare-related activities. Closer managerial supervision of nurses' activities, in-service educations about effective time management, and determination of the optimum nurse–patient ratio and the best task division schedule are needed to reduce nurses' workload, improve care quality, and enhance patient satisfaction.

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Background: Oral health-related quality of life (OHRQOL) means the subjective perception of oral health and its impacts on the quality of life. It is an important indicator in oral surveys. Objectives: The aim of this study was to evaluate OHRQOL in older people in Kashan city (Iran) in 2015. Methods: In this cross-sectional study, 500 elders aged <60 years were evaluated. The Geriatric Oral Health Assessment Index (GOHAI) was used for data collection along with demographic and oral cavity characteristics. Mann–Whitney U, Kruskal–Wallis test, and multiple logistic regression were used for data analysis. Results: The 58.6% of participants were male. Mean age was 73.79 ± 10.13 years. The 284 (56.8%) participants were edentulousness. The GOHAI total score was 43.08 ± 8.35 that showed the above average scores of measurements. Statistical tests showed that the OHRQOL was significantly better in married persons, with negative history of smoking, and those who used mouthwash, toothpicks, regular tooth brush, and tooth floss (P < 0.05). In multiple regression analysis, the age, gender, education, the history of smoking, color of gum, number of decayed teeth, the firmness of gum, having denture, and frequency of tooth brushing could explain 38.7% of OHRQOL. Conclusion: The physical indicators of the oral cavity in older people of Kashan were not satisfactory although the OHRQOL was above medium level. In Kashan, it seems that use of full dentures is more common than other treatments such as filling caries or using implants.

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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.

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Background: Homeless women can provide valuable information about the prevalence of sexually transmitted infections (STIs), especially human immunodeficiency virus (HIV) infection, in Iran. However, they are not readily accessible for epidemiological studies and hence, there is limited information about HIV infection prevalence among them. Objectives: The aim of the present study was to assess the prevalence of HIV infection and the perceptions of STIs among homeless women in Tehran, Iran. Methods: This cross-sectional study was conducted in 2014. Participants were 241 homeless women who were recruited through quota sampling from twelve drop-in centers and night shelters affiliated to a local welfare organization in Tehran, Iran. Data were collected using the perception of STIs Questionnaire as well as serological testing for HIV infection using DS-EIA-HIV-Ag/Ab-Screen kit (manufactured in Italy). Descriptive statistics measures and the independent-samples t-test were used for data description and analysis. Results: The prevalence of HIV infection was 8.3%. There were significant differences between HIV-positive and HIV-negative women respecting their overall STI risk perception (P = 0.003) and its two subscales, namely insufficient knowledge (P = 0.007) and inconsistent condom use (P = 0.030). Conclusion: Homeless women have low STI risk perception. Training and counseling programs are necessary to improve their STI-related knowledge, perception, and attitudes.

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Background: Vaginal discharge is a common gynecological complaint among women in the reproductive age group. Objective: The aim of this study was to explore cultural practices and health-seeking behaviors related to vaginal discharge among women living in a socially marginalized community in Colombo district, Sri Lanka. Methods: A descriptive qualitative design was used in this study. Three focus group discussions (FGDs) were conducted in an urban slum community among women who had a previous history with vaginal discharge. A total of 23 women of different ethnicities and religions were included. FGDs were audio recorded and field notes were taken. Verbatim transcripts were analyzed on the basis of qualitative content analysis. Results: Six themes emerged from the data, namely, confusion in differentiating normal from abnormal vaginal discharge, effects on day-to-day life, confusion toward the causative factors, difficulties in disclosing, neglecting behaviors, and socio-cultural influences toward health-seeking behaviors. Majority of women expressed that they use home remedies before consulting a doctor for abnormal vaginal discharge. Conclusions: Women are unable to differentiate normal from abnormal vaginal discharge. Thus, it is important for nurses and primary healthcare workers to plan health education activities for women to empower them with adequate knowledge and improve their health-seeking behaviors.

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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.

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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.

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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.

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Background: Despite the beneficial effects of the internet, inappropriate, and overuse of it may result in negative consequences such as internet addiction (IA). Despite the increasing uses of the internet among students and the concern about IA, the mechanism and the direction of association between IA and psychological stain is still unknown. Objectives: This study aimed to investigate the correlation between IA and psychological strain in nursing and midwifery students of Islamic Azad University, Qom Branch, in 2018. Methods: A cross-sectional study was carried out on 298 nursing and midwifery students of Islamic Azad University, Qom Branch. The students were recruited through a census method and responded to a three-part instrument. The study instrument included questions addressing the students' characteristics, the Young's IA Test, and the Osipow Psychological Strain Inventory. Data analysis was performed using descriptive and inferential statistics. Results: The mean age of the students was 21.93 ± 2.91 years. The mean IA and psychological strain were 53.12 ± 16.66 and 25.22 ± 7.33, respectively. About 50% of the students were moderately addicted to the internet, and 53% of the students showed moderate psychological strain. A direct significant correlation was found between IA and psychological strain in nursing and midwifery students (P = 0.001 and r = 0.41). IA and students' age could predict psychological strain in nursing and midwifery students (r² = 0.18). Conclusion: A majority of nursing and midwifery students showed moderate levels of IA and psychological strain, and these two variables are significantly correlated. The authorities in nursing and midwifery education should establish appropriate strategies to diminish the harmful effects of excessive internet use by the students.

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Background: Autism spectrum disorder (ASD) is a severe developmental disorder which leads to physical disability. Positive normative feedback can promote motor learning. Objectives: The aim of this study was to evaluate the effects of positive normative feedback on learning a throwing task among children with ASD. Methods: This quasi-experimental study was carried out on twenty children with ASD who aged 6–10 years. Children were assigned to a positive normative feedback and a control group. In the positive normative feedback group, children were trained to throw beanbags to a target point on the ground with their nondominant arms. The acquisition phase included six ten-trial sets. Children in both groups received veridical feedback after each trial. However, children in the positive normative feedback group also received bogus feedback (scores, which were 20% greater than their actual scores) about their performance in each set. A retention test was performed 24 h after the acquisition phase. The independent sample t-test and the repeated measures analysis of variance were used to analyze the data. Results: There was no significant difference between the groups regarding the performance mean score at baseline. Moreover, despite increases in the performance mean scores over time in both groups, between-group differences in the acquisition and the retention phases were not statistically significant (P > 0.05). Conclusion: Positive normative feedback does not have significant motivational effects on motor learning among children with ASD.

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Background: The ethical climate of hospitals and job satisfaction are two main factors behind nurses' productivity. Yet, there is limited information about ethical climate and nurses' job satisfaction in the operating room (OR). Objective: This study aimed to investigate the relationship of ethical climate with nurses' job satisfaction in the OR. Methods: This cross-sectional study was done on 197 OR nurses. The Olson Hospital Ethical Climate Survey and the Minnesota Job Satisfaction Questionnaire were used for data collection. Data were analyzed by doing Spearman's rank correlation. Results: About half of the participants had a moderate job satisfaction and negative perceptions about the ethical climate of the OR. Ethical climate was significantly correlated with nurses' job satisfaction (r = 0.93, P < 0.001). Conclusion: There are some defects in the ethical climate of the ORs. Health policymakers need to devise strategies to improve both ethical climate and nurses' job satisfaction in the ORs.

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Background: Aging population is progressively increasing. Older adults suffer from the different chronic health conditions such as hypertension. Behavior change is a key strategy for effective hypertension management. Successful behavior change necessitates the adequate self-efficacy. Objectives: This study aimed to evaluate the effects of a self-management program based on the 5 A's model on self-efficacy among the older men with hypertension. Methods: This randomized controlled trial was conducted in 2016–2017 on older men with hypertension in Ramsar, Iran. In total, 60 eligible participants were randomly allocated to an intervention and a control group. The participants in the intervention group were offered a self-management program based on the 5 A's behavior change model. Data were collected using a demographic questionnaire, a hypertension assessment form, the Self-Efficacy for Managing Chronic Disease Scale, and the hypertension Self-Efficacy Scale. Self-efficacy scales were completed for participants both before and 12 weeks after the intervention onset. The paired- and independent-sample t, Wilcoxon signed-rank, Mann–Whitney U, and Chi-square tests were used in the data analysis. Results: The pretest mean scores of hypertension self-efficacy in the intervention and the control groups were, respectively, 48.62 ± 11.71 and 44.65 ± 15.4, which significantly increased to 79 ± 13.13 and 62.06 ± 15.38 at posttest (P < 0.001). Moreover, the pretest mean scores of chronic disease management self-efficacy in these groups significantly increased from, respectively, 5.64 ± 1.28 and 5.35 ± 1.40 at pretest to 8.05 ± 1.29 and 6.12 ± 1.48 at posttest (P < 0.001). The pretest–posttest mean differences of the mean scores of both types of self-efficacy in the intervention group were significantly greater than the control group (P < 0.001). Conclusion: The self-management program based on the 5 A's model is effective in significantly improving the self-efficacy among older men with hypertension.

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Background: Maternal postpartum depression (PPD) is a common problem after childbirth. It is a risk factor for low-quality mother–infant interaction. Infant massage may help alleviate depressive disorders. Objectives: This study aimed to investigate the effects of infant massage by mothers on maternal PPD. Methods: This clinical trial was conducted on 120 primiparous mothers with PPD. Mothers were randomly recruited and allocated to a control and an intervention group. In the intervention group, mothers were instructed to give their infants 15-min massage twice daily for 6 consecutive weeks from the 3^rd postnatal week onward. However, mothers in the control group did not receive such training. Before and after the intervention, PPD was assessed using the Edinburgh Postnatal Depression Scale. Data analysis was performed using the Chi-square test, independent-samples t-test, paired-samples t-test, Wilcoxon signed-rank test, and univariate and multivariable logistic regression. Results: Groups did not significantly differ from each other concerning parents' and infants' demographic characteristics (P > 0.05) and the pretest mean score of PPD (P = 0.46). However, the posttest mean score of depression in the intervention group was significantly lower than the control group (7.75 ± 2.18 vs. 9.2 ± 2.04; P < 0.001). In addition, the posttest relative frequency of PPD was significantly lower in the intervention group (15/60 [25%] vs. 26/60 [43.3%]; χ² = 4.48; P = 0.034). After controlling the effects of other variables, the odds of PPD in the intervention group was 0.5 times (95% confidence interval: [0.2, 0.94]) less than the control group (P = 0.003). Conclusion: Infant massage by mothers significantly alleviates maternal PPD. Health-care professionals, particularly midwives, are recommended to instruct mothers to provide infant massage in order to alleviate their own PPD.

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Background: Spiritual care is an integral part of holistic care. Its delivery should be based on patients' spiritual needs. Objectives: This study aimed to explore the interprofessional dimensions of spiritual care for chronically ill patients. Methods: This exploratory qualitative study was done in Isfahan, Iran, on a purposive sample of 25 participants including patients, family caregivers, nurses, physicians, psychologists, social workers, and religious counselors. Data were collected through semi-structured interviews and analyzed through conventional content analysis. Results: The interprofessional dimensions of spiritual care for chronically ill patients fell into four main themes. The first theme was religious care with the three subthemes of assistance in doing religious rituals, assistance in referring to religious values, and assistance in doing religious activities. The second theme, that is, pastoral care, consisted of three subthemes, namely, assistance in finding the meaning of life/death/illness, assistance in achieving spiritual transcendence, and encouragement to communicate with self and to do spiritual exercises. The third theme was psychological care, the four subthemes of which included assistance in acquiring peace of mind, assistance in accepting and coping with illness, assistance in creating a source of hope, and empathizing with patients. Finally, the fourth theme was supportive care and included the four subthemes of support and assistance to meet basic needs, continuity of care after hospital discharge, providing patient and family education, and respecting patients. Conclusion: Spiritual care has different dimensions. Its delivery necessitates adequate knowledge and expertise, close interprofessional collaboration, effective teamwork, and efficient patient referral system.

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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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Background: Hospitalization of infants with congenital anomalies to undergo surgery is extremely stressful for their family members, particularly their parents. The resultant stress can negatively affect parents' self-confidence. Objectives: The aim of this study was to examine the correlation of perceived nursing support with stress and self-confidence among the mothers of infants with congenital gastrointestinal anomalies. Methods: This correlational study was conducted in June–November 2015 on 120 mothers whose infants were hospitalized due to congenital gastrointestinal anomalies in the surgical ward of Tabriz teaching children's hospital, Tabriz, Iran. Data were collected using a demographic questionnaire, the Nurse Parent Support Tool, the Parental Stress Scale, and the Parenting Confidence Scale. Spearman's correlation analysis was used to assess the correlation of perceived nursing support with stress and self-confidence. Results: Mothers perceived high levels of communicational-informational nursing support and low levels of emotional nursing support. Perceived nursing support had positive correlations with stress (r = 0.22; P = 0.013) and self-confidence (r = 0.35; P < 0.001). Conclusion: Although the mothers of infants with congenital gastrointestinal anomalies receive adequate communicational-informational nursing support, their perceived emotional nursing support is inadequate. Therefore, neonatal care nurses need to provide the mothers with comprehensive support and adopt strategies to alleviate their concern.

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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 3^rd 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.

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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.

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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.

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Background: Involving patients to make decision is a fundamental principle of patient's rights. It is also one of the components of cultural rights. Health professionals have undeniable role in this field through patient participation. “Power” is something that highlights this role. Objectives: This study aimed to explore the existing power imbalance between patients and practitioners and its influence on patient autonomy and cultural rights, based on cultural safety perspective. Methods: A critical ethnography was conducted in a nephrology ward. Data collection was started by observation to build a primary record undertaken over 7 months and continued by interview about 6 months. Data were analyzed using the reconstructive analytical approach, developed by Carspecken. Results: Two main themes from high-level coding were emerged one: suspense of uncertainty, information desperation, and alienation by the health care. Two: misunderstanding of patient participation, professional centrism, and abstract participation. Conclusion: The medical praxis has drawn a glass wall between patients and health professionals and divided them into two groups of “self” and “others”. The current dominant culture of medical centers could not provide an appropriate setting for ethical decision-making based on cultural right. This paternalistic view is a threat to the public discursive ethics and the cultural safety of patient as well in the medical and health-care settings.

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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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