Iranian Journal of Nursing and Midwifery Research
Iranian Journal of Nursing and Midwifery Research (IJNMR) applies the Creative Commons Attribution License (CCAL) to all of its published papers. Under the CCAL, authors retain ownership of the copyright for their article, but authors allow anyone to download, reuse, reprint, modify, distribute, and/or copy articles in IJNMR, so long as the original authors and source are cited. No permission is required from the authors or the publishers.
A Comprehensive Review of Technological Innovations in Teaching Clinical Nursing Skills: A Scoping Review
Abstract Background: Nursing professionals require practical clinical skills to ensure patient‑centered and safe care. Traditional teaching methods face challenges, such as limited student engagement and resource intensity, prompting a shift toward integrating technology into clinical nursing education. This scoping review aims to explore and categorize technological innovations used in teaching clinical nursing skills, thereby supporting nursing educators and policymakers. Materials and Methods: Following Arksey and O’Malley’s five‑stage scoping review methodology and PRISMA‑ScR guidelines, we conducted a systematic literature search across MEDLINE, EMBASE, Scopus, WoS, CINAHL, ERIC, and PsycINFO databases. Inclusion criteria encompassed studies from 1995 to 2023 focusing on technology used to teach clinical nursing skills to students or nurses. The data from 58 studies were charted and synthesized through template analysis to identify key technological features. Results: The review identified seven primary categories of technological features: Content, accessibility, learning environment, usability, pedagogical approach, security, and ethical issues. Mobile applications, virtual simulations, and educational videos were the most frequently employed technologies. Findings highlight how these tools enhance skills acquisition, accessibility, and user engagement while raising ethical considerations, particularly around privacy and data security. Conclusions: Integrating educational technologies into nursing curricula has demonstrated significant potential to enhance clinical skill development. However, successful adoption necessitates addressing ethical issues and balancing technology with traditional teaching methods. Future research should examine the long‑term impact of these innovations on clinical competence and explore strategies to mitigate ethical concerns.
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Depression, Anxiety, and Stress among Pregnant Women During the Spread of COVID 19 Virus in Jordan
Abstract Background: The COVID‑19 infection showed serious psychological influences on pregnant women’s mental health that required psychological evaluation and intervention to overcome the negative consequences developed during the COVID‑19 pandemic. The main goal of the present study was to evaluate depression, anxiety, and stress among pregnant women during the spread of the COVID‑19 pandemic in Jordan. Materials and Methods: This cross‑sectional correlation study was carried out among pregnant women in Jordan. From April to June 2022, data were collected from three hospitals in Jordan (two public and one private). The Arabic version of the Depression, Anxiety, and Stress Scale 21 items (DASS‑21) was used to collect the data. Data were collected from 355 participants and then analyzed. Results: During the COVID‑19 pandemic, pregnant women experienced mild levels of stress (mean (SD) =14.43, 4.46) and anxiety (mean (SD) =9.06, 4.60), with no depression (mean (SD) = 8.12, 4.04). Jordanian women had lower stress levels (mean (SD) =13.07, 4.49) compared to non‑Jordanian women (mean (SD) =15.15, 4.32) (t = 5.26, p < .05). Employed women (mean (SD) = 15.74, 4.39) had higher stress levels than non‑employed women (mean (SD) =12.76, 4.73) (t = 3.35, p < .05). Women with a bachelor’s degree or higher (mean (SD) =15.64, 4.44) also experienced more stress than those with less education (mean (SD) =12.96, 4.20) (t = 2.63, p < .05). No statistically significant differences in stress levels were found based on marital status or pregnancy stage (p > .05). Conclusions: The study emphasizes the importance of integrating targeted antenatal support for pregnant women during the COVID‑19 pandemic. Elevated stress levels emphasize the need for proactive measures to prevent maternal complications. Practical steps to address these challenges are crucial, promoting the well‑being of expectant mothers and enhancing the resilience of maternal healthcare systems.
The Effect of Guided Imagery and Music with Sasando Music on Anxiety among Ischemic Stroke
Background: Guided Imagery and Music (GIM) interventions reduced the anxiety in many clinical settings. Traditional music pictures the emotion of specific culture. No interventional study was found in reducing anxiety among ischemic stroke patients using GIM with traditional music. The aim of the study is to determine the effect of GIM with sasando music on anxiety among ischemic stroke survivors. Materials and Methods: The method was a quasi‑experimental design with a pretest–post‑test with a control group. Respondents are 50 ischemic stroke survivors divided into two groups and selected by the consecutive sampling technique. The instrument is the HAM‑A questionnaire. The intervention group listened to GIM with Sasando Music from the Nusa Tenggara Timur Province, Indonesia. The statistical test used was the Mann–Whitney test. Results: The anxiety score in the intervention group before and after the GIM intervention showed a statistically significant difference, p value = 0.001 (p < 0.05), while in the control group, there was no statistically significant difference, p value = 0.683 (p > 0.05). The test on the two groups showed that there was no significant difference of anxiety score before intervention, p value = 0.351 (p > 0.05). After intervention, there was a significant difference in anxiety score, p value = 0.001 (p < 0.05). Conclusions: GIM intervention affects anxiety level on post‑ischemic stroke patients. As a recommendation, GIM can be used as an intervention to reduce anxiety in post‑ischemic stroke patients.
Comparison of Emotional Regulation During Controlling Neuroticism in Different Types of Premenstrual Syndrome in Students
Background: Premenstrual Syndrome (PMS) involves cyclical mood and physical symptoms tied to the menstrual cycle. Neuroticism is a fundamental personality trait characterized by a tendency toward experiencing negative emotions like grief, anxiety, anger, and guilt. Emotion regulation enables individuals to manage their feelings during such situations. This study aimed to compare emotional regulation during controlling neuroticism in different types of premenstrual syndrome in students. Materials and Methods: This descriptive cross‑sectional study was conducted on 421 students from Qom University of Medical Sciences. The participants were selected dormitories, sports venues, health and treatment centers, and hospitals from April 2018 to the end of December 2019 using convenience sampling. Research instruments included three questionnaires to diagnose PMS: A Premenstrual Symptoms Screening Tool (PSST), an Emotion Regulation Questionnaire (ERQ), and NEO‑Five Factor Inventory (NEO‑FFI) questionnaire. The data were analyzed using analysis of variance (ANOVA (, Pearson, and multiple regression. Results: ANOVA analysis indicated a significant relationship between PMS, emotional regulation (F3,25 = 2, p = 0.04), and neuroticism control (F4,22 = 2, p = 0.01). The results of multiple regression showed that the neuroticism controlling score had a significant effect on the score of those who had moderate PMS symptoms, emotion regulation, while neuroticism control in those with mild PMS symptoms had a significant impact and increased mild PMS by 0.03 and 0.01, respectively. Conclusions: The study found a strong link between emotional regulation and PMS. Also, the impact of controlling Neuroticism in reducing Premenstrual Dysphoric Disorder (PMDD) symptoms and recommending interventions was highlighted based on emotion regulation and neuroticism control.
Effectiveness of Neonatal Resuscitation Program in Improving Knowledge and Skills Among Nursing Officers Working in Maternal and Child Health Wards
Background: Newborn resuscitation involves reviving a newborn soon after birth to ensure normal breathing and circulation. This study aimed to evaluate the knowledge and skills of nursing officers in the Neonatal Resuscitation Program. Materials and Methods: A quasi‑experimental study was conducted on 60 nursing officers, with 30 in the experimental group and 30 in the control group. They were working in Maternal and Child Health wards from March to April 2022. The participants were selected through simple random sampling from SGT Medical College Hospital and Research Institute and Kalawati Hospital in Gurugram, Haryana, India. The experimental group received a full day of hands‑on Neonatal Resuscitation training on a rotating basis. Data were collected using a structured knowledge questionnaire and checklist to assess the knowledge and skills of both groups. Data analysis was performed using IBM SPSS for calculating frequency, percentage, Chi‑square, and paired t‑test. Results: In the experimental group, the mean (standard deviation (SD)) knowledge score increased from 12.46 (1.85) to 17.80 (2.07). However, there was no improvement in the control group 12.1 (2.84) to 11.70 (2.76). The mean (SD) skill level also increased in the experimental group from 9.43 (2.48) to 12.60 (2.71) as compared with the control group, from 9.73 (1.74) to 9.73 (1.50). A paired t‑test was used, showing a significant difference between pre‑ and postknowledge (t60 = 7.55, p = 0.05) and skills scores (t60 = 32.97, p = 0.05) among the experimental group, with no significant difference in the control group. Conclusions: The study concluded that participation in a skill training program significantly improved the knowledge and abilities of nursing officers in neonatal resuscitation.
The Effect of a Positive Psychotherapy Based Program on the Perceived Social Support of Patients with Depression
Background: Positive psychotherapy aims to enhance the quality of life in patients while alleviating the symptoms of their condition. This study sought to evaluate the impact of a positive psychotherapy‑based program on the social adjustment of patients with depression. Materials and Methods: This randomized clinical trial involved 66 patients diagnosed with depressive disorder who were hospitalized in the psychiatric wards of Khorshid and Farabi hospitals in Isfahan during 2022. Participants were randomly assigned to either the intervention group or the control group, with 33 individuals in each. The intervention group underwent a series of six group‑based training sessions, each lasting 90 minutes, conducted twice a week with 8‑10 participants per session. The control group received standard routine care. Perceived social support was assessed using a standardized questionnaire at three time points: before the intervention, immediately after the intervention, and 1 month later. Data analysis was conducted using descriptive and inferential statistical methods in SPSS (version 16). Results: Significant differences in the mean perceived social support scores were observed between the two groups both immediately after the intervention (t = –2.12, df = 42.35, p = 0.040) and 1 month later (t = 3.09, df = 44.42, p = 0.003). In addition, within the intervention group, the mean perceived social support scores showed significant variation across the three measurement points (F = 16.84, p < 0.001). Conclusions: The positive psychotherapy‑based program effectively improved the perceived social support of patients with depression in the intervention group compared to the control group.
The Correlation of the Perfusion Index with Pain Scales in Infants Undergoing Surgery
Background: The Perfusion Index (PI) is considered an important tool for evaluating the condition of infants, but there are few studies on the correlation between PI and pain assessment in infants. Therefore, this study aimed to investigate the correlation between PI and pain scale in infants undergoing surgery. Materials and Methods: This prospective, cross‑sectional study was conducted in the Neonatal Intensive Care Unit (NICU) of the Children’s Medical Center in Tehran, Iran, between April 2020 and April 2023. Using the Crying Requires, Oxygen, Increased vital signs, Expression, and Sleeplessness and right‑hand mean PI, using a Masimo pulse oximeter, pain scales were recorded immediately after surgery in the NICU and every 4 h for a total of 24 h by a skilled nurse unaware of the study. The correlation between PI and factors such as age, weight, NICU admission length, and pain scale was analyzed. Results: Our study found an inverse correlation between the pain scale and PI (p < 0.05; r: −0.385). Additionally, age, gestational age, and PI had a positive correlation with weight (p < 0.05; r: 0.233, 0.132, and 0.044, respectively). The age of the infant was also correlated with PI (p < 0.05; r: 0.307). Moreover, NICU admission length was inversely related to the PI scale (p < 0.05; r: −0.119).m Conclusions: The ease of use and objective measurement method of the PI makes it a valuable nursing tool for pain measurement in infants, in addition to other methods. However, further studies are needed to confirm the effectiveness of this correlation.
Assessment of Prenatal Care Quality and Related Factors after the Implementation of the Family Physician Program in Northwest Iran
Background: Prenatal Care (PNC) is a fundamental topic of the family physician program. This study aimed to evaluate the PNC quality and related factors after the Implementation of the Family Physician Program in northwest Iran. Materials and Methods: This cross‑sectional study was conducted among 385 pregnant women visiting four Comprehensive Health Services centers in Tabriz City, in 2019. Samples from each center were selected proportionally to the size of the center over 3 months. Data were collected using a researcher‑made questionnaire on PNC assessment. Poisson regression analysis was used to evaluate the associations. Results: Nearly 95% of participants were homemakers with a mean age of 29.5) 5.74) years, and 60% had planned pregnancies. Participants who visited healthcare providers regularly reported a higher quality of care. The quality of care significantly varied depending on the referral location for receiving care. Lower education levels in mothers, utilization of preconception care, and early referrals to care centers were associated with enhanced care quality (p-value < 0.001). Conclusions: The gap between perceived quality of care and actual standards reveals strong associations between care quality and factors such as regular visits, referral sources, maternal education, preconception care, and timely access to care. It is recommended to implement targeted interventions in these areas to enhance PNC quality.
Social Cyberloafing as a New Antecedent of Nurse Work Performance
Background: Because the use of social media and social networking sites during work hours is increasing, the effect of such behaviors (defined as social cyberloafing) on nurse performance must be investigated. This study was conducted to determine the effect of nurses’ social cyberloafing on their individual work performance. Materials and Methods: This cross‑sectional and descriptive study was conducted with 213 nurses working in private hospitals between April and May of 2022 in Turkey. Data were collected using the Social Cyberloafing Scale (SCS) and the Individual Work Performance Questionnaire (IWPQ). Results: The mean social cyberloafing score of the nurses was 3.20, and the mean individual work performance score was 3.66. A significant and positive correlation was found between the mean scores of the SCS and the IWPQ (r: 0.41; p < 0.01). SC had a significant and positive effect on IWP (t: 5.37; β =0.68; R2 = 0.16), SC had a significant and positive effect on Task Performance (t: 5.97; β =0.38; R2 = 0.15), SC had a significant and positive effect on Contextual Performance (t: 4.13; β =0.31; R2 = 0.10), and SC had a significant and negative effect on Counterproductive Work Behavior (t: −3.27; β = −0.26; R2 = 0.06). Conclusions: In this study, nurses’ social cyberloafing was found to be moderate, and their individual work performance was found to be high. It was found that as nurses’ social cyberloafing increased, their individual work performance also increased.
Uterine Cervical Cancer: Diagnostic Accuracy of Clinical Staging, Magnetic Resonance Imaging, and Histopathology Findings
Background: Cervical cancer (CC) ranks as the fourth most commonly diagnosed cancer in women globally. Accurate staging is crucial for treatment planning. Although magnetic resonance imaging (MRI) has been validated as a reliable modality for CC staging, limited evidence exists on its accuracy compared to dual International Federation of Gynecology and Obstetrics (FIGO) classifications in an Iranian population. This study addresses this gap by evaluating the diagnostic accuracy of MRI against both clinical FIGO staging systems and the gold standard of histopathology in untreated CC patients. Materials and Methods: A prospective study was conducted on 45 CC patients from January 2021 to December 2023, at tertiary‑care centers in Isfahan, Iran. Clinical FIGO staging and pretreatment MRI were performed, followed by surgery and histopathological examination. MRI’s diagnostic accuracy was compared with clinical FIGO staging and postoperative pathological findings. Results: The overall diagnostic accuracy of MRI for staging cervical carcinoma was 82.20%, with clinical FIGO staging achieving 57.80% accuracy. MRI demonstrated higher sensitivity (82.20%) and positive predictive value (PPV; 97.40%) compared to clinical FIGO. However, both methods showed equal and lower specificity (50%) compared with the postoperative pathological findings. Conclusions: MRI appears to be more effective than FIGO in terms of sensitivity and PPV for staging cervical carcinoma. The present study underlines the need for cautious interpretation of the results and further research due to significant uncertainty in specificity and negative predictive value. Combining FIGO staging and MRI provides a comprehensive assessment essential for effective treatment planning.
Effectiveness of Dual‑System Endotracheal Suction on Cardiopulmonary Functions in Mechanically Ventilated Adult Patients at Ismailia City, Egypt: Nursing Practice
Background: Tracheal suctioning is an essential procedure used to maintain airway patency by removing secretions. However, it is a critical nursing skill that carries potential risks. This study aims to evaluate the effects of the dual‑system endotracheal suction on cardiopulmonary function in mechanically ventilated adult patients. Materials and Methods: A quasi‑experimental design was employed in this study. A purposive sample of 74 patients was recruited from the intensive care unit of a teaching hospital in the city of Ismailia, Egypt. The patients were assigned to two equal groups, with 37 patients in each group: Group I received closed‑system suction, while Group II received open‑system suction. Data were collected using a single structured tool consisting of three sections: demographic information, health history, and a hemodynamic parameters sheet used to assess cardiopulmonary function before and after suctioning. Results: The mean (SD) ages of the studied patients were 49 (6.70) years in Group I and 47.2 (7.10) years in Group II. There was a highly significant difference between the use of closed‑ and open‑suction systems for cardiopulmonary function during (t = 4.23; P = 0.01) and directly postsuction (t = 4.23, P = 0.01). However, no statistically significant differences were observed between the study groups in the presuction phase. Conclusions: Patients managed with a closed‑suction system demonstrated improved cardiopulmonary function compared to those who received open suction. Therefore, the use of a closed‑suction system is an effective intervention for minimizing cardiopulmonary instability and supporting the overall well‑being of mechanically ventilated adult patients.
Assessment and Analysis of the Data from the Program “Basic Interventions of Non‑Communicable Diseases in Iran’s Primary Health Care System in Urmia City, Iran, 2023
Abstract Background: Cardiovascular diseases are among the leading causes of death and disability worldwide, including in Iran. Identifying their risk factors is essential for implementing cost‑effective preventive interventions. This study aimed to determine the prevalence of behavioral risk factors for non‑communicable diseases and their relationship with of cardiovascular diseases risk level in Urmia City, Iran. Materials and Methods: This cross‑sectional study involved 10,000 individuals aged 30 years and older who underwent risk assessment in 2023. Participants were selected through multi‑stage cluster sampling. Data were collected using a researcher‑designed checklist within the Integrated Health System and analyzed using, employing independent t‑tests and Chi‑square tests. Results: The prevalence of risk factors was: history of diabetes (12.22%), hypertension (17.24%), high cholesterol (14.93%), family history of diabetes (4.25%), pre‑diabetes (7.19%), and pre‑hypertension (29.33%). The distribution of risk levels was as follows: 91.15% of participants was classified as having a risk level below 10%, 8.24% between 10 and 20%, 0.33% between 20 and 30%, and 0.28% above 30%. There was a significant positive correlation between risk level and fasting blood sugar, cholesterol, systolic and diastolic blood pressure, age, body mass index (BMI), and waist circumference. Conclusions: The implementation of the risk assessment program and the identification of risk factors at early stages will help in the regular follow‑up of high‑risk individuals, provide them with necessary health care, and lead to the prevention or early diagnosis of disease.
Examining the Unmet Needs of Family Caregivers of Cancer Survivors and their Related Factors in Clients Referring to Oncology Clinics and Offices
Background: The complex process of caring for cancer survivors can affect various aspects of caregivers’ needs and health. The present study was conducted to determine the unmet needs of family caregivers of cancer survivors and their related factors. Materials and Methods: This descriptive cross‑sectional study included 314 family caregivers of cancer survivors. The required data were collected using a demographic characteristic form and the Comprehensive Needs Assessment Tool using the simple random sampling method. The main inclusion criteria for family caregivers were being 18–70 years old, lacking other chronic physical or mental illnesses, being willing to participate in the research, and not being a member of a treatment team. The collected data were analyzed in SPSS V.18. Results: Most of the participants were female, married, and urban citizens. The mean (SD) total score of unmet needs was obtained at 74.97) 19.67(, which indicated a medium‑to‑high level of the unmet needs of caregivers. It was found that the mean score of unmet needs in caregivers had a significant relationship with gender, marital status, education level, occupation, relationship with the patient, living with the patient in the same place, and the income status of caregivers, as well as with patients’ gender, education level, occupation, income status, travel for treatment, type of insurance, type of treatment, and place of treatment (p < 0.005). Conclusions: It seems necessary to pay attention to the unmet needs, consider interventional programs to satisfy these needs, and take into account the factors related to these needs.
Spiritual Well‑Being, and Caring Burden of Informal Caregivers of Stroke Patients
Background: Caregivers of stroke patients face the significant burden. This study aimed to explore the relationship between caregiver burden and spiritual well‑being among caregivers of stroke patients in Qom, Iran. Materials and Methods: This cross‑sectional study included 112 caregivers of stroke patients. Participants were selected using convenience sampling from three rehabilitation centers in Qom, Iran, between March and December 2022. Data was collected using the Caregiver Burden Inventory and the Ellison and Paloutzian Spiritual Well‑being Questionnaire. The data were analyzed using descriptive and analytical statistical methods, including linear regression analysis, in SPSS 24 software. Results: The mean (SD) caregiver burden was 67.10 (6.76), with 87.10% of participants reporting a high caregiver burden. The mean (SD) religious well‑being score was 50.25 (9.41), while the mean (SD) existential well‑being score was 42.78 (11.28). The stepwise multiple linear regression analysis showed that, after adjusting for demographic characteristics, care dependency (â = 0.380, p = 0.001) and existential well‑being (â = 0.277, p = 0.009) were significantly associated with caregiver burden. These variables explained 38.00% of the variance in caregiver burden. Conclusions: The study suggests that enhancing spiritual aspects, particularly existential well‑being, could reduce the perceived burden of caregivers. This valuable insight can be utilized to create interventions aimed at alleviating the challenges experienced by caregivers of stroke patients, ultimately reducing the impact of these difficulties.
The Effect of Virtual Breastfeeding Counseling on Breastfeeding Self‑ Efficacy
Background: Maternal self‑efficacy plays a pivotal role in achieving exclusive breastfeeding (EBF). This study aimed to evaluate the impact of virtual breastfeeding counseling based on Rapport building, Exploration, Decision‑making, and Implementation (REDI) approach on breastfeeding self‑efficacy (BSE) and EBF rates among breastfeeding women. Materials and Methods: This randomized clinical trial was conducted in comprehensive health centers in Hamadan City, Iran, from 2023 to 2024. Using the block randomization method, 70 eligible participants were randomly assigned to either the intervention or control groups. Data were collected using a demographic and reproductive characteristics checklist, the Breastfeeding Self Efficacy Scale (BSES), and a breastfeeding status follow‑up checklist. The intervention consisted of one face‑to‑face breastfeeding counseling session followed by ten virtual sessions guided by the REDI model consultation framework. Data were analyzed using Stata software, with statistical significance set at P < 0.05. Results: There were no significant differences in demographic and reproductive characteristics between the study groups, and mean (SD) BSES scores before the intervention (P > 0.05). However, after the intervention, the mean (SD) BSES scores in the intervention group were significantly higher than that in the control group (t = 2.40; P = 0.01). Moreover, the 6‑month EBF maintenance was significantly higher in the intervention group than the control group (61.30% vs. 33.30%; P = 0.029). Conclusion: The results of this study suggest that virtual counseling intervention is effective in improving breastfeeding outcomes. Specifically, these interventions appear to enhance BSE and increase EBF rates during the critical first 6 months postpartum.
The Effect of a Program Based on the Common‑Sense Model on Illness Perception and Health‑Promoting Behaviors in Women with Breast Cancer: A Randomized Clinical Trial Study
Background: Breast cancer survivors face substantial challenges, including the risk of disease recurrence and the development of secondary chronic conditions. These issues create significant burdens for both patients and healthcare systems. Many survivors struggle to maintain health‑promoting behaviors, which highlights the need for tailored educational interventions. This study examines the effectiveness of an intervention program, based on the Common‑Sense Model, in improving illness perception and promoting healthy behaviors among breast cancer survivors. Materials and Methods: A randomized controlled trial was conducted between November 2023 and February 2024, enrolling 72 women with breast cancer from selected treatment centers in Isfahan, Iran. Participants were recruited using convenience sampling and randomly allocated to either the intervention group (n = 36) or the control group (n = 36). The educational intervention was delivered by a multidisciplinary team over four consecutive weeks and included virtual support sessions. Both groups completed validated questionnaires measuring illness perception and health‑promoting behaviors at baseline and post‑intervention. Data analysis employed descriptive and inferential statistical methods. Results: Prior to the intervention, no significant differences were observed between the groups (p > 0.05). However, the intervention group demonstrated significant improvements in the mean scores for overall illness perception and health‑promoting behaviors following the intervention (p < 0.001). Conclusions: The results indicate that educational interventions based on the Common‑Sense Model can effectively enhance illness perception and health‑promoting behaviors among breast cancer patients. It is recommended that nurses incorporate this model into their clinical practice to improve patients’ illness perceptions and promote healthy behaviors alongside standard care protocols.
Needs of Family Caregivers of Older Adults with Trauma Admitted to the Emergency Department: A Cross‑Sectional Study
Background: Family caregivers (FCs) play a vital role in supporting the care of older adults with trauma admitted to the emergency departments (EDs). However, their needs are often unmet and overlooked by healthcare providers. This study aimed to assess the needs of FCs of older adults with trauma admitted to the EDs in Iran. Materials and Methods: A cross‑sectional study was conducted in 2024 at Shahid‑Beheshti Hospital in Kashan, Iran, involving 402 FCs of older adult trauma patients. Participants were recruited through consecutive sampling. Data were collected using the Questionnaire for the Assessment of the Needs of Caregivers of Patients with Trauma in the Emergency Department (QANCPT). Descriptive statistics and regression analysis were performed using. Results: The mean (SD) age of FCs was 44.80 (12.90) years, and 52.98% were female. Among patients, 45.02% were female, and falls were the most common cause of their injury (50.25%). The mean (SD) overall needs score was 2.47 (0.32) out of 4. In regression analysis, caregiver needs were associated with their own education level and gender, as well as patient‑related factors, including age, number of children, length of ED stay, and cause and location of injury. Conclusions: FCs of older trauma patients reported substantial unmet needs in the ED. Acknowledging and addressing these needs is essential for healthcare providers in the ED. Doing so can significantly improve both the patient care process and recovery outcomes.
The Effect of Counseling Based on Motivational Interviewing on Childbearing Intention in Single‑Child Women: A Randomized Clinical Trial
Background: Childbearing is the key factor influencing the demographic pyramid of communities. Today, couples’ reduced desire to have children or delay it has exerted many adverse effects on various social dimensions. Thus, this study determined the effect of counseling based on motivational interviewing on childbearing intention in single‑child women. Materials and Methods: This parallel randomized clinical trial was conducted between January 2023 and May 2024 at Rahmat Abad Comprehensive Health Center in Yazd, Iran. Ninety single‑child women were randomized to intervention and control groups. The data collection tools included the Child‑bearing Motivation Questionnaire and the Demographic Information Questionnaire, which were completed before, immediately after, and 2 months after the intervention. Data were analyzed using SPSS 16, independent t‑tests, analysis of variance with repeated measures, and chi‑square test. Results: There was a significant difference in the score of intention to childbearing between the intervention and control groups immediately (t 88 = 11.435, p < 0.001) and 2 months after intervention (t 88 = 13.591, p < 0.001), and the mean score of the intention to childbearing in each time was greater in intervention group compared to the control group. Furthermore, there was a significant difference in the dimensions of intention to childbearing (positive motivation for childbearing, fertility preferences, fertility concerns, and social beliefs) immediately (p < 0.001) and 2 months after the intervention (p < 0.001) between the intervention and control groups. Conclusions: Considering the effectiveness of counseling based on the motivational interview approach, it is suggested that this method be implemented in health centers for single‑child mothers to help increase childbearing.
Caring Behaviors and Job Involvement among Cardiac Nurses: A Descriptive Study
Background: Cardiovascular diseases present significant challenges to healthcare systems, highlighting the need for nurses capable of providing high‑quality care. Caring behaviors and job involvement are key factors that significantly influence the quality of care delivered in cardiac units. This study aimed to identify the determinants of these factors among nurses working in cardiac units. Materials and Methods: This descriptive‑correlational study was conducted in 2023 to determine the predictors of caring behavior and job involvement among 220 cardiac unit nurses in Iran (Isfahan). Data were collected using random sampling and demographic questionnaires, Kanungo’s Job Involvement questionnaires, and Wolf’s Caring Behaviors Inventory. The collected data were analyzed using SPSS V.26, including descriptive statistics, independent t‑test, and ANOVA. Results: The findings revealed that the mean (SD) age of participants was 32.43 (6.83) years, with 27.7% male and 72.3% female nurses. The nurses reported an above‑average caring behaviors score of 82.53 (9.97) and a moderate job involvement level of 24.1 (6.38). Caring behaviors was significantly correlated with marital status, work experience, ward and hospital of employment, and professional interest (p < 0.05). Job involvement was also significantly associated with gender, education level, marital status, employment status, work experience, hospital of employment, and professional interest (p < 0.05). Conclusions: Providing high‑quality care in cardiac units requires consideration of factors beyond nurses’ education, permanent job position, or age. In the Iranian cultural context, married nurses with more work experience, a greater interest in their profession, and a positive relationship with their work environment demonstrated higher job involvement and better caring behaviors toward cardiac patients.
Lived Experience of Individuals Covered by Harm Reduction Centers in Isfahan: A Qualitative Study
Background: Addiction is among the most pressing matters across the globe. Harm reduction (HR) is among the most basic public health approaches aimed at altering high‑risk behaviors in the addict population. The authors of the present work sought to investigate the health issues of addicted people through a qualitative study of the “lived experience of individuals covered by harm reduction centers in Isfahan.” Materials and Methods: The researcher in this qualitative research conducted in‑depth 30–45‑min semistructured interviews with 35 individuals utilizing the services of six HR centers in Isfahan and some of their family members. The data collected from interviews were analyzed using the qualitative content analysis method, employing Granheim and Lundman’s conventional inductive approach. Results: Participants had a mean (SD) age of 38 ± 3.5, among whom 77.14% were unemployed, 48.57% were illiterate, and 80% used drugs more than once daily. Codes were classified into the three main categories of reasons behind addiction, reasons behind quitting, and various life challenges of respondents, encompassing 14 subcategories. Conclusions: Findings from the interviews and identified challenges suggested the imperativeness of further attention to the studied population regarding health, well‑being, and socio‑economic issues.
Challenges of Iranian Migrant Nurses: A Qualitative Insight into their Experiences Abroad
Background: In recent years, the migration of Iranian nurses has significantly increased. They are faced with various professional and social challenges during their transition. This study explored these challenges faced by Iranian migrant nurses in three primary destination countries: Germany, Denmark, and Australia. Materials and Methods: This study employed a descriptive phenomenological approach to explore the lived experiences of 20 Iranian migrant nurses (8 in Australia, 8 in Denmark, and 4 in Germany). Data were collected via semi‑structured, audio‑recorded online interviews conducted between April and August 2024. Each interview lasted approximately 45 minutes. Data were analyzed using Colaizzi’s method, supported by MAXQDA software. Results: Analysis revealed four main themes reflecting complex challenges faced by Iranian migrant nurses: Professional Transition Challenges, Economic Vulnerability, and Cultural and Social Dislocation. Professional Transition Challenges included unrecognized prior qualifications, diminished professional competencies, limited opportunities for advancement, and language‑related difficulties in professional and clinical communication. Economic Vulnerability involved financial strain due to high living costs and economic instability, substantial expenses related to visas and exams, and negative impact of currency fluctuations. Cultural and Social Dislocation was marked by difficulties in cultural adaptation, value conflicts, experiences of discrimination, and strained interactions. Psychological and Emotional Strain included persistent loneliness, homesickness, anxiety, and identity disruption. Conclusions: The findings highlight the complex challenges faced by Iranian migrant nurses and emphasize the need for targeted support policies in host countries. Addressing issues like ethical recruitment, financial support, and language training can facilitate their integration and improve healthcare outcomes in host countries.
eHealth Literacy and Professional Attitudes as Predictors of Influenza Vaccination and Recommendation Among Spanish Primary‑Care Nurses
Background: Influenza vaccination among Spanish Healthcare Workers (HCWs) remains below the 75.00% benchmark. Primary‑care nurses are both recipients and gatekeepers, yet the roles of digital competence and professional attitudes remain unclear. We examined how eHealth literacy (eHL) and professional attitudes predict influenza vaccination uptake and recommendation among Spanish primary‑care nurses. Materials and Methods: We conducted a nationwide cross‑sectional online survey (November 2024 to March 2025) of 526 primary‑care nurses. Instruments included the Questionnaire on Professional Attitudes Toward Official Influenza Vaccination (CAPSVA), and the eHealth Literacy Scale (eHEALS). The statistical analysis was performed using Jamovi version 2.4. Results: Vaccination coverage was 89.40% (n = 470). Higher eHEALS, CVF, and IIO scores were independently associated with vaccination (adjusted OR per point = 1.07, 1.46, and 1.32, respectively). These factors, together with recent training and online information seeking, explained 26.90% of the variance in recommendation strength. Online information seeking mediated 16.00% of the association between eHL and vaccination. Conclusions: Digital skills and favorable professional attitudes, rather than sociodemographic or incentives, appear to drive both vaccination and advocacy among Spanish primary‑care nurses. Interventions combining eHealth‑literacy training with evidence‑based education and supportive workplaces may further boost coverage.
Psychosocial Contradictions in the Transition to Adulthood for Patients with Congenital Heart Disease – A Qualitative Study
Background: While survival into adulthood among individuals with congenital heart disease (CHD) has markedly improved, the psychosocial challenges accompanying the transition to adult care remain underexplored, particularly in diverse cultural contexts. This study explored the lived experiences and psychosocial contradictions of young adults with CHD in Iran, emphasizing the influence of cultural and systemic factors on this transition. Materials and Methods: A qualitative descriptive approach was used to capture the experiences of 15 individuals aged 16–40 years, who were diagnosed with CHD, along with five family caregivers and six healthcare providers (HCPs). Semi‑structured interviews were conducted and analyzed through conventional content analysis to identify key patterns and underlying meanings within the narratives. Data management and systematic coding were facilitated via MAXQDA (version 2020). Results: Four main themes revealed profound psychosocial contradictions: (1) “Caught between Independence and Fear,” describing the struggle between autonomy and anxiety over leaving pediatric care; (2) “Hidden Illness, Visible Self,” highlighting the dissonance between outward appearance and internal limitations; (3) “Identity in Question,” involving uncertainty in self‑perception shaped by chronic illness; and (4) “Navigating an uncertain future,” capturing concerns about long‑term health, relationships, and life planning. Conclusions: This study revealed that transitioning to adulthood with CHD is fraught with psychosocial contradictions extending beyond clinical management. Our findings highlight an urgent need for holistic, culturally tailored support systems in Iran that integrate psychosocial well‑being with clinical continuity. These insights can empower healthcare providers, families, and policymakers to develop more empathetic and effective transition strategies, including culturally sensitive counseling and improved access to information.
Early Warning Scores for COVID‑19 Outcomes: Modified Early Warning Score and Rapid Emergency Medicine Score Performance in Mortality and Hospital Readmission Risk Stratification
Abstract Background: The COVID‑19 pandemic highlighted the need for rapid and reliable triage tools to predict patient outcomes and support resource allocation. This study aimed to compare the predictive performance of Modified Early Warning Score (MEWS) and Rapid Emergency Medicine Score (REMS) for predicting mortality and hospitalization among COVID‑19 patients. Materials and Methods: This prospective cohort study included 900 outpatients and 280 inpatients with COVID‑19 who presented to 22 Bahman Hospital in Neyshabur, Iran, between 2022 and 2024. Physiological parameters for both MEWS and REMS were recorded at admission and monitored for 30 days. The receiver operating characteristic curves were used to assess the prognostic accuracy of MEWS and REMS for mortality and hospitalization. Results: At 48 hours before death, MEWS showed slightly better discrimination than REMS (AUC = 74.00, 95% CI: 68.80, 79.20 vs. 73.20, 95% CI: 67.50, 78.90; both p < 0.001). REMS exhibited greater sensitivity (75.50 vs. 38.00), while MEWS showed higher specificity (84.60 vs. 75.80). At 24 hours before death, REMS marginally outperformed MEWS (AUC = 62.80, 95% CI: 55.50, 70.10 vs. 62.30, 95% CI: 54.90, 69.70; p < 0.001 and < 0.001 respectively), with higher sensitivity (48.90 vs. 42.80) and slightly lower specificity (75.00 vs. 83.60). Conclusions: REMS demonstrated better prognostic accuracy 24 hours before death, likely reflecting its inclusion of age and neurological status. MEWS showed stronger performance 48 hours before death and in predicting hospitalization.
Predictors of Pregnant Women’s Delayed Initiation of Antenatal Care in Central Thailand
Background: Delayed initiation of antenatal care leads to adverse effects on maternal and fetal health outcomes. This study aimed to identify the predictors of delayed initiation of antenatal care among pregnant women. Materials and Methods: This descriptive cross‑sectional study used a purposive sample of 330 women attending a hospital’s antenatal clinic in Central Thailand, divided into two groups: those attending the first antenatal visit before 12 weeks of gestation and those attending the first antenatal visit 12 weeks or more after. From May to October 2024, data were collected on sociodemographic information, knowledge, beliefs about pregnancy and antenatal care, antenatal care service setting, and social support. Data were analyzed using descriptive and multivariate logistic regression. Results: The predictors of delayed initiation of antenatal care were attitude (95% CI: 3.65–17.59; P < 0.001; OR = 8.02), social support (95% CI: 3.29–14.91; P < 0.001; OR = 7.00), perceived benefit (95% CI: 2.65–17.59; P < 0.001; OR = 5.91), unplanned pregnancy (95% CI: 1.72–8.46; P = 0.001; OR = 3.81), and perceived risk (95% CI: 1.58–7.08; P = 0.002; OR = 3.34). Conclusions: Healthcare providers should address these predictors to encourage timely antenatal care before 12 weeks of gestation.
Health‑Related Quality of Life among Employed and Unemployed Women: A Cross‑sectional Study
Background: The general belief is that working women have better quality of life (QOL), yet the dual responsibility of home and workplace may have physiological or psychological issues. The study compares the Health‑Related Quality of Life (HRQOL) of employed and unemployed women. Material and Methods: A descriptive study using convenience sampling technique was conducted, and the data were collected online using Google Forms. SF 36 questionnaire was used to assess the HRQOL of two groups aged 20 to 45 years age. The study participants were employed and unemployed women working or not working for 6 months or more. Results: The study results show that 72.80% of employed and 70% of unemployed women had good HRQOL. Conclusions: The study result reflects that both employed and unemployed women had good HRQOL. Our results reflect that the physical aspects of unemployed women were better than those of employed women, whereas employed women had better emotional wellbeing.
Men in Preconception Care – The Road Not Taken
Dear Editor, A recent publication in your hold dear journal titled “How to Engage Men in Preconception Health?” concluded that strategic programs should be developed focusing on their ‘limitations or barriers’ toward involving ‘Men in preconception care – The Road Not Taken’.[1] I am here to shine a light on techniques that can alleviate men’s obstacles and intensify men’s potential value in preconception health. Although preconception care pertains to couples’ health prior to pregnancy, the majority of the prevailing preconception health information predominantly focuses on women rather than couples.[2] Some of the notable barriers faced by men are a lack of understanding of the role of preconception health care and fertility, a lack of knowledge of the role of preconception health care and fertility, and limited awareness, potentially leading to underutilization of available health services.[3]……………………