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 Meta‑Analysis Examining the Impact of Levothyroxine Supplementation on Gestational Weight Gain in Women with Overt Hypothyroidism
Background: Overt Hypothyroidism (OH) is commonly treated with Levothyroxine (LT4), typically at a dose of 50 to 100 mg per day. Hypothyroidism is associated with excessive weight gain; therefore, we meta‑analyzed the effect of LT4 on Gestational Weight Gain (GWG) in women treated for OH compared to control subjects. Materials and Methods: We conducted a comprehensive review of several databases, including Medline, Science Direct, ProQuest, Scopus, Web of Science, and the Cochrane Library, as well as Google Scholar. Our goal was to identify English‑language Randomized Controlled Trials (RCTs) and observational studies assessing the impact of LT4 on GWG and Body Mass Index (BMI) in pregnant women with OH, between August 4 and January 30, 2023. Additionally, we explored Persian databases such as Magiran, Islamic World Science Citation (ISC), and Scientific Information Database (SID). Because the studies reviewed included participants with Subclinical Hypothyroidism (SCH) as well, the meta‑analysis also incorporated data from individuals with both OH and SCH. Results: The random‑effects model indicated that after LT4 therapy, the GWG was not significantly different between the treated and control groups in studies involving women with OH [mean = 0.04, 95% CI: (−0.64, 0.72), p = 0.908, I² = 57.13%]. Similarly, in studies comprising women with both OH and SCH, the difference in GWG was negligible [mean = −0.02, 95% CI: (−0.40, 0.35), p = 0.909, I² = 22.93%]. Conclusions: Following LT4 treatment in pregnant women diagnosed with hypothyroidism, there was no significant difference in total GWG between the treated and control counterparts.
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Identification of Factors Related to the Research Vitality of Faculty Members in Medical Universities: A Scoping Review
Background: Vitality, as a key component of mental wellbeing, is considered essential within research systems and academic institutions. This study aims to identify the factors associated with the research vitality of faculty members at medical universities. Materials and Methods: This scoping review was conducted in 2024 following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta‑Analyses) guidelines. Between April and August 2024, a comprehensive search was performed across databases including PubMed, Embase, Scopus, Web of Science, and ProQuest (based on MeSH), as well as the Persian databases such as Magiran, Noormags, and the Scientific Information Database. A total of 1998 studies were initially retrieved. After removing duplicates and screening the records, 27 studies were ultimately selected for inclusion. The extracted data were summarized, synthesized, and categorized based on the study objectives. Results: The findings were organized into four main categories, ten subcategories, and 66 codes. The main categories included individual factors (e.g., personality traits and professional characteristics), organizational factors (e.g., management style, regulations, and facilities), professional factors (e.g., nature and importance of research), and environmental factors (e.g., interaction and collaboration, rewards and recognition, and institutional values). Conclusions: Policymakers and academic administrators should prioritize enhancing the key factors that influence research vitality across individual, organizational, professional, and environmental domains. Addressing these dimensions can foster greater motivation, creativity, and productivity, among faculty members, ultimately contributing to the improvement of research quality in medical universities.
Sexual and Reproductive Health Instrument for Temporary Marriage Wives: Development and Psychometric Properties
Background: This study was conducted with the aim to identify their reproductive health needs, and design the sexual and reproductive health needs questionnaire for Temporary Marriage (TM) wives and assess its psychometric properties. Materials and Methods: This study evaluated the psychometric properties of the Sexual and Reproductive Health Needs Questionnaire for Iranian TM wives in Persian. The initial items of the questionnaire were extracted based on a qualitative study. Then the face, content, and construct validity, and reliability of the questionnaire were assessed in a cross‑sectional study. To evaluate the content construct validity, and reliability of the questionnaire, Content Validity Ratio (CVR) and Content Validity Index (CVI), Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA ), Cronbach’s alpha coefficients, and intraclass correlation coefficient were used, respectively. Results: The initial instrument contained 44 items and was prepared based on the results. CVI and CVR for all items were, respectively, higher than 0.79 and 64%, except one item that was eliminated. In face and content validity assessment was provided the instrument with 43 items. To evaluate construct validity, EFA was performed and eight hidden factors were extracted, which explained 64.895% of the total variance of the variables. Furthermore, to examine model fitness in CFA, goodness‑of‑fit indices were used in SmartPLS software. The results showed a good model fit. The convergent and divergent validity, and the reliability of the scale ranged from strong to excellent s above 0.7). Conclusion: The results showed that the Sexual and Reproductive Health Instrument with 43 items for Iranian temporary marriage wives was a valid and reliable measure.
The Process of Acquiring a Professional Identity by Male Nursing Students: A Grounded Theory Study
Background: Professional identity, encompassing nurses’ perception of the meaning of nursing and their role as nurses, significantly influences their performance. This study aimed to elucidate the professional identity formation among Iranian male nursing students. Materials and Methods: This qualitative research employing a grounded theory approach was conducted from October 2019 to February 2021 in the Nursing School and affiliated clinical settings of Isfahan University of Medical Sciences, Iran. Data collection used semi‑structured interviews and observations. Purposive sampling of fourth‑year nursing students was initially employed, followed by theoretical sampling. Data analysis followed the adapted version of Strauss and Corbin’s 1990 model. Results: Analysis of research data generated 700 primary codes, refined through continuous comparative analysis into 13 subcategories and further condensed into five main categories: “underlying factors before and after entering the field,” “self‑esteem,” “self‑confidence,” “professional performance,” and “professional commitment.” The core variable, “self‑esteem,” emerged as the central concept underpinning professional identity. Conclusions: Acquiring professional identity in male nurses is a complex, dynamic, and multidimensional process. Self‑esteem is identified as the central variable in this process, emphasizing the need for educational and clinical environments conducive to fostering professional identity.
The Role of Infection Control Nurse in Prevention and Control of Hospital Acquired Infection in ICU
Background: A well‑trained Infection Control Nurse (ICN) plays a crucial role in the management of Hospital Acquired Infections (HAIs). The primary responsibilities of an ICN include identifying, developing, and implementing best practices related to the sanitation, infection prevention, and control strategies within healthcare settings. This study aimed to evaluate the impact of an ICN on supervised patient care, proper sampling techniques, and infection control in an Intensive Care Unit (ICU) setting. Materials and Methods: A prospective, non‑randomized controlled study was conducted involving 406 ICU‑admitted patients over 6 months (October 2022 to March 2023) at a tertiary care ICU in KGMU, Lucknow, India. During the first 3 months (October 1st to December 31st), no ICN was appointed, and this group served as the control group (Group A). In the following three months (January 1st to March 31st), one trained ICN was deployed in each shift, forming the intervention group (Group B). In both groups, patients were treated following standard ICU protocols. However, in Group B, care was additionally supervised by ICNs. Blood, tracheal aspirate, and urine samples were collected from all patients for culture and antibiotic sensitivity testing. Results: The presence of an ICN significantly improved sampling techniques, leading to the notable reduction in sample contamination. Moreover, supervised patient care under ICN guidance yielded better clinical outcomes. Conclusions: Supervision by an Infection Control Nurse is vital in ICU settings for effective infection prevention, accurate sampling, and timely management, ultimately enhancing patient outcomes and reducing hospital‑acquired infections or Nosocomial Infection.
Designing and Psychometrics of Teacher–Student Relationship Questionnaire in Health Sciences: An Exploratory Mixed Study
Background: The teacher–student relationship is the basis of education. Assessment of this relationship requires the use of a valid instrument. This study was conducted to design psychometrics features of Teacher–Student Relationship Questionnaire in Health Sciences (TSRQ‑HS). Materials and Methods: This exploratory study was carried out in two distinct phases. In the initial stage (qualitative phase), we established the framework for the teacher–student relationship by using 22 individual interviews with teachers and students. This was achieved through conventional content analysis. Subsequently, the quantitative phase, as the second stage, focused on evaluating the psychometric attributes of the questionnaire. This encompassed an assessment of face, content, and construct validity, as well as internal consistency and homogeneity. Results: The initial pool of items included a total of 121 entries, while the final scale was refined to encompass 31 items. The S‑CVI/Ave, which is the average content validity index for the questionnaire, was determined to be 0.93; it was observed that item factor loadings through exploratory factor analysis ranged from 0.22 to 0.94 (x2465 = 9568.15, p < 0.001). Subsequently, five items were excluded, and the three dimensions established in the primary questionnaire were confirmed. The comprehensive intraclass correlation coefficient of the instrument was 0.97. The reliability of the instrument was evaluated regarding internal homogeneity, revealing a Cronbach’s alpha value of 0.96 for the entire instrument. Conclusions: The findings indicated that the newly developed questionnaire designed to evaluate the teacher–student relationship had a satisfactory level of reliability and validity. Educational administrators are recommended to utilize this instrument.
Collegiality in Nursing: A Concept Analysis
Background: Collegiality in nursing is crucial for fostering a positive work environment, promoting teamwork, and improving patient care outcomes. The aim of this study was to clarify the concept of collegiality in the nursing profession using the concept analysis method developed by Walker and Avant. We intended to generate knowledge that enhances the understanding of collegiality and its application in nursing research and clinical practice. Materials and Methods: The concept analysis of collegiality in nursing was guided by the eight stages of the Walker and Avant approach. A comprehensive review of the literature on Collegiality in nursing was conducted using the electronic databases Web of Science, Scopus, Ovid, Science Direct, Google Scholar, and PubMed without a time limit until 2023. Results: Through the analysis conducted, collegiality in nursing is identified as a collaborative process, whether within the nursing profession or across different healthcare disciplines. It involves nurses working together as a team to address patient care or healthcare system issues. This entails respectful sharing of knowledge and resources among team members. Conclusions: Collegiality in nursing is vital for creating a supportive work environment, where nurses can freely seek assistance and guidance for their colleagues. This can lead to better decision‑making and ultimately improves patient care outcomes. It also promotes teamwork and collaboration, which are essential for providing high‑quality care. Additionally, collegiality plays a role in reducing workplace stress and burnout, benefiting both nurses and patients.
Comparison of the Effect of Milk Booster Drops and Acupressure on the Milk Volume of Mothers with Premature Infants: A Randomized Clinical Trial
Background: Reducing the milk premature neonates receive threatens their lives and growth. Many studies have examined the effectiveness of milk booster drops and acupressure. This study aimed to compare the impact of milk booster drops and acupressure on milk volume in mothers with premature infants. Materials and Methods: This randomized clinical trial was performed in three Children’s Specialized Hospitals of Mashhad, Iran, from June to November 2022. Fifty‑four women with premature neonates were selected through convenience sampling and randomly assigned to milk booster (n = 27) and acupressure (n = 27) groups using permutation blocks. The milk booster group received 30 drops of milk booster drops three times and placebo point pressure for 2 weeks. The acupressure group also performed acupressure twice a day, for 10 min at points Stomach Meridian 16 (ST‑16), PERICARDIUM‑1 (PC‑1), and Extra Point Head and Neck 3a (EX‑HN3), and they also received placebo drops. The volume of milk expressed before the intervention on the 14 day of the intervention was measured using electric breast pumps. Results: There was no statistically significant difference in the volume of milk measured by mothers before the intervention in the two groups (p = 0.699). The mean (SD) of the mother’s measured milk volume in the morning shift on the fourteenth day of the intervention in the milk‑booster drop 31.85 (8.68) and acupressure group was 38.07 (9.38) cc (p = 0.005). Conclusions: Acupressure is more effective in increasing mothers’ milk volume, so it is recommended that acupressure be taught to mothers in the neonatal intensive care units.
Protecting the Little Ones: Empowering Mothers to Prevent Home Hazards ‑ A Quasi‑Experimental Study
Background: Children under the age of 5 years are most vulnerable to injuries. The mother is the best person to pass on learning to children, and mothers’ knowledge of home injuries and preventive behaviors is an important factor in reducing these hazards. The present study examined the role of maternal education in the prevention of home hazards in children. Materials and Methods: This quasi‑experimental study was performed on 70 mothers of 2‑ to 5‑year‑old children, who were referred to the community health centers of Shahid Beheshti University of Medical Sciences in 2019. The participants were randomly selected and assigned to two groups. Data related to mothers’ demographic information, knowledge, and performance were collected, and the Injury Behavior Checklist for children was filled. Results: The findings of this study revealed that the mean (SD) of mothers’ knowledge 99.80 (1.12) and performance 61.71 (21.75) increased significantly in the intervention group after the training course (p < 0.05). Moreover, the mean score obtained based on the children’s risky behavior assessment checklist decreased significantly after the intervention (F = 181.35, p < 0.001). Conclusions: Based on the findings of this study, establishing the role of educational intervention in preventing home hazards in 2‑ to 5‑year‑old children, it has been advised to conduct training courses for mothers to improve their performance in childcare.
The Effectiveness of Modified Early Obstetric Warning System Training on Midwives’ Knowledge and Interpersonal Skills for Early Detection of Maternal Complications in Indonesia
Background: The maternal mortality rate in Indonesia is still high. Efforts are needed to increase the capacity of midwives. The study aims to evaluate the effectiveness of Modified Early Obstetric Warning System (MEOWS) training on midwives’ knowledge and interpersonal skills, while also assessing the feasibility of employing MEOWS training, as perceived by participants. Materials and Methods: We used a mixed‑methods study. The study was carried out from November to December 2022 in Indonesia. A purposive sampling technique was employed to select 60 midwives for the quantitative study and 20 midwives for the qualitative study, equally divided between the blended and online groups. The intervention consisted of 82 sessions that were equal for both groups, with each session lasting 45 minutes. Quantitative data were collected using questionnaires and Likert scales, while qualitative data were gathered through focus group discussions. Quantitative data were analyzed using t‑tests, while thematic content analysis was employed for the qualitative data. Results: Significant improvements in midwives’ knowledge were seen in both groups. The mean (SD) knowledge was 97.10 (5.80) in the intervention group and 94.00 (8.80) in the control group (p = 0.12). Midwives reported greater engagement with blended training, perceiving it as feasible and valuable, and expressing eagerness for its implementation to enhance early detection of maternal complications. Conclusions: While both blended and online training effectively enhanced knowledge and self‑efficacy in the early detection of maternal complications, participants found blended training to be more practical. Continuous evaluation is necessary for the retention of knowledge over time.
Fear and Hope, The New Perspective of Iranian Women with Polycystic Ovary Syndrome: A Qualitative Study
Background: Polycystic Ovary Syndrome (PCOS) is one of the most prevalent endocrinopathies in women of reproductive age. This condition can increase the risk of physical and mental diseases. Improvement in medicine has led to increased Quality of Life (QOL), which can change patients’ perception regarding their chronic condition. Therefore, this study was carried out to understand the impact of scientific progress on the view of women with PCOS toward their disease. Materials and Methods: This qualitative study was based on the conventional content analysis approach. It was carried out using purposive sampling on 18 women with PCOS between April 2021 and January 2022, in Kerman, Iran. Semi‑structured, face‑to‑face, in‑depth interviews were conducted. After transcribing the recorded interviews, the texts were reviewed several times. The data were analyzed using conventional content analysis. The codes, subthemes, and main themes were extracted according to the opinions of experts in qualitative sciences. Results: As a result of the content analysis of codes, two themes (hope and fear), six main categories (infertility treatment, outward appearance, support, presence in the community, decreased relationship and intimacy with spouse, and complications of the disease and the need for complementary treatments), and 30 subcategories were obtained. Conclusions: According to the findings, it is better to develop programs to improve the QOL and the treatment process of these patients in terms of spiritual, psychological, financial, and informational support, which can be implemented by health and medical personnel and managers of various categories of medical sciences, associations, and charities.
Challenges and Opportunities of Internship Method in Technologist Surgery Undergraduate Interns: A Qualitative Content Analysis Study
Background: In the clinical environment, clinical education is one of the components of nursing education that transforms a student from a novice to a competent student. This professional transition can be taught in a variety of methods. One of these ways is training students through internships. The purpose of this study is to examine the Strengths, Weaknesses, Opportunities, and Threats (SWOT) of internships for undergraduate surgical technology students. Materials and Methods: In this qualitative content analysis based on SWOT theory, ten faculty trainers, non‑faculty trainers, operating room supervisors, and undergraduate intern students in the operating room field were selected based on the entry criteria. Then, based on the mentioned theory, face‑to‑face interviews were conducted with the participants, the questions were asked, and after extracting the codes, classification was performed based on the SWOT theory. Results: Based on the findings, four subcategories of strengths, weaknesses, problems, and opportunities were identified in the management and implementation domain. The most often used code for its qualities was enhancing the student’s communication with the surgical team and lowering his nervousness. The most repeated code in its weak points were using the student as a tool and staying away from working scientifically. Conclusions: Based on the results of the present study, an internship in the operating room can solve the problem of lack of human resources to a large extent, however, it can lead to the improvement of the professional skills of students during the internship period, provided that the work of students, and staff is based on scientific principles.
The Impact of Virtual Patient Education on Enhancing Clinical Reasoning in Nursing Students
Background: This study investigated the effect of Virtual Patient (VP) education on improving Clinical Reasoning (CR) skills among nursing students, addressing a major challenge in nursing education, particularly within the context of an oncology course. Materials and Methods: This quasi‑experimental, two‑group, pretest–posttest study was conducted in 2021 at the School of Nursing of Isfahan University of Medical Sciences, Iran. A total of 148 fourth‑ and fifth‑semester nursing students were selected through a census sampling method. After obtaining informed consent, the subjects were randomly assigned to either the intervention or control group. After the pretest, five VPs (cancer module), designed and validated by eight nursing experts, were provided to the intervention group for 6 weeks, followed by a posttest. Data collection tools included two series of 23‑item tests (KF) designed to assess CR skills, with a CVI = 0.94 and CVR = 0.84. The collected data were analyzed in SPSS software using correlation tests and t‑tests. Results: The mean (SD) of pretest scores was 25.01 (2.51) in the intervention group and 25.03 (2.71) in the control group, with no significant difference (p > 0.05). After training, posttest scores increased significantly in the intervention group, 32.22 (3.47), compared to the control group, 25.18 (2.47) (p ≤ 0.05). The intervention group showed significant improvement from pretest to posttest (p ≤ 0.05). Conclusions: The use of VPs in nursing education can effectively improve students CR skills and provide a foundation for enhancing nursing education.
Emotional Adaptation Using a Program Based on Cognitive Emotion Regulation Strategies in Patients with Substance Use Disorder: A Double blinded Randomized Controlled Trial
Background: Disturbances in emotion regulation and emotional adaptation are common problems in drug users. This issue affects the quality of life in different dimensions. Therefore, training these people in cognitive emotion regulation strategies as a supplement to drug treatment helps improve their adaptation skills. In this study, we investigated the effect of a training program based on the cognitive emotion regulation on the emotional adaptation of patients with substance use disorder. Materials and Methods: This study was a double‑blinded randomized controlled trial that was conducted in 2022–23. Forty‑eight men with substance use disorder (SUD) under methadone Maintenance Treatment (MMT) participated in the study. The participants were randomly divided into two intervention and control groups. The intervention consisted of six training sessions based on the cognitive regulation of emotion. The emotional adjustment was examined using the Emotional Adjustment Measure (EAM) before and 1 month after the end of the intervention. Descriptive and inferential statistics, such as independent and paired t‑tests were used for data analysis. Results: Forty‑eight male patients with SUD under MMT participated in the present study. There was a significant difference in the mean score of the EAM between the intervention and the control group after conducting the intervention (p = 0.012). Conclusions: Educational programs based on emotion regulation can play a significant role in improving emotional adaptation in patients with substance use disorder. Therefore, this educational program is suggested as a complementary psychological approach to improving the level of psychological health of patients with substance use disorder.
The Predictive Role of Body Image on Attitude toward Fertility and Childbearing in Mothers with Two to Four Years Old Children
Background: One of the key factors affecting attitudes toward childbearing is women’s physical fitness. Dissatisfaction with body image may affect mother’s and child’s physical and mental health. Therefore, this study aimed to determine the predictive role of body image in shaping attitudes toward childbearing. Materials and Methods: This descriptive‑predictive study was conducted on 265 mothers with children aged 2–4 years who visited the comprehensive healthcare centers in Kashan, Iran, in 2023–24. The sampling method was multistage clustering. A demographics questionnaire, Söderberg’s Attitudes to Fertility and Childbearing Scale, and Littleton’s Body Image Concern Inventory were used for data collection. The validity and reliability of the questionnaires were confirmed. Pearson’s correlation coefficient and multiple linear regression analysis were used for data analysis in SPSS. The significance level was set at p < 0.05. Results: According to the results, a one‑unit increase in women’s body image concerns was associated with a 0.309‑point decrease in their positive attitudes toward fertility and childbearing. Additionally, there were significant negative correlations between body image concern and the dimensions of attitudes toward fertility and childbearing: the child as a pillar of life (r = −0.20, p < 0.001), the child as an obstacle to a relationship (r = −0.33, p < 0.001), postponing childbearing to the future (r = −0.33, p < 0.001), and childbearing prerequisites (r = −0.02, p < 0.001). Conclusions: The study findings corroborated the predictive role of body image in shaping attitudes toward fertility and childbearing. Appropriate interventions should be developed to enhance women’s body image during pregnancy and identify and control the factors negatively affecting it.
The Effect of a Family Centered Care Intervention Model on the Health Literacy of Family Caregivers of Heart Failure Patients
Background: Heart failure (HF) is considered a chronic and debilitating condition that, in addition to imposing heavy costs on the individual and society, creates many problems and has numerous consequences for patients and their families. Caregivers face challenges in patient control and care due to insufficient awareness and knowledge. The purpose of the present study is to investigate the effect of the family‑centered care (FCC) intervention model on health literacy in family caregivers of HF patients. Materials and Methods: This quasi‑experimental, two‑group study with a pretest–posttest design was carried out on 100 people assigned to the experimental and control groups. The study population included caregivers of HF patients admitted to the medical teaching centers of Shahrekord, Iran, in 2022. Data were collected using the Health Literacy for Iranian Adults scale. Data analysis also carried out using descriptive and inferential statistics. Results: The mean health literacy scores were not significantly different between the intervention and control groups before the intervention. However, the mean health literacy score and its dimensions were significantly increased in the experimental group compared to the control group (t = 30.12, degrees of freedom = 98, p < 0.001). Conclusions: The FCC program, as a simple, practical, and efficient program, can reduce the challenges of family caregivers and support them more by improving their level of health literacy.
The Experiences of Patients, Patient Companions, and care Providers with Ethical and Unethical Behaviors Toward Patients: A Qualitative Study
Background: Despite the existence of ethical codes in the clinical environment, the rate of unethical behaviors in practice is alarmingly high today. An exploration of the experiences from multiple perspectives (patients, patients’ companions, and different groups of care providers) can result in a more comprehensive and holistic understanding of the concept of ethical behaviors toward patients. The present study was conducted to investigate the experiences of patients, patient companions, and care providers with ethical and unethical behaviors toward patients using a qualitative study. Materials and Methods: This was a qualitative study with a conventional content analysis design. The setting of the study was different departments of teaching hospitals in Shiraz, Iran. The participants consisted of 25 individuals: nine patients, three patient companions, and 13 healthcare providers. The subjects were selected via the purposeful sampling method until data saturation was reached. Data were collected through face‑to‑face, in‑depth, and semi‑structured interviews and observation from March 2022 to April 2023. Data analysis was performed using MAXQDA. Results: Analysis of the data resulted in three main categories: respect for human dignity (seven subcategories), professional duty of care (five subcategories), and effective interaction (four subcategories). Conclusions: The findings of the present study stress the need for on‑the‑job training programs for healthcare providers to raise their awareness of the role of ethical behaviors in caregiving. Establishment of clinical ethics committees and arrangement of ethical rounds with doctors and nurses can promote ethical behaviors in clinical environments.
Enhancing Nurse Performance in Iranian Hospitals: Expert and Stakeholder Insights on Key Influencing Factors
Background: Nurses play a critical role in healthcare delivery and public health advancement, yet they face numerous challenges such as work pressure, financial constraints, job‑related stress, and burnout. This research aims to identify the factors that influence enhancing nurses’ performance in Iranian hospitals, as perceived by experts and stakeholders. Materials and Methods: This qualitative study, conducted in 2024, employed conventional content analysis. Participants included nurses, hospital administrators, human resources specialists, and healthcare policymakers, selected through targeted sampling from university hospitals with varied performance metrics. Data were collected via semistructured interviews and analyzed in three stages: identifying themes, comparing concepts, and categorizing subthemes to extract core concepts. Results: The analysis revealed seven primary themes, 21 subthemes, and 70 specific issues. Key themes included skill and occupational knowledge, job satisfaction, organizational structure and managerial support, nurse involvement and roles, professional growth, standards and service excellence, and professional proficiency in nursing. For instance, the theme of Job Knowledge and Skills encompassed subthemes such as the necessity of domain‑specific knowledge, the development of learning opportunities, and the importance of continuing education. Conclusions: The findings indicate that improving nurses’ performance requires a multifaceted approach, focusing on skill and knowledge enhancement, increased job satisfaction, stronger managerial and organizational support, and pathways for professional growth. Continuous educational improving working conditions and robust professional networks are essential to elevate nursing quality and job satisfaction. These insights can inform the development of effective policies to enhance nurses’ performance and improve the overall quality of healthcare services.
The Relationship between Caregiver Burden and Family Functioning among the Family Caregivers of Hemodialysis Patients: A Descriptive correlational Study
Background: Family caregivers of hemodialysis (HD) patients usually experience high and severe caregiver burden. A factor that may be related to the perceived caregiver burden is family functioning. Therefore, this study aimed to investigate the relationship between caregiver burden and family functioning among the family caregivers of HD patients. Materials and Methods: For this descriptive‑correlational study, 160 family caregivers of HD patients in the HD units of five educational hospitals in Tehran, Iran, from 2023 to 2024, were selected through a convenience sampling method. The participants completed a demographic questionnaire, the Caregiver Burden Questionnaire for Family Caregivers of HD Patients, and the Family Assessment Device. Data analysis was performed using descriptive and inferential methods. Results: The mean (SD) scores of total caregiver burden and general functioning among family caregivers of HD patients were 3.40 (0.64) and 3.11 (0.58), respectively. The physical and psychological, mental, and total burden dimensions positively correlated with all family functioning dimensions. Mixed effect multiple linear regression analysis indicated that the caregiver’s job, the patient’s dependency on the family caregiver in daily tasks, and all of the caregiver burden dimensions were related and predictive factors for the general functioning of participants. Conclusions: Most of the caregiver’s burden and family functioning dimensions among participants were higher than the average achievable scores, suggesting relatively unfavorable conditions. There was a statistical relationship between most of these dimensions. Implementing caring and educational interventions in order to reduce the caregiver burden and improve family functioning among family caregivers of HD patients is recommended.
Assessment of Breastmilk Microbiome Focusing on Probiotics
Background: Breastmilk is an important factor affecting the infant’s gut microbiota and health. Both milk microbiome and the content of oligosaccharides play a role in this effect. The mother’s lifestyle can affect the breast milk microbiome. In this study, we assessed the breast milk microbiome in healthy mothers in Iran and its relationship to the mother’s lifestyle during lactation. Materials and Methods: In a cross‑sectional study, from May 2022 to January 2023, 20 mother‑neonates participated by donating their breastmilk samples and completing two questionnaires (food recall for nutritional status and DASS‑21 for psychological status). Milk samples in aerobic and anaerobic conditions were cultured to isolate bacterial strains, and the probiotic strains were determined. Data entrees and analysis were done using SPSS‑15, and the independent T‑student or Mann–Whitney U test was used for statistical analysis. Results: Seven bacterial species were isolated, including Pedicoccus acidilactici, Lactobacillus fermentum (potential probiotics), Corynebacterium kroppenstedtii, Staphylococcus epidermidis, Rothia kristinae, Streptococcus rubneri, and Streptococcus parasanguinis. It was shown that the consumption of dairy products in the diet was related to probiotic strains in breast milk (p value = 0.03). Conclusions: Among the microbiome isolated from breast milk, two probiotics, Pedicoccus acidilactici and Lactobacillus fermentum, were detected. In the mother’s diet, dairy product intake during lactation can increase the probiotics in breast milk and give the infant more valuable content.
Factors Influencing Long term Home Care for Patients with Tracheostomy from the Perspectives of their Family Members
Background: Family caregivers are the principal caregivers of patients with tracheostomy and can reduce the risk of re‑hospitalization through giving quality care to their patients. Caregiving to patients with tracheostomy is a complex process influenced by many different factors. However, there are inadequate data about these factors, and hence, this study aimed at exploring the factors influencing long‑term home care for patients with tracheostomy from the perspectives of their family caregivers. Materials and Methods: We conducted this descriptive qualitative study in 2023–2024. Participants were nine family caregivers, one patient with a tracheostomy history of three years, a home care nurse, and an anesthesiologist purposefully selected from Mazandaran, Iran. Data were collected through 12 in‑depth semi‑structured interviews and were analyzed through conventional content analysis. The criteria proposed by Lincoln and Guba were used to ensure trustworthiness. Results: The three main categories of the factors influencing long‑term home care for patients with tracheostomy were healthcare system dysfunction, challenges of tracheostomy care, and effective management of tracheostomy care. These three categories had 13 subcategories. Conclusions: Careful attention to the special needs of patients with tracheostomy, close collaboration among healthcare professionals and family caregivers, and development of a strong support network are essential to reduce the challenges and complications of home‑based caregiving to patients with tracheostomy.
Modeling Time Series of Mortality Cases Due to Traffic and Non Traffic Accidents in Northwestern Iran from 2013 to 2022
Background: Globally, accidents rank as the third leading cause of mortality, following cardiovascular diseases and cancer. Accidents also account for 12% of the global disease burden. This study aims to examine the trends in mortality cases resulting from both traffic and non‑traffic accidents. Materials and Methods: This descriptive‑analytical study utilized recorded data from the Health Deputy of West Azerbaijan Province, Iran, spanning from 2013 to 2022. A complete census was conducted across the entire province during the study period, yielding a total of 7716 fatalities due to traffic accidents and 7316 deaths due to non‑traffic accidents. The Box‑Jenkins AutoRegressive Integrated Moving Average (ARMA) models were employed for time series analysis. Descriptive analysis was performed using SPSS software, while modeling conducted using R Studio and SAS. Result: A total of 7716 deaths were recorded due to traffic accidents, and 7316 deaths were attributed to non‑traffic accidents. Among traffic‑related fatalities, 19.67% were female and 80.33% were male. In contrast, for non‑traffic accidents, 29.65% of the victims were female and 70.35% were male. The ARIMA model was employed for modeling based on autocorrelation and partial autocorrelation plots, with the ARIMA (2, 0, 0) (2, 0, 0) model identified as the best fit for traffic accidents and the ARIMA (1, 0, 1) (2, 0, 0) model for non‑traffic accidents in the context of monthly mortality time series. Conclusions: The predictions for both traffic and non‑traffic accidents indicated a decreasing trend in mortality. Furthermore, mortality trends and distributions for both categories of accidents exhibited similarities.
Strategies Used for Management of Patients with COVID 19: A Comparative Study of Iranian and Chinese Nurses’ Experiences
Background: Medical infrastructures, application of control strategies, and proper implementation of logistic policies are vital for successful management of an epidemic in a country, but all of them are under the influence of the health and management policies of countries. Thus, this study aimed to compare the strategies used by Iranian and Chinese nurses for management of patients with COVID‑19. Materials and Methods: This study was conducted based on the conventional content analysis method of Graneheim and Lundman approach. Participants were recruited by purposeful sampling among the nurses working in the COVID‑19 wards of Shariati Hospital in Tehran, Iran, and Haikou Hospital in Hainan, China. Data were collected by conducting semistructured interviews from August 2020 to February 2021. Then, the differences in used strategies by the nurses in the two countries were investigated using the data were analyzed using MAXQDA-10, qualitative data analysis software, and descriptive analysis technique. Results: In‑depth interviews were carried out with nine Chinese and ten Iranian nurses. With “Managers as the key element to overcome the crisis” as the main category, six categories and 22 subcategories were excluded from the Iranian interviews. With “Action to control crisis” as the main category, eight categories and 19 subcategories were excluded from the Chinese interviews. Conclusions: Nursing managers in China focused on the process of training nurses to take care of patients with COVID‑19 and reducing the transmission of infection among health care workers. However, nursing managers in Iran focused on compensating the shortage of nurses, shortening the duration of patients’ hospitalization, daily monitoring of nurses’ performance, and ventilator settings of patients.
The Facilitators to Care Transition from Hospital to Home After Stroke: A Qualitative Study
Background: Ineffective hospital‑to‑home care transition (HHCT) can lead to the early rehospitalization of patients with stroke (PWS). Therefore, effective HHCT management is essential to maintain patient safety and reduce rehospitalization. This study was undertaken to examine the factors facilitating HHCT after stroke from the perspectives of all stakeholders involved in the process. Materials and Methods: This qualitative study was undertaken from 2023 to 2024 in Tehran, Iran, using conventional content analysis. Data were gathered via semistructured interviews with 23 healthcare clients, professionals, and policy‑makers. The data were analyzed using Zhang and Wildemuth’s 8‑step conventional content analysis method. Results: A total of 138 codes were generated and classified into eight subcategories and three categories. The categories were improvement of communication and education, maintenance of care continuity, and improvement of infrastructures. Conclusions: Different interrelated factors facilitate the process of HHCT. These facilitators include effective communication and education, care continuity, patient‑centered care, efficient information systems, quality community‑based services, strong support, and clear HHCT guidelines. These findings can be used in designing strategies to improve care quality, reduce rehospitalization, and enhance safe patient management after discharge.
Endometrial Expression of Angiogenesis related Factors Following Ovarian Stimulation and Epigallocatechin Gallate Administration
Background: AngiomiRs are a specialized subclass of microRNAs that target genes related to angiogenesis, such as Vascular Endothelial Growth Factor (VEGF). Angiogenesis is crucial in all stages of pregnancy and is essential for creating a receptive endometrium for embryo implantation. Both ovarian stimulation and Epigallocatechin Gallate (EGCG), a major component of green tea, can influence angiogenesis. This study aims to examine endometrial quality, with a focus on angiogenesis, as well as serum levels of estradiol and progesterone, following EGCG administration in ovarian‑stimulated mice, as a valuable model for studying human reproductive health and diseases. Methods and Materials: Forty adult female mice were assigned to four distinct groups: 1) control, 2) ovarian stimulation (7.5 IU HMG followed by 7.5 IU HCG 48 hours later, administered intraperitoneally), 3) EGCG (5 mg/kg EGCG for 4 days, IP), and 4) ovarian stimulation + EGCG groups. Gene expression analysis of miR‑16‑5p was performed using real‑time polymerase chain reaction. VEGF protein and CD31‑positive cell density were assessed through immunohistochemistry, and serum estradiol and progesterone levels were measured using ELISA. Results: Endothelial cell density, VEGF protein, and miR‑16‑5p expression and estradiol concentration significantly increased in the ovarian stimulation group compared to the control group (p < 0.05). The smallest reduction in these parameters was observed in the group that received EGCG. EGCG also significantly reduced the progesterone level (p < 0.05). Conclusion: EGCG significantly reduced endometrial angiogenesis, and angiomiR‑16‑5p may mediate the effects of EGCG on endometrial quality; however, further studies are needed.