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.
Critique of the Peaceful End of Life Theory Using Meleis’ 2012 Approach
Background: Providing a peaceful end of life while preserving dignity is a fundamental goal of nursing care. The Peaceful End‑of‑Life Theory (PELT) offers a middle‑range theoretical framework to guide holistic nursing care for terminally ill patients. Despite its broad application, this theory has not yet been systematically critiqued using Meleis’ theory analysis framework. Materials and Methods: This study presents a theoretical discussion employing a structured critique based on Afaf Meleis’ (2012) theory analysis framework. The structural and functional components of PELT—including its concepts, assumptions, propositions, inner dimensions, clarity, consistency, practical, educational, and research utility, as well as empirical support—were systematically examined. The primary source of analysis was the original theory article by Ruland and Moore (1998), supported by relevant theoretical and empirical literature. Results: The analysis identified PELT as a coherent and internally consistent middle‑range theory that effectively links nursing interventions to holistic patient outcomes such as pain relief, comfort, dignity, peace, and closeness to significant others. However, several limitations were noted, including insufficient operational guidance for prioritizing interventions, challenges in measuring culturally sensitive concepts such as peace and comfort, and systemic barriers to implementation such as nursing shortages and misalignment with diagnosis‑focused reimbursement systems. Conclusions: Although PELT provides a valuable conceptual framework for guiding end‑of‑life nursing care, its effective application requires further development of context‑specific clinical guidelines, culturally sensitive and validated assessment tools, and supportive health policies that acknowledge the interdisciplinary and resource‑intensive nature of palliative care. Addressing these gaps may enhance the theory’s practical applicability and contribute to more equitable and dignified end‑of‑life care across diverse settings.
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Investigating Factors Affecting the Nursing Shortage During the First and Acute Phase of COVID 19: A Systematic Review
Background: The COVID‑19 pandemic has resulted in a severe shortage of nurses in health care systems worldwide. The first and acute phase of COVID‑19 was challenging for health systems due to the unknown nature and complexity of the disease. This study aimed to extract the factors that influenced the shortage of nurses during the first and the acute phase of COVID‑19. Materials and Methods: Based on the PRISMA guidelines, a systematic search was conducted in PubMed, ScienceDirect, Cochrane, Scopus, and Web of Science databases from the start of the COVID‑19 outbreak to 2021. Studies were screened separately; the inclusion criteria were applied. The risk of bias was assessed with the Hoy tool, and data extraction was conducted. Factors were extracted and categorized by thematic analysis. Results: In total, 1035 studies were found. Finally, 11 original papers met the eligibility criteria. Most studies (seven) were cross‑sectional. After thematic analysis, the results showed that the nursing shortage during the COVID‑19 outbreak can be attributed to three main categories: 1) The pandemic perceived threat, 2) Internal and External Factors, and 3) Professional and Psychosocial Support. Conclusions: This study highlighted the need for the healthcare system to switch from reactive crisis management to proactive and resilient strategies. To prevent nurse burnout and attrition and guarantee the continuity of care in future emergencies, it is essential to plan to address perceived threats and strengthen support systems in addition to implementing multilevel interventions in organizational and psychological domains. This integrated strategy will convert vulnerability into readiness and resilience.
The Challenges Experienced by Oncology Nurses during the COVID 19 Pandemic: A Systematic Review
Background: The coronavirus disease 2019 (COVID‑19) pandemic has introduced a range of obstacles for healthcare workers, including oncology nurses. These frontline workers have had to adjust to updated procedures and protocols while providing care for patients with cancer during times of increased stress and uncertainty. This systematic review aimed to examine the difficulties faced by oncology nurses during the COVID‑19 pandemic. Materials and Methods: A systematic review was performed on the literature using databases, including Web of Science, Scopus, and PubMed, to find related studies published between January 2019 and July 2024. The quality of the articles was evaluated using the Critical Appraisal Skills Program (CASP) tool. Results: This systematic review was performed in international databases, resulting in eight eligible studies. The studies highlighted several difficulties experienced by oncology nurses during the COVID‑19 pandemic, including heightened workload, lack of personal protective equipment, emotional distress, and challenges in communicating with patients and families. Conclusions: This research revealed that oncology nurses faced numerous challenges during the COVID‑19 pandemic, which impacted their well‑being and their ability to provide quality care for patients with cancer. Healthcare organizations should provide support and resources to help oncology nurses cope with these difficulties and continue to deliver high‑quality care.
The Effect of Online Mindfulness Based Stress Reduction Program on Sleep Quality in Mothers of Children with Autism Spectrum Disorder: A Randomized Clinical Trial
Background: Mothers of children with autism spectrum disorder (ASD) would experience elevated levels of stress and psychological distress. This study examined the effect of an online Mindfulness‑Based Stress Reduction (MBSR) Program on sleep quality in mothers of children with ASD. Materials and Methods: This was a randomized single‑blinded controlled trial that was conducted in 2022 on 72 mothers of children with ASD from Fatemeh Zahra and Parnian Autism Centers in Isfahan City, Iran. Participants were recruited through a convenient sampling and randomly assigned to intervention (n = 36) and control (n = 36) groups. The intervention group underwent eight 90‑min MBSR sessions twice a week. Data were collected using a demographic information form and the Pittsburgh Sleep Quality Index (PSQI) at baseline, immediately after, and one month after the intervention. Data were analyzed using independent samples: t‑test, Chi‑square, and one‑way repeated‑measure. Results: The intervention group showed significantly improved sleep quality scores immediately after (F = 107.004, P < 0.001) and one month after (F = 107.004, P < 0.001) the intervention compared to the control group (lower PSQI score indicates better sleep quality). Repeated‑measure ANOVA indicated a significant change in sleep quality scores over time within the intervention group (F = 107.004, P < 0.05), but no significant change was found in the control group (F = 1.292, P > 0.05). Conclusions: The findings of this study demonstrate that MBSR effectively improves sleep in mothers of children with ASD. Given its cost‑effectiveness, MBSR should be integrated into healthcare protocols.
Understanding Palliative Care Needs in Multiple Sclerosis: Insights from a Qualitative Descriptive Study
Background: Given the variability in the provision of palliative care for patients with multiple sclerosis (MS) across diverse communities and cultural contexts, and considering the paramount importance of a patient‑centered approach in needs assessment, this study aimed to identify the palliative care needs of individuals with MS. Materials and Methods: This qualitative descriptive study employed a directed content analysis approach on 2024. Data were collected through semistructured and in‑depth 30‑minute interviews with 14 patients diagnosed with MS in southern Iran. The interviews continued until data saturation was achieved. Concurrently with data collection, analysis was performed using the Elo‑Kyngas method and MAXQDA 2022. The Guba and Lincoln criteria were utilized to ensure the validity and reliability of the data. Results: The analysis identified eight primary categories of needs that align with the National Consensus Project framework: structure and processes of care, physical, psychological and psychiatric, social, cultural, ethical and legal, spiritual, religious, and existential aspects, and end‑of‑life care. Conclusions: A thorough understanding of the palliative care needs of patients with MS can improve the responsiveness of the treatment team and empower caregivers to address these needs more effectively. Consequently, this leads to the delivery of more comprehensive palliative care services for these patients. While the palliative care needs of patients can be considered a multidimensional concept, determining the perceptions of family caregivers and healthcare providers regarding these needs is recommended to develop a more comprehensive approach in future research.
Rocky Paths: Family and Society as a Double Edged Sword in the Strategies of Patients in Coping with Scleroderma: A Qualitative Descriptive Study
Background: Family and society, as key sources of support in the patient adaptation process, can play a substantial role. However, the contribution of family and society to patients’ coping methods, encompassing both positive and negative effects, has not been sufficiently studied. This qualitative study explores the challenges of living with scleroderma, the related strategies, and the dual impact of family and society on patients’ coping strategies. Materials and Methods: This study was conducted using a qualitative approach with conventional content analysis in 2023–2024. Data were collected via semi‑structured interviews with 22 patients and eight family caregivers who were selected through purposive sampling in Ahvaz, Iran. The interviews continued until data saturation was achieved. All interviews were analyzed using Graneheim and Lundman’s approach. Results: The findings included eight categories and 22 subcategories. The categories include the following: disrupted cohesion and functional breakdown, psychological stressors, family support dynamics, disrupted support circles, dynamic social support, gaps in the society support network, comprehensive care management, and maladaptive coping mechanisms. Conclusions: This study highlights the absence of an independent scleroderma association in Iran and underscores the role of nurses, evidence‑based platforms, and media advocacy in amplifying patients’ voices. Addressing stigma, cultural misconceptions, social isolation, and financial hardship requires targeted interventions and policymaking. Particularly, nursing interventions, through educational workshops and innovative tools such as AI‑based platforms, can enhance patients’ social and informational support.
Noninvasive Vibratory Stimulation on Pediatric Pain Scores during Intravenous Cannulation in a Selected Hospital in the United Arab Emirates
Background: Pediatric patients often experience significant distress and discomfort during intravenous (IV) cannulation. The noninvasive vibratory buzzy device, which utilizes vibration technology, has emerged as a potential solution for mitigating procedural pain in children. However, its application and effectiveness have not been investigated in the United Arab Emirates. Materials and Methods: This quasi‑experimental study was conducted among children (aged between two and six years) on admission. The children were selected consecutively and assigned to either the intervention group (IVG) or control group (CG). The IVG (n = 5) had the buzzy vibration applied proximal to the IV insertion site along with routine care, while the CG participants (n = 51) received only routine care. Pain level was assessed using the face, legs, activity, cry, and consolability (FLACC) scale before and during IV catheter insertion. Results: Results showed that 31 (62%) of children in the IV group were between four and six years old. The pre‑intervention FLACC scores in the IVG indicated moderate pain in 21 (41%), mild pain in 20 (39%), and severe pain in 9 (18%). During the intervention, the IVG experienced mild‑to‑no pain, whereas the CG reported mild‑to‑moderate pain. A significant negative correlation between pain score and age was observed in the CG (r = −0.2, P = 0.037), indicating higher pain scores in younger children. Conclusions: Vibratory stimulation using a noninvasive buzzy device effectively reduced procedural pain during cannulation.
Exploring the Knowledge and Attitudes of Clinical Nurses Toward Palliative Care: A Qualitative Enquiry in Ghana
Background: Palliative care is an essential aspect of healthcare that focuses on improving the quality of life for patients with life‑threatening illnesses by alleviating pain and other distressing symptoms. However, its integration into clinical practice remains inconsistent. Nurses play a vital role in delivering palliative care, which is significantly influenced by their knowledge and attitudes. As such, this study explored the knowledge seeks to explore the knowledge and attitudes of clinical nurses toward palliative care. Materials and Methods: This qualitative descriptive study was conducted from May to September 2023 and enrolled 14 healthcare personnel from Ho Teaching Hospital. Participants were selected using purposive sampling until data saturation was achieved. Data were collected by conducting face‑to‑face in‑depth interviews with the participants at a place and time of the interview convenient to participants. Only participants who consented were recruited into the study. Data collection and analysis occurred at the same time. Data were analyzed using the conventional content analysis approach of Graneheim and Lundman. Results: Four major themes and 12 subthemes were generated. The themes were 1. Nursing practice experience, 2. Knowledge of palliative care with subthemes, 3. Assessment of pain and its management with subthemes, and 4. Attitude toward palliative patients with subthemes. Conclusions: The study highlights the multifaceted experiences, knowledge, pain management practices, and attitudes of nurses in palliative care. It underscores the importance of comprehensive training to enhance care delivery and support for palliative patients. The study recommends regular in‑service training to support nursing staff in providing comprehensive and compassionate palliative care.
Comparison of the Dialysis Adequacy Across Four Types of Dialysis Machines in Hemodialysis Patients
Background: Chronic renal failure causes a gradual loss of kidney function. This study compares four types of dialysis machines for blood purification in hemodialysis patients. Materials and Methods: This descriptive‑analytical cross‑sectional study was conducted in 2024 at the Dialysis Department of Sepehr Dialysis Center and Pasteur Hospital in Kerman Province, Iran. It included 64 dialysis patients selected through convenience sampling. Four different dialysis machines, Fresenius 4008 S, Fresenius 4008 B, ATF1022, and B. Braun, and 102 blood samples were analyzed, with patients undergoing either one or two sessions of hemodialysis. Data were gathered using a questionnaire about demographic and clinical information before and after dialysis. Vital signs and biochemical tests were taken, and dialysis adequacy was measured using KT/V and urea reduction ratio (URR), where K = urea clearance, T = dialysis time, and V = urea distribution volume. Data were analyzed using chi‑square, t‑tests, and Pearson correlation tests. Results: The mean (SD) dialysis adequacy (KT/V) among patients was 1.21 (0.41), and the mean (SD) URR was 58.97 (7.65). Only 17.06% of patients achieved a URR greater than 65%, and 21.60% achieved a KT/V greater than 1.20, which are established indicators of hemodialysis adequacy. Although the performance of the four machines varied, with higher values observed for the Fresenius 4008 B (KT/V = 1.16 ± 0.299 and URR = 61.47 ± 8.48), there was no statistically significant difference between dialysis machine types and dialysis adequacy (p > 0.05). Conclusions: Healthcare officials and stakeholders should examine factors affecting dialysis adequacy and implement newer machines and better quality assurance programs.
Mobile Health Intervention on Body Image Fear and Fatigue in Women with Breast Cancer: A Randomized Controlled Trial
Background: Breast cancer represents a major public health concern and is associated with significant psychological challenges. This study aimed to evaluate the effect of a mobile health (mHealth) intervention on fatigue and body image fear among breast cancer survivors. Materials and Methods: This randomized controlled trial was conducted with 104 women with breast cancer in Mazandaran Province, Iran during 2023‑2024. Participants were randomly assigned to an intervention group (n = 52) or a control group (n = 52). The intervention was delivered through social media platforms. Data were collected at pretest, post‑test, and follow‑up using a demographic questionnaire, the Cancer Fatigue Scale (CFS), and the Littleton Body Image Concern Inventory (BICI). Independent t‑tests, ANCOVA, and repeated‑measures ANOVA were used for data analysis at a 0.05 significance level using SPSS software. Results: The mean (SD) age of participants was 51.43 (8.47) years, and 91 (87.50) had a diploma‑level education or lower. Results showed that body image fear and fatigue scores at post‑test and follow‑up were significantly lower in the intervention group compared to the control group (F = 300.1, p < 0.001). Post hoc tests indicated that the mean total fatigue score in the intervention group differed from the control group by 8.83 points, and the mean total body image fear score differed by 19.30 points. Conclusions: The findings demonstrate that the mHealth intervention had a positive effect on reducing fatigue and body image fear in breast cancer survivors. These results support the incorporation of mHealth as an effective approach within the health sector for decision‑making and policy development.
Marital Life after Infertility Diagnosis: Sexual and Intimacy Issues Experienced by Iranian Infertile Couples
Background: Infertility is a life‑altering condition that not only affects reproductive capacity but also deeply disrupts emotional intimacy and marital stability in couples. Understanding couples’ experiences of changes in marital relationships following infertility can be valuable for healthcare providers’ care planning. This study aimed to explain the experiences of infertile couples regarding sexual issues and intimate relationships. Materials and Methods: This study was conducted using a qualitative content analysis approach based on the method proposed by Graneheim and Lundman. Data were collected through semistructured interviews with 14 infertile couples using purposive sampling at the infertility treatment center of Birjand University of Medical Sciences, Birjand, Iran. Coding and classification of data were performed using MAXQDA 2020. Results: The results indicated the negative impact of infertility on marital life and intimate relationships between couples, which can be understood by the four categories that emerged from the data: shock to marital life, couple’s intimacy downhill, diminished bed‑life pleasure, and prescribed, instead of pleasurable sex. Conclusions: This study highlights the profound impact of infertility on couples’ sexual and intimate relationships, emphasizing the need for holistic treatment approaches. Healthcare providers—especially nurses and infertility counselors—should incorporate psychosexual support into routine infertility care. By offering culturally sensitive counseling and facilitating open communication between partners, professionals can help couples preserve emotional intimacy and marital stability throughout the treatment process.
Quality of Life among Iraqi Ostomy Patients and Its Associations with Demographic and Clinical Characteristics of Patients
Background: The surgical creation of an ostomy can substantially affect patients’ daily functioning and quality of life (QoL). However, no previous study has evaluated QoL among ostomy patients in Iraq, and the influence of demographic and clinical factors remains insufficiently explored. Materials and Methods: This cross‑sectional study included 200 ostomy patients recruited from three oncology centers in Baghdad, Iraq. QoL was assessed using the City of Hope–Quality of Life Ostomy Questionnaire (CoH–QoL–OQ). Associations between demographic and clinical variables and QoL were analyzed using multivariate analysis of covariance (MANCOVA), adjusting for age and sex. Results: Based on the total QoL score, none of the patients had a good QoL; 92.00% had moderate QoL and 8.00% had low QoL. Patients aged ≥48 years had lower overall QoL compared with younger patients (η² =0.05, p = 0.001). Lower QoL was also observed in patients with malignant tumors before surgery (η² =0.10, p < 0.001) and those receiving chemotherapy after surgery (η² = 0.07, p = 0.001). Social QoL differed significantly across marital status, ostomy type, tumor type, and treatment methods (all p < 0.01). Conclusions: Iraqi ostomy patients experience low‑to‑moderate QoL. Age, marital status, ostomy type, tumor malignancy, and postsurgical treatment methods are significant determinants of QoL in this population.
Transitional Care in Long Covid Patients, The Missing Link in the Healthcare Systems in Iran: A Qualitative Study
Background: Long COVID, a chronic and multisystemic consequence of coronavirus infection, significantly reduces patients’ quality of life due to persistent symptoms. Transitional care (TC) is essential to ensure continuity and coordination of care and to reduce the risk of hospital readmissions. This study aims to identify the barriers to providing effective TC for long COVID patients within the Iranian healthcare system. Materials and Methods: This qualitative descriptive study used thematic analysis. Participants—10 long COVID patients, 5 family caregivers, and 16 healthcare providers—were selected via purposeful sampling from outpatient clinics and rehabilitation centers affiliated with Isfahan University of Medical Sciences, Iran. Between November 2022 and May 2023, 33 semistructured, in‑depth interviews (30–40 min each) were conducted, audio‑recorded, transcribed verbatim, and analyzed using MAXQDA (v. 20) until data saturation. Trustworthiness was ensured using Guba and Lincoln’s criteria. Results: Barriers to effective TC for long COVID patients were systematically classified into three main themes with 10 subthemes. The main theme included inefficient healthcare infrastructure, nonintegrated management, and lack of comprehensive continuous care. Conclusions: The findings revealed that the Iranian healthcare system lacks integrated TC for long COVID patients. Addressing these barriers requires policy‑level reforms, standardized care pathways, and investment in community‑based and rehabilitation services. Strengthening TC could bridge the current gaps and significantly improve outcomes for long COVID patients in Iran. The findings provide insights into structural and operational challenges in TC delivery and highlight the need for policy reforms to improve outcomes for long COVID patients.
Miscarriage Trends and Blood Group Associations During the COVID 19 Pandemic: A Comparative Study in Ramsar, Iran
Abstract Background: The COVID‑19 pandemic has placed significant physiological, physical, and psychological burdens on populations worldwide. Childbearing, as a fundamental aspect of human life, can be negatively affected during such crises. This study aimed to evaluate the impact of the COVID‑19 pandemic on miscarriage rates and to investigate the potential association between spontaneous abortions and maternal blood groups. Materials and Methods: A retrospective analytical cross‑sectional study was conducted using 8,613 hospital records from two healthcare centers in Ramsar and Tonekabon, Iran. Miscarriage rates were analyzed relative to total delivery requests during the pre‑pandemic (2017–2019) and pandemic (2020–2022) periods. In the second phase, unexplained spontaneous abortions were examined in relation to maternal ABO and the Rhesus factor (Rh) blood groups across both periods. Results: The analysis revealed a significant increase in miscarriage rates during the pandemic, despite a general decline in delivery requests. In the study sample, blood group distribution was A: 29.86%, B: 21.53%, O: 43.06%, and AB: 5.56%, while 9.72% were Rh‑negative and 90.28% Rh‑positive. Although abortions appeared more common in certain blood groups (notably B and O), statistical analysis showed no significant association between miscarriage and maternal individual blood types before or during the pandemic. Conclusions: The findings suggest that physiological and psychological stressors during the pandemic may have contributed to increased miscarriage rates. Health systems should implement integrated strategies, including mental health support and enhanced prenatal care, to reduce adverse pregnancy outcomes during pandemics or similar crises.
Exploring the Lived Experience of Women Receiving Antenatal, Intrapartum, and Immediate Postnatal Care: The Essence of Being with the Midwives
Background: Midwives have essential roles in shaping policies, advancing practice, and ensuring women‑centered education that leads to positive maternal and neonatal outcomes. In Qatar, healthcare systems integrated midwifery‑led services to increase the workforce supporting women, but no studies have examined women’s experiences with midwives. Thus, this study explores women’s lived experiences of midwifery care in Qatar to identify its impact and areas for improvement. Materials and Methods: A qualitative descriptive‑phenomenological design was used. Twelve women who received perinatal care from midwives were purposively recruited from midwifery‑led services at a tertiary maternity facility in Doha, Qatar. After discharge, interviews were conducted via Zoom from January to June 2022 using a semi‑structured guide. Audio recordings were transcribed and analyzed using Colaizzi’s method to identify key themes. The essence of the lived experience was derived through phenomenological reduction and theme integration. Results: Five themes and nine subthemes emerged: midwives’ presence and support; midwives’ care and comfort; learning from midwives; developing authentic partnerships; and changing perspectives on perinatal care. The essence of “being with midwives” transformed women’s experiences toward perinatal care. This transformation empowered women, encouraged positive physiologic childbirth experiences, and reinforced the need to expand midwifery services in Qatar. Conclusions: Being with midwives shapes women’s perinatal experiences and transforms perceptions about midwifery and obstetric care. Their compassionate approach builds trust and strong partnerships. Narratives suggested expanding services, increasing recruitment, and refining the midwifery care model in Qatar to enhance maternal healthcare.
Practices of Al Hijama Practitioners at Cupping Community Centers in Qatar
Background: Cupping therapy (CT) is an alternative healing method widely practiced in Asian and Middle Eastern cultures. Materials and Methods: An analytical cross‑sectional study was conducted among 120 Al‑Hijama practitioners working at five cupping community centers in Qatar. Data were collected using a self‑administered questionnaire covering sociodemographic characteristics and safety practices. Statistical analysis was performed using SPSS software, applying Chi‑square, independent t‑test, and ANOVA tests, with statistical significance set at P ≤ 0.05. Results: Approximately half of the practitioners demonstrated nonadherence to established safety guidelines. Critical safety practices, including hand hygiene, equipment sterilization, use of disposable lancets, and documentation, were frequently neglected. No statistically significant associations were found between practitioners’ demographic characteristics and adherence to safety practices. Conclusions: The study revealed significant gaps in cupping therapy safety practices among practitioners in Qatar. Although adherence was observed in certain areas, the findings emphasize the need for regular training programs and standardization of safety protocols to improve practice quality and patient safety.
Effectiveness of Nursing Interventions in Preventing Pressure Ulcers among Immobile Stroke Patients
Background: Individuals with physical disabilities are more likely to develop pressure ulcers due to restricted mobility and diminished sensation. Stroke is the most prevalent medical diagnosis associated with pressure injuries. Pressure ulcer (PU) is a common complication associated with strokes. Timely recognition and implementation of preventive measures are essential in preventing the development of pressure ulcers. This study aimed to explore the effectiveness of nursing interventions in preventing pressure ulcers among immobile stroke patients. Materials and Methods: A simple random sampling technique was used to recruit 128 patients; 64 patients were assigned to the control group and 64 to the intervention group. Patients were recruited from the neurological ward at Rizgary Teaching Hospital, Erbil City, Kurdistan region of Iraq, and from the intensive care unit (ICU) at the East Emergency Hospital. Data collection tools included the Braden scale, a risk assessment tool for PUs, and a structured questionnaire. The Chi‑square test, logistic regression, and an independent sample t‑test were used to analyze the data. The significant level was set as a p < 0.05. Results: Heart diseases, diabetes mellitus, smoking, advanced age, and friction and shear were the main risk factors for PUs development among immobile stroke patients. The nursing educational interventional program was highly effective in reducing the incidence of PUs among immobile stroke patients (t = 4.130, p < 0.001). Conclusions: Appropriate nursing interventions and patient education can significantly reduce the incidence of PUs as well as prolong the development of PUs among immobile stroke patients.
Effectiveness of a Family Centered Empowerment Model on Self Efficacy in Patients with Hypertension: A Randomized Clinical Trial
Background: Hypertension is a major public health challenge, and low self‑efficacy undermines adherence to lifestyle change and treatment. Family‑centered empowerment may strengthen self‑efficacy, yet evidence in Iranian patients with hypertension is limited. This study evaluated the effect of a family‑centered empowerment program on self‑efficacy in adults with hypertension. Materials and Methods: In this randomized clinical trial (Zahedan, Iran; November 2020–September 2021), 70 patients were randomized 1:1 to intervention (four weekly 60‑min family‑centered empowerment sessions with a primary caregiver) or usual care. The primary outcome was hypertension self‑efficacy (17‑item validated scale) measured at baseline, immediately post‑intervention, 1 month, and 3 months. Repeated‑measures analysis of variance (ANOVA) tested time, group, and time × group effects; partial eta squared (η2p) and Cohen’s d complemented p values. Results: Groups were comparable at baseline (all p > 0.05). Repeated‑measures ANOVA showed a significant time × group interaction for total self‑efficacy (F = 148.72, p < 0.001; η2p ≈ 0.69). The intervention group improved across all time points, whereas the control group remained largely stable. At 3 months, total self‑efficacy was 53.40 (2.87) (intervention) versus 46.48 (3.64) (control; p < 0.001; Cohen’s d = 2.11). Similar patterns were observed for dietary adherence (32.22 (1.30) vs 28.45 (2.13); p < 0.001; d = 2.14), treatment adherence (12.88 (1.45) vs 11.65 (1.69); p < 0.001; d = 0.78), and disease management (8.28 (0.98) vs 6.37 (1.00); p < 0.001; d = 1.93). Conclusions: A structured family‑centered empowerment program meaningfully increased self‑efficacy in patients with hypertension over 3 months, with large effect sizes across total and domain scores. Given its cultural fit and low resource needs, integrating this model into routine nursing practice may enhance hypertension self‑management.
The Impact of Group Reflection on Preventive Behaviors for Ventilator Associated Pneumonia Among ICU Nurses
Background: Reflection is a fundamental component of nursing education and professional practice. This study aimed to evaluate the impact of structured group reflection sessions on ICU nurses’ adherence to Ventilator‑Associated Pneumonia (VAP) prevention practices. Materials and Methods: This quasiexperimental study a total of 44 ICU nurses from Namazi Hospital in Shiraz, Iran, participated. Two ICUs were randomly selected. The intervention consisted of four group reflection sessions, each comprising 7–8 participants, conducted over 2 weeks and guided by VAP prevention protocols. Nurses’ performance was assessed before the intervention and at 1, 4, and 8 weeks afterward using the Behesht Aeen checklist. Data were analyzed using SPSS v. 16. Results: The findings revealed that the intervention group demonstrated a significant improvement and an upward trajectory in all dimensions of nurses’ performance across the postintervention follow‑up periods (p < 0.001). In sharp contrast, the control group’s performance remained stable across all time points (p > 0.05) for all dimensions, with the sole exception being endotracheal tube protection. One week after the intervention, the control group scored 18.13 (5.30), whereas the intervention group scored 28.59 (1.65) (t42= −12.64, p < 0.001(. This divergence was maintained at 4 weeks, with scores of 17.22 (3.71) for the control group and 30.00 (1.77) for the intervention group (U42 = 00.00, p < 0.001(. At eight weeks later, the scores were 15.86 (3.94) for the control group and 29.31 (1.49) for the intervention group (U42 = 00.00, p < 0.01). Conclusions: The findings indicate that structured group reflection sessions are an effective educational strategy to enhance ICU nurses’ preventive behaviors for VAP, thereby improving clinical performance and quality of care
Effect of Psychoeducational Childbirth Preparation with Relaxation on PTSD and Childbirth Fear After Traumatic Birth: A Randomized Controlled Trial
Background: Traumatic childbirth significantly elevates the risk of developing post‑traumatic stress disorder (PTSD) and fear of childbirth (FOC). This study aimed to investigate the effects of a psychoeducational intervention, incorporating relaxation training, on PTSD and FOC in pregnant women with a history of traumatic childbirth. Materials and Methods: This randomized controlled trial included 70 pregnant women in Hamadan, Iran, with a history of traumatic childbirth. Participants were randomly assigned to either an intervention group (n = 35) or a control group (n = 35). The intervention group underwent an 8‑session psychoeducation protocol that integrated relaxation training, delivered between 24 and 32 weeks of gestation, while the control group received standard prenatal care. PTSD symptoms were assessed using the PSS‑SR, and FOC was measured with the CAQ at baseline and at 36 weeks of gestation (4 weeks’ postintervention). Data analysis was conducted using ANCOVA in Stata‑13. Results: Four weeks’ postintervention, the intervention group exhibited a statistically significant reduction in PTSD scores compared to the control group (adjusted mean difference: –9.23; 95% CI: –11.28, –7.18; p < 0.001; Cohen’s d = 2.29). Similarly, FOC scores were significantly lower in the intervention group (adjusted mean difference: –5.02; 95% CI: –7.00, –3.05; p < 0.001; Cohen’s d = 1.30). Conclusions: A structured psychoeducational intervention for childbirth preparation that incorporates relaxation training effectively alleviates PTSD symptoms and reduces fear of childbirth in pregnant women with a history of traumatic childbirth. The substantial effect sizes observed underscore its clinical relevance.
Rebirth of the Meaning of Natural Childbirth: A Qualitative Study on the Perceived Impacts of Effective Midwife–Mother Communication among Iranian Midwives and Mothers
Background: Although effective communication between midwives and mothers is linked to positive physiological and emotional outcomes, research on this topic within maternity wards remains limited, and both perspectives have not been adequately explored. A comprehensive understanding of these perceived impacts is essential to highlight the importance of communication in maternity care. This study aims to explore the perceived impacts of effective midwife–mother communication in the maternity ward. Materials and Methods: A qualitative approach was adopted to explore perceptions of effective midwife–mother communication using the conventional content analysis method. Semi‑structured interviews were conducted between July and October 2023 with 11 midwives and 12 postpartum mothers in the maternity wards of Ahvaz, Iran. Participants consisted of midwives working in maternity units and mothers who had experienced vaginal births, selected through purposive sampling. Data were analyzed using a thematic analysis approach. Results: Thematic analysis revealed one central theme: the rebirth of the meaning of natural childbirth, supported by three themes: 1) reshaping mothers’ beliefs and attitudes toward childbearing, 2) meaning‑making in natural childbirth, and 3) improving the quality of midwifery services. Conclusions: Effective communication between midwives and mothers can help restore values and positive emotions and redefine the meaning and experience of natural childbirth. It is recommended that comprehensive frameworks or guidelines for effective communication be developed and integrated into midwifery curricula, training programs, and clinical interventions. Future studies should focus on communication processes and barriers across different maternity care settings to identify effective practices and areas for improvement.
The Antecedents of Horizontal Violence Among Nurses: A Qualitative Content Analysis Study
Background: Horizontal violence (HV) in healthcare settings refers to any type of violence among healthcare providers and is a serious challenge in nursing. Many different factors may put nurses at risk for HV. This study aimed to explore the antecedents of HV among nurses. Materials and Methods: This qualitative content analysis was conducted in 2022–2023. Participants were 15 nurses purposefully selected from five hospitals affiliated to Hamadan University of Medical Sciences, Hamadan, Iran. In‑depth semistructured interviews were conducted for data collection. The main interview question was, “Have you ever experienced HV in your relationships with your colleagues?” Graneheim and Lundman’s conventional content analysis was used for data analysis. Results: The antecedents of HV among nurses were grouped into two main categories, namely, nurses’ personality traits and the violence‑laden culture of nursing. The subcategories of specific personality traits were bullying personality and oppressed personality, and the subcategories of the violence‑laden culture of nursing were managers’ discriminatory and unjust behaviors and the tense work atmosphere of nursing. Conclusions: Nurses’ personality traits, managers’ discriminatory and unjust behaviors, and the tense work atmosphere of nursing are among the most important antecedents of HV among nurses. These factors can negatively affect nurses’ physical, mental, emotional, and social health, reduce their job motivation, lead to their intention to quit nursing, and undermine care quality.
Hesitant Steps: An Exploratory Qualitative Study of the Influential Factors on Women’s Attitudes Toward Elective Abortion
Background: Abortion is one of the most complex and controversial issues in ethics, legislation, and health. Strict abortion restrictions and population growth policies have increased the complexity of abortion in Iran. Thus, this study aimed to explore women’s attitudes toward Elective Abortion (EA). Materials and Methods: This exploratory qualitative study was conducted between January and September 2024. Participants included 20 women (aged 15–49 years) with no previous history of abortion, purposively selected from eight healthcare centers in Hamadan, Iran. Data were gathered through in‑depth, semi‑structured interviews, and analyzed through Graneheim and Lundman’s conventional content analysis. Trustworthiness was ensured according to Guba and Lincoln’s criteria. Results: The five main themes regarding factors influencing women’s attitudes toward EA included moral and religious beliefs, violation of the right to live, sheer panic, modern rethinking, and an insecure future. The 10 categories of these themes were God’s will, respectability of life, EA as antisocial behavior, EA as murder, heavy penalty, physical, and mental consequences, changes in values, ambiguities in maternal roles, socioeconomic insecurity, and familial insecurity. Conclusions: Moral and religious beliefs, fears, and personal, socioeconomic, and value changes can influence women’s attitudes toward EA. Therefore, implementing multifaceted strategies in shaping reproductive health policies, emphasizing individual, economic, and social components, is essential for the assessment and management of EA.
Apixaban vs Enoxaparin for Preventing Postoperative Thromboembolic events in Women Undergoing Surgery for Gynecologic Cancers: A Randomized Clinical Trial Study
Background: Venous thromboembolism (VTE), encompassing deep venous thrombosis and pulmonary embolism, presents a significant clinical risk for women undergoing surgical intervention for gynecologic malignancies. Enhanced prophylactic strategies are vital to mitigating these complications. This study evaluates the efficacy and safety of oral apixaban compared to subcutaneous enoxaparin for postoperative VTE prevention in this high‑risk population. Materials and Methods: This randomized clinical trial was conducted from March 2022 to March 2023. One hundred eligible patients undergoing gynecologic cancer surgery were randomized to receive either oral apixaban (2.5 mg twice daily) or subcutaneous enoxaparin (40 mg daily). The primary endpoints included the incidence of thromboembolic events and bleeding complications, monitored up to 12 weeks postoperatively. Results: This cohort consisted of 48 patients in the apixaban group and 52 in the enoxaparin group. Postoperative complications included vaginal bleeding (8.32% apixaban vs. 3.85% enoxaparin), hematoma (2.15% apixaban vs. 3.85% enoxaparin), and ecchymosis (6.37% apixaban vs. 9.62% enoxaparin). None of these differences achieved statistical significance (p > 0.05). Both groups demonstrated comparably high levels of treatment adherence and patient satisfaction. Conclusions: Apixaban and enoxaparin demonstrated comparable efficacy and safety profiles in preventing postoperative VTE following gynecologic cancer surgery. Given its oral administration route, apixaban may serve as a feasible alternative to enoxaparin, potentially enhancing patient compliance. Further large‑scale studies are warranted to validate these findings.
Overcoming Barriers to Skilled Midwifery Care: The Role of Nurse Practitioner Midwives in India
Dear Editor, Women’s and newborns’ survival depends on skilled care during pregnancy and childbirth. India’s maternal mortality rate is 97 per 100,000 live births, and the neonatal mortality rate is 20 per 1,000 live births.[1] Nurse practitioner midwives (NPMs) provide care to women throughout their lives, focusing on pregnancy, childbirth, and reproductive health. The NPM program in India, initiated in 2019, is an 18‑month government initiative to enhance maternal healthcare by creating a professional midwifery workforce.[2] This initiative addresses previous approaches where midwifery was merged with general nursing, leading to unclear roles and underutilized midwifery skills.[3] Autonomous midwifery practice can prevent 41% of maternal deaths, 39% of neonatal deaths, and 26% of stillbirths by 2035.[4].............