Journal of Research Development in Nursing and Midwifery

Happiness Program in Improving Sleep Quality in Multiple Sclerosis Patients

Kobra Zaheri

Background: Since happiness affects the various aspects of human life and is considered as one of the most important psychological needs, achieving it and it effects on the health of the body and soul has always occupied the mind of human beings. The aim of this study was to determine the effect of Forde's happiness program on sleep quality in patients with multiple sclerosis (MS).
Methods: This randomized clinical trial study was performed in the MS Society of Shahrekord in 2018. 70 eligible patients with MS were recruited through convenience sampling method and randomly allocated into intervention and control groups equally. The Fordyce Happiness Training Program was conducted in eight sessions in the intervention group. The sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI), before intervention, immediately and three months after the implementation of Fordyce Happiness Program. The data analysis was analyzed using Chi-square, and independent t-test and Fishers exact test for demographic data distribution in intervention and control group, and repeated measures ANOVA for sleep quality in SPSS-16.
Results: The findings indicated that total scores of sleep quality of the two intervention (4.61±.052) and control (6.62±.054) groups were not significantly different before the intervention (P=0.05). However, the mean sleep quality scores of intervention and control groups showed a significant difference before, immediately after the intervention with a significant decrease in sleep quality scores over time (F=23.291, P˂0.001).
Conclusion: The results of this study demonstrated that the implementation of Fordyce Happiness Training Program in MS patients is a suitable method for improving sleep quality, and if this program continues, they will get better results.

Knowledge and Attitude of Midwifery Students toward Human Papilloma Virus Infection and Cervical Cancer at Ahvaz Jundishapur University of Medical Sciences, Iran

Abdolhussein Shakurnia

Background: Human papillomavirus (HPV) is one of the most important causes of cervical cancer. It is essential to evaluate the knowledge and attitude of people about HPV infection in the community, especially among midwifery students who will act as health professionals in the society. This study aimed to determine the knowledge and attitude of midwifery students toward HPV infection and cervical cancer.
Methods: This cross-sectional study was done on midwifery students at Jundishapur University of Medical Sciences in Ahvaz (Iran) in 2019. 141 midwifery students were recruited through census. The knowledge and attitude of 112 eligible midwifery students toward HPV infection were assessed using a self-administered questionnaire. The validity and reliability of the questionnaire were confirmed. Data were analyzed in SPSS16 using the chi-square test and the Pearson’s correlation coefficient at statistical significance of 0.05.
Results: Mean age of midwifery students was 21.6±2.4 years. Of 112 students, only 38 (33%) had desirable knowledge about HPV infection. The majority of students (77.7%) had a positive attitude towards HPV infection. The knowledge and attitude of midwifery students in different academic years did not differ significantly (P>0.05).
Conclusion: There is insufficient knowledge about HPV infection and cervical cancer prevention among midwifery students at the Jundishapur University of Medical Sciences in Ahvaz. Therefore, it is recommended to incorporate HPV-related educational programs in order to increase students' awareness.

The Correlation between Spiritual Health and Loneliness in the Elderly

Gholam Reza Mahmoodi-Shan

Background: Loneliness is a serious issue among the elderly that considerably affects their health. Spiritual health might affect the level of loneliness in these individuals. Therefore, the present study was conducted to determine the relationship between spiritual health and loneliness.
Methods: This cross-sectional study was performed on 330 older adults who live in the western areas of the Golestan Province, Iran in 2019. The subjects were selected using stratified random sampling method with proportional to size. Data were collected by the short form of the Social and Emotional Loneliness Scale for Adults (SELSA-S) and the Spiritual Health Questionnaire (SHQ). Data analysis was performed in SPSS software (version 18) using Mann-Whitney U test and Spearman's rank correlation coefficient. Statistical significance level was set to 0.05.
Results: The mean of spiritual health and loneliness were 96.57±4.10 and 21.25±9.05, respectively. There was no significant correlation between spiritual health and loneliness (P=0.72), but there was a significant difference between urban and rural residents in this regard (P=0.037 and P=0.003). In addition, there was a significant relationship between spiritual health and loneliness in general (r=-0.139 and P=0.02). There was an inverse correlation between spiritual health and loneliness among urban residents (r=-0.27 and P=0.001) but not among rural residents (r=-0.06 and P=0.41).
Conclusion: Based on the findings, there is an inverse correlation between spiritual health and loneliness among the elderly. This could be a useful finding for planners and activists in the field of geriatric mental health in development of educational counseling and support programs.

Effect of Toddlers’ Daily Toilet Training Program Based on Developmentally Appropriate Practice Approach on Toilet Training Duration

Azam Tangestani

Background: One of the main responsibilities of the parents is training toddlers how to control urination. Developmentally Appropriate Practice (DAP) is a useful method of toilet training for children. Video modeling is an important tool for teaching new motor skills to both children and adults. The purpose of this study was to determine the effect of Toddlers’ Daily Toilet Training (TDTT) based on DAP on duration of toilet training in toddlers.
Methods: This quasi-experimental field trial was conducted in healthcare centers of Isfahan, Iran, in 2018-2019. Overall, 130 pair of mothers and their 18-24 months old infants were recruited using multi-stage sampling. The subjects were then divided into a control (n=75) and an intervention (n=55) group by random assignment. At the beginning of the DAP-based approach, the subjects were assessed every 2-4 weeks in terms of readiness for toilet training by using the Child and Mother Readiness Assessment Checklist. After achieving 80% score in the checklist, the mothers in the intervention group participated in TDTT program, while the control group received no intervention. For both groups, another checklist was completed every two weeks to determine toilet training duration and time to achieve urination control. Data analysis was carried out in SPSS18 software using the independent t-tests, Chi-square test, and Mann-Whitney test at significance level of 0.05.
Results: The mean duration of daily urination control in the control group (43.6±22.58 days) was significantly longer than in the TDTT group (28.71±12.12 days) (P=0.02). The age of readiness in both group ranged from 21 to 27 months. The duration of urination control was significantly associated with the mother's level of education (P=0.04) but inversely related to the age of achieving readiness (P=0.03) and the mother's employment status (P=0.05).
Conclusion: Based on the results, the TDTT program using video modeling and the DAP approach is effective in shortening the duration of toilet training in toddlers.

Relationship between Self-Care Needs and Self-Care Abilities of the Retired Elderly Based on Orem’s Model

parand pourghane

Background: Having self-care abilities based on the needs of the elderly promotes health in these individuals and minimizes the complications associated with aging. This study aimed to determine relationship between self-care needs and self-care ability in retired elderly based on Orem’s model.
Methods: This cross-sectional study was done on 120 older people who had been referred to the Civil Servants Pension Organizations in east of the Guilan Province (north of Iran) in 2017. Subjects were selected through simple random sampling method. Data were gathered using a questionnaire of elderly’s self-care needs and self-care abilities based on the Orem's model. Data were analyzed in SPSS (version 16) using the t-test, analysis of variance, Tukey's test, and Pearson correlation coefficient.
Results: The participants obtained an average self-care score of 19.80±6.44 and an average self-care ability score of 132.41±15.92. Most subjects were semi-dependent (73.33%) and had high self-care abilities (81.66%). Self-care needs and self-care abilities were significantly associated with variables of age, marital status, education level, occupation status, and monthly income. In addition, there was a significant relationship between self-care needs and self-care abilities of the elderly (P=0.0001).
Conclusion: Our results indicated a significant inverse relationship between self-care needs and self-care abilities of the elderly. It is recommended to design self-care program based on the needs of the elderly while considering their individual-social conditions to improve self-care abilities and minimize injuries.

Effect of Warm Saline Solution Gargle on Sore Throat after Extubation in Open Heart Surgery Patients: A Randomized Clinical Trial

Khadijeh Yazdi

Background: Sore throat is one of the most common complications of endotracheal intubation, which interferes with patient's normal breathing and oral feeding process. This may ultimately delay the patient's discharge from the hospital. The aim of this study was to determine effect of warm normal saline solution gargling on sore throat in open heart surgery patients after estuation.
Methods: This clinical trial was performed in 2016 on 60 patients undergoing open heart surgery at the Amir Al-Momenin Hospital in Kordkoy, Northeast of Iran. The subjects were selected by convenience sampling method and randomly assigned to an intervention and a control group. Patients with sore throat were assessed using the Numerical Pain Rating Scale (NPRS 0–10) one hour after endotracheal tube removal and then every 6 hours for 24 hours. An overall score of zero, 1-3, 4-6, and 6-10 indicated no pain, mild pain, moderate pain, and severe pain, respectively. Data were analyzed with SPSS (version 18) using the Shapiro–Wilk test, independent t-test, Fisher's exact test, Chi-square test, and Friedman test. All analyses were carried out at significance of 0.05.
Results: At the beginning of the study, there was no statistically significant difference between the two groups in terms of age, sex, ethnicity, history of addiction, and sore throat severity (p> 0.05). Six hours after the intervention, pain intensity did not differ significantly between the two groups (p <0.05). However, pain intensity was significantly lower in the intervention group compared with the control group 12, 18, and 24 hours after the intervention (p<0.001).
Conclusion: The results indicate that warm normal saline solution gargling after removal of the endotracheal tube is a practical, simple, and cheap approach to relieve sore throat in patients undergoing open heart surgery.

Effect of Telephone Counseling on Self-Efficacy in Self-Care Behaviors of Patients with COVID-19

Neda Mirbagher Ajorpaz

Background: Promoting self-efficacy behaviors in self-care and people's true understanding of these behaviors are effective in controlling the disease, reducing the rate of transmission, and empowering patients. The aim of this study was to determine the effect of telephone counseling on self-efficacy in self-care behaviors of patients with coronavirus disease 2019 (COVID-19).
Methods: This experimental study was conducted on patients with COVID-19 who had been referred to Shahid Beheshti hospital in Kashan, Iran, from May 2020 to August 2020. Eligible patients were recruited through convenience sampling and then allocated into an experimental (n=30) and a control (n=30) group using block randomization. In the experimental group, patients were trained through telephone counseling one, five, and 10 days after discharge. The control group received the usual training in the hospital. Data were gathered using a self-care questionnaire at different time intervals. The collected data were analyzed with SPSS software (version 11.5) using the Chi-square, one-way analysis of variance (ANOVA), and t-test. The significance level was set at 0.05.
Results: The mean score of self-care at time of discharge and two and four weeks later were 47.86±6.84, 62.23±5.24 and 78.46±3.38, respectively. There was a significant difference in self-efficacy scores between the study groups at time of discharge (P=0.29). In addition, there was a significant difference in self-efficacy scores two weeks (P=0.01) and four weeks (P=0.001) after discharge from the hospital. The self-efficacy score in the experimental group increased significantly over time. Furthermore, group and time had significant effects on the self-efficacy score (P<0.05) two weeks (P=0.01) and four weeks (P=0.001) after discharge from the hospital between two groups.
Conclusion: Telenursing could improve COVID-19 patients' self-efficacy in self-care. Therefore, it is recommended to use telenursing in the treatment protocol of COVID-19 patients for improving self-care.

Distribution Pattern of Stressful Events in Districts of Tehran, Iran: Evidence from a Regional Survey

Hassan Rafiey

Background: Tehran metropolis has been the center of urban growth in Iran in recent decades, which has led to the growth of psychological problems and stressful events. The present study aimed to determine the distribution of stressful events in different districts of Tehran.
Methods: The present descriptive-analytical study examined 5,985 citizens of Tehran in 2018. Subjects were selected via multi-stage cluster sampling, and data were collected using a researcher-made questionnaire to measure stressful events. The exploratory and confirmatory factor analyses confirmed the validity and reliability of the questionnaire, respectively. Eleven stressors were extracted based on factor analysis, which were scored from 0 to 100. Mean scores of stressful events were compared using one-way analysis of variance and the Tukey's post hoc test. All statistical analyses were carried out using SPSS 16 and AMOS 18. The statistical significance level was set to 0.05.
Results: The mean total score of stressful events was 6.78. The highest and lowest scores of stressful events were related to fear of the future (15.15) and academic changes (1.11), respectively. Results of the Tukey's post hoc test indicated differences between districts 12 and 20 in political problems, between districts 11 and 16 in neighborhood underdevelopment and social harm, between districts 16 and 19 in the livelihood problems, and between districts 1 and 2 in educational problems and educational changes. Moreover, mean scores of stressful events were highest in districts 1 in terms of worry about the future, in district 22 in terms of individual changes, in district 20 in terms of occupational difficulty, and in district 18 in terms of housing problems. There was no significant difference in the mean scores of stressful events due to employment and family relationships between the districts.
Conclusion: Based on the results, residents in less developed districts of Tehran, with poor urban facilities, are less affected by events due to subsistence, occupational, and economic issues, while residents in more developed districts are more affected by non-subsistence events, such as filtering, political instability, social constraints, and other factors.

Relationship between Adherence to Treatment and Self-Efficacy in the Elderly with Arthritis

Nasrin Nikpeyma

Background: Arthritis is one of the most common diseases among the elderly, which is affected by adherence to treatment and self-efficacy. The purpose of this study was to determine relationship of adherence to treatment and self-efficacy among the elderly with arthritis.
Methods: This descriptive–correlational study was conducted in 2019. Based on the convenience sampling method, 200 eligible elderly patients were recruited from three clinics affiliated with Tehran University of Medical Sciences in Tehran, Iran. Data were collected using the Modanloo adherence to treatment questionnaire and the perceived self-efficacy scale. Data were summarized using descriptive statistics (mean, frequency percentage, and standard deviation) and analyzed using inferential statistics (the Pearson correlation coefficient) in SPSS software (version 16). The statistical significance level was set at 0.05.
Results: The mean age of patients was 67.97±5.32 years. The mean scores of self-efficacy and adherence to treatment among the elderly with arthritis were 119.8±35.3 and 123.88±23.04, respectively. There was a statistically significant correlation between adherence to treatment and self-efficacy (r=0.648). The strongest positive correlation (r=0.693) was observed in the subscale of adherence to the treatment, and the weakest positive correlation (r=0.228) was observed in the subscale of indecisiveness for applying treatment with pain.
Conclusion: Because of the direct relationship between treatment adherence and self-efficacy in the elderly with arthritis, healthcare policymakers and planners should develop and implement programs to increase self-efficacy and treatment adherence among the elderly with arthritis and other chronic diseases.

Determination of Factors Associated With Adherence of Pregnant Women to HIV Screening in Indonesia: A Single-Center Study

Nurmisih Nurmisih

Background: The number of human immunodeficiency virus (HIV)-positive cases is increasing every year. This will in turn increase the risk of mother-to-child transmission of HIV. Despite the efforts made and counseling from health workers, only a small proportion of pregnant women adhere to HIV screening and retests in the city of Jambi, Indonesia. This study aimed to determine factors associated with adherence of pregnant women to HIV screening at the Putri Ayu public health center, Jambi City, Indonesia.
Methods: This cross-sectional study was done on 93 pregnant women who received antenatal care services at the Putri Ayu health center in Jambi City, Indonesia, from February to August 2020. The subjects were selected via a proportional quota sampling method. Data were collected using a 4-part questionnaire on demographic characteristics, vulnerability perception, knowledge of HIV, and adherence to HIV screening. The collected data were analyzed using the chi-square test and logistic regression analysis. A P-value of less than 0.05 was considered statistically significant.
Results: The majority of subjects were young (66.3%), unemployed (59.8%) and with low education level (71.7%). Only 33.7% of the respondents had good adherence to HIV screening. Of these individuals, 22.8% had good knowledge of HIV, 28.3% were adults, 40.2% were employed, and 28.3% had high education level. Adherence to HIV screening had significant association with knowledge (P=0.0001), age (P=0.0001), perceptions of vulnerability (P=0.017), occupation status (P=0.017), and education level (P=0.020).
Conclusion: Based on the results, knowledge, perception, age, education level, and occupation of pregnant women significantly affect their adherence to HIV screening at the Putri Ayu Health Center, Jambi City.

Health Tourism: Entrepreneurial Strategy of Nursing and Medical Sciences

Majid Nasiri

Abstract

Background: Entrepreneurship has important role in development and expansion of health tourism. The purpose of this study was to explore the experience of faculty members on entrepreneurships in health tourism.
Methods: This qualitative study was performed using the foundation data approach. Participants were selected via purposive sampling. Nineteen faculty members at Golestan University of Medical Sciences were interviewed in 2020. The individual and semi-structured interviews were conducted and continued until data saturation was achieved. The data was analyzed based on the foundation data approach.
Results: Based on the results, 554 primary codes, 56 sub-categories and nine main categories were obtained. The main categories included tourism laws and standards, health tourism beneficiaries, development of entrepreneurial strategies, facilitation of health tourism infrastructure, quality of health tourism services, Iran's tourist attractions, gaining competitive advantage, technology and modern knowledge, and entrepreneurial management.
Conclusion: Based on the results, having an entrepreneurial approach in the field of health tourism can turn nursing and medical sciences capacities in the Golestan Province into prosperity.

Consequences of Moral Distress in faculty member in the field of nursing: a qualitative Study

Shiva Pejmankhah

Abstract
Background: While institutional constraints make the teacher has not able to implement his moral decision, leading to a conflict between the right moral decision and his professional conduct, alternatively he will suffer from a negative feeling and psychological imbalance that emphasized moral distress. Moral distress occurs not only in clinical settings but also in academic area. The purpose of this study was to explain the experience of faculty member in the field of nursing in regards to the consequences of moral distress impact on their activities in the work environment.
Methods: This qualitative study was applied during a period of 11 months in in Nursing and Midwifery schools in Tehran, Iran in 2017. 13 faculty member in the field of nursing were selected through purposive sampling method. Data was gathered using in-depth semi-structured interviews with main question in term of the consequences of moral distress in working environment. Conventional qualitative content analysis was used for analyzing the data.
Results: The analysis of the data in this study led to emerge four main categories and eight subcategories based on the experience of faculty member in the field of nursing about the consequences of moral distress. The main categories included; the ineffective training, organizational silence, decreased sense of professional development and job burnout and the subcategories included decreased teaching quality, ineffective communication in the educational space, silent protest, damage to team performance, threat to professional identity, stagnation of professional growth, psychological reactions, and physical reactions.
Conclusion: The consequences of moral distress in faculty member in the field of nursing lead to make some barriers to desirable educational activities, such as a lack of a sense of accomplishment, a tendency toward negative moods in the workplace which causes damage of their performance or others professonal problems for provide learning. Therefore use of specific management and organizational strategies to control the consequences of moral distress in faculty member have been recommended.

Self-Screening in the Family Members of Tuberculosis Patients: A Systematic Review

Abbasiah Abbasiah

Background: Public awareness and knowledge about tuberculosis (TB) are still limited, which increases the risk of TB spread among vulnerable individuals. This systematic review aimed to identify effectiveness of self-screening in reducing TB transmission among family members of TB patients.
Methods: This systematic review was carried out on articles published between 2008 and 2021. The articles were retrieved from various databases including Scopus, Wiley Online Library, Cochrane Library, PubMed, and Google Scholar using the following keywords: Self-screening OR screening OR early detection AND TB OR pulmonary TB AND vulnerable OR susceptible AND group OR people OR high-risk Group. All quantitative studies on household or community based self-screening for TB were included in the study.
Results: Nine eligible articles were subjected to qualitative analysis. Early detection of TB transmission could be done through tuberculosis counselling and household screening, including self-screening for TB household contacts.
Conclusion: The management of self-screening of household contacts of TB patients is very important for reducing TB spread.

Effect of Self-Care Training Based On VARK Learning Style Preference on Blood Pressure of Patients with Hypertension

Elham Imani

Background: Hypertension has been a global public health crisis. Complications of hypertension can be reduced by educating patients. Consideration of the learning styles of patients is important for effective education. The aim of this study was to determine effects of self-care training based on visual, aural, reading/writing, and kinesthetic (VARK) learning style preference on blood pressure of hypertensive patients.
Methods: This semi-experimental study was conducted in Bandar Abbas, South of Iran in 2019. Forty-four eligible patients who were referred to six comprehensive health centers in Bandar Abbas were selected by convenience sampling and then allocated into four visual, aural, reading/writing, and kinesthetic groups based on the results of the VARK learning style questionnaire.
Educational interventions were performed according to patients' learning style preference in four sessions. To evaluate effectiveness of the training, patients' blood pressure was measured before the intervention and two months after the intervention. Data were analyzed with SPSS 16 software using paired t-test, Wilcoxon test, and one-way analysis.
Results: After the educational intervention, a statistically significant difference was observed in the mean systolic and diastolic blood pressures of all patients (P<0.001). After the intervention, the mean systolic blood pressure did not change significantly in the kinesthetic group (P>0.05) but decreased significantly in other groups (P<0.05). In addition, the mean diastolic blood pressure decreased significantly after the intervention in all study groups (P<0.05).
Conclusion: Providing education based on the preferred learning style can be an effective way to educate patients with hypertension in comprehensive health care centers across the country.

Effects of the Youth Health Application and Flipcharts on Adolescents’ Knowledge about Early Marriage: A Quasi-Experiment Study

Ruwayda Ruwayda

Background: Early marriage affects both the children who are married and their future offspring, and might lead to intergenerational poverty. This study aimed to determine effects of using the Youth Health application and flipcharts on adolescents’ knowledge about early marriage.
Methods: This quasi-experiment study with a pretest-posttest design was done on 60 adolescents from the Penyengat Olak Health Center, Muaro Jambi Regency (Indonesia) from March to May 2021. The subjects were recruited through convenience sampling method and then allocated into intervention (n=30) and control (n=30) groups. The subjects in the intervention group received an educational program about early marriage using the Youth Health application, while the control group received flipcharts developed by the Ministry of Health with the same educational content. Knowledge of adolescents was assessed using a 20-item questionnaire before and three days after the intervention. A total score of less than 10 and more than 10 indicated poor and good knowledge, respectively. Data were analyzed with SPSS (version 16) using the Wilcoxon test and Mann-Whitney t-test. P-values less than 0.05 were considered statistically significant.
Results: At baseline, 18 subjects (60%) in the intervention group and 17 subjects (56%) in the control group had good knowledge of early marriage. After the intervention, 24 subjects (80%) in the intervention group and 20 subjects (66%) in the control group had good knowledge of early marriage. The mean score of adolescents’ knowledge about early marriage increased from 15.7±2.5 to 17.3±2.1 in the intervention group (P=0.001). The mean score of adolescents’ knowledge about early marriage also increased from 15.7±2.4 to 16.7±2.4 in the control group (P=0.001). Moreover, there was no significant difference in the adolescents’ knowledge about early marriage between the two groups (P=0.78).
Conclusion: Providing education in from of Youth Health application and flipcharts can equally increase adolescents’ knowledge about early marriage.

Improvement of nurses’ clinical practice in neonatal pain management: A Protocol of Evidence-Based Intervention

Homeira khoddam

Background: Despite the expansion of knowledge of neonatal pain assessment and management, there is still a considerable gap between nurses' clinical practices in Iran and available evidence. The aim of this study was to develop an evidence-based protocol for neonatal pain management and to evaluate its effectiveness on nurses' clinical practice.
Methods: The present study will be based on the Johns Hopkins nursing evidence-based practice (JHNEBP) model and the three stages of practice question and project planning, evidence, and translation (PET). In this way, after forming an interprofessional team, clinical practice questions will be defined, and the main stakeholders will be identified. Then, the types, levels, and quality of evidence will be assessed to summarize their final strength using the proposed tools of the model, and finally, recommendations will be developed. In the translation phase, the recommendations will be implemented during a stepped wedge cluster randomized trial, and its implications for nursing practices in the management of pain in hospitalized neonates will be evaluated.
Results: The results of this study will lead to the production of an operational and applicable protocol in the management of pain in hospitalized neonates. It can provide the basis for improving the clinical practice of nurses and subsequently improving the quality of neonatal care.
Conclusion: One of the strengths of this study is the use of an interprofessional team approach, considering the clients' priorities, and the improvement of organizational culture in order to endeavor for knowledge translation and change in clinical practice.