Journal of Research Development in Nursing and Midwifery

Enhancing comprehensive care: The importance of collaboration among healthcare professionals in managing chronic conditions in Australia

Akram Sanagoo

Letter to the Editor

The effect of prenatal yoga on maintaining the childbirth process in a physiological state in Indonesian mothers

Ocktariyana Ocktariyana

Background: Yoga is a non-pharmacological intervention that enhances maternal strength and flexibility while improving the mother's capacity to adapt to physiological changes and labor responses. This study aimed to evaluate the effect of prenatal yoga on the duration of the first, second, and third stages of labor, as well as blood volume during the fourth stage of labor.
Methods: A quasi-experimental study was conducted involving 92 pregnant women in their third trimester who presented no complications and exhibited low-risk factors. The participants were assigned to either the yoga intervention group or the control group using a simple random sampling method. The intervention group engaged in yoga sessions lasting 30 min, conducted over eight weeks, beginning at 30 weeks of gestation. In contrast, the control group received routine standard care without any yoga intervention. The durations of the first, second, and third stages of labor as well as blood volume during the fourth stage, were analyzed between the intervention and control groups using independent t-test and Mann-Whitney U test, with a significance level of p <0.05.
Results: The study revealed a significant difference in the duration of the first (p=0.004) and second stages (p=0.0001) of labor, as well as in the bleeding volume during the fourth stage of labor (p=0.0001) between the yoga intervention group and the control group. However, no significant difference was observed in the duration of the third stage of labor (p=0.234).
Conclusion: Prenatal yoga during the third trimester of pregnancy may help maintain physiological conditions during the first and second stages of labor and reduce the risk of bleeding.

The relationship between perceived stress and postpartum depression through the mediating role of marital satisfaction in postpartum women

Saeed Bakhtiarpour

Background: Postpartum depression (PPD) is a significant mental health concern affecting many women worldwide. While various factors contribute to PPD, the role of perceived stress and marital satisfaction remains underexplored. This research aimed to investigate the mediating role of marital satisfaction in the relationship between perceived stress and PPD among postpartum women in Ahvaz.
Methods: A cross-sectional study utilizing structural equation modeling examined the relationships among perceived stress, marital satisfaction, and PPD. A convenience sample of 319 postpartum women who visited healthcare centers in Ahvaz, southern Iran, in 2023 was recruited. Data were collected using the Edinburgh Postnatal Depression Scale, the Perceived Stress Scale, and the Marital Satisfaction Scale. Data analysis was performed using structural equation modeling with SPSS-26 and AMOS-26 software.
Results: The findings indicated a significant negative correlation between perceived stress and marital satisfaction (β = -0.45, P < 0.001). Both marital satisfaction (β = -0.31, P = 0.008) and perceived stress (β = 0.20, P = 0.028) were significantly related to PPD. Bootstrapping results also confirmed a significant indirect effect of perceived stress on PPD via marital satisfaction (β = 0.17, P = 0.027).
Conclusion: The interplay between perceived stress, marital satisfaction, and PPD is complex and multifaceted. This research highlights the potential importance of marital satisfaction as a critical factor in understanding the pathway between stress and PPD. Future interventions might consider incorporating strategies to enhance marital quality to reduce the risk of PPD.

The Persian version of caregiver self-efficacy scale (CSES): A psychometric evaluation among family caregivers of patients with cancer

Hossein Ebrahimi

Background: Family caregivers of cancer patients encounter numerous challenges while providing care, and self-efficacy is a key factor in alleviating these negative effects. This study aimed to investigate the psychometric properties of the Persian version of the Caregiver Self-Efficacy Scale (CSES) among caregivers of cancer patients.
Methods: This methodological study employed a cross-sectional design involving 382 family caregivers of cancer patients in a teaching hospital in Iran, in 2024. The CSES was translated into Persian using the forward-backward procedure. The initial translation was assessed for face and content validity through both quantitative and qualitative methods. Construct validity was evaluated using exploratory and confirmatory factor analysis. Discriminant validity was examined using the Heterotrait–Monotrait (HTMT) ratio. Reliability was assessed by evaluating internal consistency using Cronbach's alpha and Mcdonald's omega, and stability was measured using intraclass correlation coefficients (ICCs).
Results: In this study, 53.7% of the participants were male, and the caregivers' mean age was 42.52 ± 11.83 years. Scale-level content validity index was reported 0.97 by expert panel during content validity stage. During the exploratory factor analysis, one item was excluded, leaving seven items were categorized into two factors: caregiver self-management and patient challenges. These factors collectively accounted for 43.9% of the variance in self-efficacy. Confirmatory factor analysis confirmed the adequacy of the model derived from the exploratory factor analysis (RMSEA = 0.05, GFI = 0.947, and CFI = 0.906). The factors demonstrated discriminant validity. Cronbach's alpha values for the patient challenges and caregiver self-management factors were 0.802 and 0.798, respectively. In addition, the ICC for these two factors was reported to be 0.830 and 0.802, respectively.
Conclusion: The Persian adaptation of the CSES demonstrates satisfactory validity and reliability for assessing the self-efficacy of family caregivers of cancer patients in Iran.

Effects of buzzy device and distraction cards on pain relief during intravenous cannulation in children: A Randomized Controlled Trial

Mohammed Attaallah Ahmed

Background: Under ethical and legal professional obligations, nurses are required to utilize evidence-based methods to enhance the experience of children during intravenous cannulation. Non-pharmacological pain management techniques are increasingly employed in clinical settings, as they can be implemented without incurring additional costs or requiring extra time. The aim of this randomized controlled trial is to evaluate the effectiveness of a Buzzy device and distraction cards in reducing pain associated with peripheral intravenous catheter (PIVC) insertion among school-aged children.
Methods: A randomized controlled trial study was conducted on 221 school-age children patients who underwent PIVC in emergency departments. Three groups of patients were randomly assigned using a lottery method: the Buzzy device group (n=73), the distraction cards group (n=71), and the control group (n=77) receiving the standard procedure without any interventions. The children were asked to evaluate the pain level immediately following PIVC using the Wong-Baker Faces Pain Scale. Using SPSS (version 26), the independent t-test, Fisher's exact test, analysis of variance, and chi-square test were used to analyze the data.
Results: Children in the intervention groups experienced significantly less pain during the PIVC procedure compared to those in the control group, with a pain score of 5.45 ± 1.67 (p = 0.0001). There was no statistically significant difference in pain reduction between the two intervention methods: the distraction cards (2.54 ± 1.37) and the Buzzy device (2.43 ± 1.60), both showing effectiveness (p = 0.0001).
Conclusion: The results of this study indicate that both the Buzzy device and distraction cards effectively reduce pain levels during intravenous cannulation when compared to the control group. Furthermore, the two strategies demonstrated equivalent effectiveness in pain reduction, as their outcomes were nearly identical. Therefore, it is recommended that these therapeutic approaches be employed to manage and alleviate pain associated with PIVC.

Nurses' perspectives on the challenges of sickle cell disease management and associated factors in a teaching hospital in south-western Nigeria

Olamide O Afolalu

Background: Since the discovery of sickle cell disease (SCD) in the early 1990s, enormous strides have been made to reduce its global spread. More studies have focused on the management of SCD complications, with little or no information on how nurses cope with the care of hospitalized patients. This study aimed to assess the challenges nurses face in managing SCD and associated factors at Osun State University Teaching Hospital, Osogbo, Nigeria.
Methods: This cross-sectional survey study was conducted to elicit responses from 215 nurses selected through a simple random sampling technique between August and October 2022. A structured, validated questionnaire consisting of 31 items served as an instrument for data collection. Data were analyzed using SPSS. Inferential statistical analyses, including Chi-square test, independent samples t-test, and one-way ANOVA with post hoc multiple comparison tests, were conducted.
Results: Among the participants, 167 (77.7%) were female, with a mean age of 24.3 ± 0.94 years. The majority, 81 (37.7%), of the participants were aged between 31 and 40 years. The most significant challenge to SCD management was addiction to opioids and other analgesics, 174 (80.9%), while the least experienced challenge was patient signing out against medical advice 180 (83.7%). The majority of the participants, 194 (90.2%), stated that lack of financial resources to initiate treatment was the most significant factor associated with the challenges experienced in managing these patients. Significant associations were found between challenges of SCD management and the age of the nurses (P = 0.038), years of work experience (P = 0.011), and the level of professional education of the nurses (P = 0.002).
Conclusion: The administration of care for patients with SCD is hindered by multiple factors, which necessitates further investigation into the long-term impacts of educational background and job experience of nurses in the delivery of care to patients with SCD.

Strategies, practices, and challenges in enhancing quality assurance in qualitative biomedical research: A multi-method study protocol

Shima Shirozhan

Background: The qualitative research paradigm is crucial for understanding complex human phenomena, making credibility essential for its findings. Challenges in applying quality assessment criteria and promoting responsible practices in biomedical research underscore the need to review strategies, practices, and challenges in evaluating the quality of qualitative research. This protocol aims to support a multi-method study that develops evidence-informed, comprehensive, and practical recommendations to enhance quality assurance in qualitative research within the biomedical field.
Methods: This multi-method study protocol consists of three phases: a systematic scoping review, qualitative content analysis, and a Delphi survey. The scoping review will follow Arksey and O’Malley’s five-step approach, using relevant keywords to guide a systematic search across databases such as PubMed, CINAHL, Web of Science, Scopus, and Embase, with no time restrictions. Qualitative content analysis will follow Graneheim and Lundman’s (2004) method. Purposeful sampling will be used to select experts in qualitative research. Semi-structured interviews will collect their experiences in evaluating qualitative research quality. Based on the review and interview findings, comprehensive, evidence-informed, and practical recommendations within the biomedical field will be developed and further refined using the Delphi method.
Conclusion: This study aims to critically examine quality achievement and evaluation in the qualitative paradigm and identify challenges, practices, and strategies through a review of existing evidence, focusing on related experiences and perceptions. The study also seeks to address gaps and controversies in the literature using qualitative content analysis. Ultimately, the goal is to develop comprehensive, evidence-informed, and practical recommendations to enhance quality assurance in qualitative research.

The relationship between the perception of spiritual care and attitudes and behaviors toward end-of-life care in critical care nurses in northern Turkey

Asuman Çobanoğlu

Background: Critical care nurses’ spiritual care and end-of-life care practices are important in providing and maintaining holistic care. This study aimed to explore the relationship between critical care nurses’ perceptions of spiritual care and their attitudes and behaviors toward end-of-life care.
Methods: This cross-sectional and correlational study was conducted with 174 critical care nurses employed in two state hospitals in northern Turkey. Research data were collected from May 2024 to July 2024. The inclusion criteria were being employed as a nurse in the intensive care unit for at least one year and voluntarily participating in the study. Data were collected using a Nurse Introduction Form, the Spirituality and Spiritual Care Rating Scale (SSCRS), and the End-of-Life Care Attitudes and Behaviors Scale (EACAS) of Intensive Care Nurses. The data were analyzed using SPSS version 25.0. The Mann-Whitney U test and Kruskal-Wallis test were employed, along with Pearson correlation analysis and hierarchical multiple regression analysis, to analyze the data.
Results: There was no significant correlation between the mean total score of critical care nurses on SSCRS and their mean total score regarding attitudes and behaviors toward end-of-life care (r = -0.063, p = 0.408). There was a moderate positive correlation between age (r = 0.224, p = 0.03) and professional experience (r = 0.189, p = 0.013) of critical care nurses and their attitudes and behaviors toward end-of-life care (p <0.05). Age (β = 0.013, p = 0.014), professional experience (β = 0.018, p = 0.041), and the status of receiving training on end-of-life care (β = 0.399, p = 0.00) were the most important predictors of the attitudes and behaviors of critical care nurses toward end-of-life care.
Conclusion: In this study, it was determined that critical care nurses’ perception of spiritual care was not a significant predictor of their attitudes and behaviors toward end-of-life care. However, it was seen that nurses' age and professional experience may affect their attitudes and behaviors toward end-of-life care. In this regard, educational programs to improve nurses’ perception of spiritual care and their attitudes and behaviors toward end-of-life care are recommended.

The effectiveness of aloe vera gel versus 2% chlorhexidine gluconate in preventing phlebitis from peripheral venous catheters: A randomized controlled trial

Mahin Naderi Far

Background: While intravenous injections are essential in life-saving situations, their routine use can lead to various complications, particularly phlebitis, which negatively impacts patients' physical and psychological health. This research aims to evaluate the effectiveness of topical aloe vera gel compared to 2% chlorhexidine gluconate in preventing phlebitis associated with peripheral venous catheters.
Methods: This three-arm randomized controlled trial, executed in 2024 at a university-affiliated hospital situated in southern Iran, enrolled 90 hospitalized individuals receiving intravenous therapy. The study employed convenience sampling for participant recruitment, followed by permuted block randomization with a block size of six to allocate participants into three distinct groups, each comprising 30 patients. Aa (aloe vera group): Disinfection with 70% alcohol, and the catheter fixation with an adhesive dressing impregnated with aloe vera gel; Bb (chlorhexidine group): Disinfection with 70% alcohol and chlorhexidine, followed by fixation with a chlorhexidine-impregnated adhesive dressing; and C (control group): Disinfection with 70% alcohol and standard adhesive dressing. The catheter insertion site was systematically evaluated for the incidence of phlebitis using a standardized phlebitis checklist at discrete time points: 12, 24, 36, 48, 60, and 72 hours post-sampling. Statistical analysis of the collected data was performed employing SPSS version 25 statistical software. A significance threshold of α = 0.05 was adopted for all statistical tests, which included Chi-square tests and one-way analysis of variance (ANOVA).
Results: At 72 hours post-intervention, the incidence of phlebitis demonstrated a statistically significant disparity between the groups (p = 0.005). Conversely, no significant intergroup differences were evident in the manifestation of phlebitis symptoms at the 12-hour (p = 0.999), 24-hour (p = 0.493), 36-hour (p = 0.493), 48-hour (p = 0.186), and 60-hour (p = 0.064) time points after the intervention. Specifically, out of 30 participants in the aloe vera group, 12 (40%) remained asymptomatic for phlebitis—defined by the absence of redness, edema, pain, and vein induration—up to the 72-hour assessment. In comparison, the chlorhexidine group exhibited 5 (16.7%) patients, while the control group presented with only 2 (6.7%) patients who did not display phlebitis symptoms during this period.
Conclusion: Based on the observed outcomes, nurses may consider using aloe vera gel to reduce phlebitis in patients requiring catheterization for more than 48 hours, due to its anti-inflammatory properties and non-pharmacological benefits. However, this recommendation should be approached cautiously, pending further rigorous research to validate these initial findings and develop standardized guidelines. Future studies should investigate the long-term effects of aloe vera gel, compare its effectiveness with other interventions, and assess patient outcomes in various clinical settings to better understand its role in preventing phlebitis.

Development and validation of a nursing care protocol for pregnant women and newborns in Brazil

Eny Dorea

Background: The standards for the care of women and newborns are a collaborative plan of care based on the prioritization of diagnoses, problems, health issues, and mutually established goals, involving the interprofessional team, the patient, their supportive network, or community. Thus, it is crucial to develop a plan of care and implement it in this field to promote the health of women and newborns. This study aims to develop and validate a clinical protocol modeled on the nursing process for implementation in a Normal Birth Center (NBC) in Brazil.
Methods: This methodological study with a qualitative approach was developed in four distinct phases: scoping reviews, qualitative discussions with nurses, and the construction and validation of the protocol.
Results: The scoping review on diagnoses yielded 26 nursing diagnoses. The scoping review on interventions underscored the significance of employing non-pharmacological techniques for pain relief and maternal and neonatal care, highlighting the importance of providing physical and emotional support to women and their babies. The clinical protocol was developed utilizing the minimum nursing dataset, correlating with the 35 evaluated diagnoses in consultations with nurses, and integrating interventions and linkages from NANDA-NIC-NOC. 10 nursing experts validated the protocol.
Conclusion: The clinical protocol will be implemented in an NBC to enhance nursing care for pregnant women and neonates. Additionally, it is anticipated that this study will stimulate the development of new research on the topic, linking various contributions to the field of obstetric nursing and increasing awareness of its value through individualized, targeted diagnoses, interventions, and activities.