Journal of Research Development in Nursing and Midwifery

Redefining nursing power: From bedside presence to health system transformation

Abbas Abbaszadeh

Letter to the Editor

Effectiveness of cinnamol and chlorhexidine in treating oral mucositis in cancer patients: A Randomized Clinical Trial

Morteza Hasheminik

Background: Oral mucositis is a common complication of chemotherapy that significantly reduces patients' quality of life. While chlorhexidine mouthwash has been shown to improve oral mucositis, it can also cause side effects such as dysgeusia. In this context, simpler, plant-based alternatives like cinnamol may offer similar benefits without the associated side effects. This study aimed to compare the effectiveness of cinnamol mouthwash with that of chlorhexidine mouthwash in treating oral mucositis in cancer patients undergoing treatment with doxorubicin.

Methods: This randomized clinical trial included 81 patients with cancer (breast, ovarian, bladder, lung, and colorectal) from two hospitals in Neyshabur and Sabzevar cities, located in northeastern Iran, in 2023. Participants were allocated to the control (n=27), chlorhexidine (n=27), and cinnamol (n=27) groups using a block randomization method. The control group received 0.9% physiological saline; the chlorhexidine group used chlorhexidine mouthwash, and the cinnamol group used cinnamol mouthwash. Participants were instructed to mix 25 drops of their assigned solution with 50 mL of lukewarm water, gargle for 30 seconds, and then expel the mixture. The intervention was administered twice every 12 hours for 14 days. Data were collected using a demographic questionnaire and the Standard Mucositis Assessment Tool on the first, seventh, and fourteenth days of the intervention. Data analysis was performed using R software version 4.2.2, employing univariate tests and the cumulative link mixed-effects model (CLMM). Results were presented as odds ratios with 95% confidence intervals.
Results: Both cinnamol and chlorhexidine mouthwashes significantly reduced oral mucositis severity compared to the control group. The odds of more severe mucositis in patients using chlorhexidine were 0.0021 times the odds in the control group (OR = 0.0021, p<0.001), meaning a lower risk in the chlorhexidine group by a factor of about 1/0.0021 ≈ 476). Also, cinnamol administration significantly diminished the odds of severe mucositis (OR = 0.0005, p<0.001) compared to the control. Over time, the protective effects of chlorhexidine (OR = 0.024, p<0.001) and cinnamol (OR = 0.269, p=0.060) became more pronounced, indicating a progressive healing trajectory.
Conclusion: Cinnamol and chlorhexidine mouthwashes demonstrated significant efficacy in reducing oral mucositis severity, while chlorhexidine effects were more enhanced over time. These insights suggest that both interventions are valuable in managing oral mucositis, offering valuable guidance for nursing practice and patient care.

The relationship between spiritual and emotional intelligence and pain tolerance in orthopedic surgery patients in Baghdad, Iraq

Hadi Ahmadi Chenari

Background: Postoperative orthopedic pain is challenging; inadequate control prolongs hospitalization and increases costs. The present study examined the relationship between spiritual intelligence and emotional intelligence and pain tolerance.
Methods: This cross-sectional, analytical study was conducted on 170 orthopedic surgery patients at Baghdad Teaching Hospital in 2023. Participants were recruited through convenience sampling. Data were collected using the King’s Spiritual Intelligence Questionnaire, the Bar-On Emotional Quotient (EQ), and the Visual Analog Scale (VAS). Patients completed instruments two days post-surgery. Data were analyzed using SPSS 23, employing Pearson correlation coefficients, independent-samples t-test, and one-way ANOVA.
Results: Among 170 participants, the mean spiritual intelligence score was moderate (71.23±8.54), while emotional intelligence was low (184.25±17.3). Pain severity was high, with a mean score of 6.22 ± 0.73. Pearson’s correlation coefficient showed a strong negative association between spiritual intelligence (r = -0.62, p = 0.012) and emotional intelligence (r = -0.86, p = 0.01) and pain, with the relationship being stronger for emotional intelligence. Additionally, there was a positive relationship between the demographic variables of age (r = 0.84, p = 0.02) and the presence of comorbidity (t = 0.45, p = 0.03) with higher pain scores. Variables identified as determinants by the linear regression model included emotional intelligence (b=0.61, P<0.001), spiritual intelligence (b=0.98, P<0.001), age (b=0.17, P=0.02), and comorbidity (b=0.28, P=0.004).
Conclusion: Spiritual and emotional intelligence reduce pain and improve tolerance, with stronger effects observed for emotional intelligence. Strengthening emotional intelligence among patients is essential. Nursing strategies should include training programs to enhance emotional intelligence skills, such as stress management and effective communication, to better equip patients in coping with pain.

Telehealth palliative care for chronic obstructive pulmonary disease in Iran: The Study Protocol of a Randomized Controlled Feasibility Trial

Arpi Manookian

Background: Chronic obstructive pulmonary disease (COPD) is a progressive, irreversible respiratory condition that imposes a significant physical and psychological burden, often leading to a poor quality of life. Although palliative care can help address these challenges, in Iran it is typically limited to cancer patients and is not commonly provided to those with COPD. Globally, the early integration of palliative care for chronic illnesses is expanding. The present study aims to investigate the feasibility and acceptability of an early tele-palliative care intervention for patients with COPD in Iran and to explore its potential effects on quality of life, anxiety, depression, and emergency department readmissions.
Methods: This randomized controlled feasibility trial protocol involves a 3-month early tele-palliative care program delivered by two nurse coaches, targeting patients with COPD. Participantswere randomly assigned to either the intervention group (n = 26) or the control group (n = 26) using permuted block randomization. Both groups received traditional COPD care; however, the intervention group also received six weekly telephone sessions and six weeks of follow-up support via phone call and WhatsApp Messenger. The primary objective was to assess the feasibility and acceptability of early tele-palliative care, measured through recruitment and attrition rates, questionnaire completion rates, patient satisfaction, attitudes toward the intervention, and adherence to the intervention. The secondary outcome included changes in quality of life, anxiety, depression, and hospital readmissions. These were measured using validated instruments at two time points: Baseline (pre-intervention) and three months post-intervention. Statistical analyses were performed using SPSS version 22, including the independent samples t-test, paired samples t-test, chi-square test, and Fisher’s exact test. Analysis of covariance (ANCOVA) was used to compare the mean outcomes between the two groups while statistically controlling for the effect of baseline values. Statistical significance was set at p < 0.05.
Conclusion: This study protocol aimed to determine the feasibility and acceptability of an early tele-palliative care intervention for patients with COPD in Iran. The findings provided essential data to inform the design of a future large-scale clinical trial and support the potential integration of early telehealth palliative care into standard COPD management in the country.

Quality of life in patients treated for oral and laryngeal squamous cell carcinoma in Northeast Iran

Maryam Ghelichli

Background: Patients with oral and/or laryngeal carcinoma face challenges that can persistently impair their quality of life (QoL) even after treatment. This study aimed to investigate QoL impairment in patients with oral and laryngeal squamous cell carcinoma receiving treatment.
Methods: This descriptive cross-sectional study was conducted on 54 individuals with oral and laryngeal cancer through census sampling in 2022. Patients over 18 years old who had received treatment were included. Individuals experiencing recurrences or relapses and those receiving neoadjuvant therapy were excluded. The list of names and phone numbers of participants was obtained from the database of the Liver and Digestive Research Centre in Golestan Province, Iran. The study utilized the Persian version of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire–Head and Neck 35, which the participants completed during phone interviews. Point prevalence (per 100,000) was reported with 95% confidence intervals, and QoL data were summarized as mean ± standard deviation (SD) and median (interquartile range, IQR).
Results: The point prevalence of oral and laryngeal squamous cell carcinoma in Golestan Province was 15.15 per 100,000, with significant variation across counties, ranging from 5.80 to 26.01. The mean QoL score for the participants was 68.20 ± 29.58. Overall, 38.9% of the participants reported normal QoL, while 22.2% and 38.9% reported mild and moderate impairment, respectively. Subdomains related to weight loss and feeling ill showed a severe decline in QoL. Meanwhile, issues such as dry mouth, sticky saliva, social contacts, swallowing, pain, taste/smell, social eating, teeth problems, and speech were associated with moderate QoL impairment.
Conclusion: The findings show that the QoL among individuals with a history of oral and laryngeal cancer was below the threshold. Most participants experienced mild to moderate QoL impairments. These results highlight the need for targeted interventions focused on improving QoL for affected individuals based on their symptoms and signs.

Fear of childbirth and its associated factors among pregnant women in Bangladesh: A cross-sectional study

Habiba Khanom

Background: Fear of childbirth (FOC) is a widespread maternal health concern associated with heightened anxiety, increased medical interventions, and negative birth experiences. While prevalent globally, FOC remains underexamined in low-resource settings such as Bangladesh. This study aimed to determine the level of FOC and identify associated factors among pregnant women in Bangladesh.
Methods: A cross-sectional study was conducted among 262 pregnant women attending antenatal care at Shariatpur Government Upazila Health Complex (December 2023–May 2024). Data were collected using a structured questionnaire and the Melender FOC Scale. Participants were selected using a convenience sampling technique. Fear was categorized as low, moderate, or high. Descriptive analysis, Chi-square tests, ordinal logistic regression, and multivariate logistic regression were performed to identify predictors of FOC using SPSS version 25.
Results: A survey of 262 pregnant women revealed a moderate mean level of fear of childbirth (FOC) (47.45 ± 6.9). Regression analysis identified several significant predictors of higher FOC. The strongest associations were with limited spousal support (AOR = 2.64; 95% CI: 1.38–5.06; p = 0.003) and not attending childbirth classes (AOR = 2.33; 95% CI: 1.21–4.49; p = 0.011). Other significant factors included younger maternal age, lower education (in both the woman and her husband), rural residence, and lower socioeconomic status. These findings underscore the multifactorial nature of FOC, highlighting the need for interventions that address its key social and educational determinants.
Conclusion: FOC is highly prevalent among pregnant women in Bangladesh and is influenced by sociodemographic, obstetric, and psychosocial factors. Routine screening, culturally sensitive prenatal education, improved communication, and partner-inclusive support are recommended to reduce FOC and improve maternal outcomes.

Effect of progressive muscle relaxation on headache-related disability in patients with multiple sclerosis: A quasi-experimental study

Alireza Salar

Background: Headache is common in multiple sclerosis and is associated with greater functional disability. We aimed to determine whether a structured progressive muscle relaxation (PMR) program reduces headache-related disability in multiple sclerosis.
Methods: We conducted a parallel-group, quasi-experimental pretest–posttest study at Multiple Sclerosis Society clinics in Zahedan, Iran (2023). Adults with MS and recurrent headaches were allocated to PMR (n = 30) or usual care (n = 30). The PMR intervention comprised three 20 - 30-minute group sessions on consecutive days plus daily home practice for six weeks; adherence was supported by weekly phone calls. The primary outcome was the Headache Disability Inventory (HDI; 0 - 88), measured at baseline and at 3-month follow-up. Analyses were conducted using SPSS version 24 and employed χ² tests and ANCOVA, adjusting for baseline HDI and disease duration (α = 0.05).
Results: Sixty participants completed the trial (30 in the PMR group and 30 in the control group). The groups were comparable in age and gender at baseline; however, disease duration was significantly longer in the PMR group (p = 0.014). At the 3-month follow-up, HDI scores showed a significant decrease in the PMR group (21.5 ± 15.6) and a significant increase in the control group (45.1 ± 16.9), resulting in a significant between-group difference (p < 0.001). An analysis of covariance (ANCOVA), controlling for baseline HDI scores and disease duration, confirmed a significant treatment effect (F = 25.07, p < 0.001) with a large effect size (partial η2 = 0.305).
Conclusion: A six-week progressive muscle relaxation program significantly reduced headache-related disability at 3-month follow-up in multiple sclerosis and appears to be a feasible, low-cost adjunct to routine care. Larger randomized trials with longer follow-up and objective adherence tracking are warranted.

Survey of workplace bullying among nurses working and related factors in the Emergency Departments of hospitals in Nasiriyah, Iraq

Mokhtar Mahmoudi

Background: Workplace bullying among nurses is a prevalent problem with well-documented adverse effects on mental health, job satisfaction, and the quality of patient care. This study aimed to determine the prevalence and characteristics of workplace bullying among nurses working in Emergency Departments.
Methods: This descriptive-analytical cross-sectional study was conducted in 2025 among 242 nurses working in the Emergency Departments of four hospitals in Nasiriyah, Iraq. Participants were selected using stratified random sampling. Data were collected using a demographic information questionnaire and the Negative Acts Questionnaire (NAQ). Data analysis was performed using SPSS version 26. Descriptive statistics (means and standard deviations) and inferential statistical tests (independent t-test and one-way ANOVA) were applied, along with stepwise multiple regression analysis.
Results: The mean ± standard deviation of the total bullying score was 50.40 ± 14.52. The mean ± standard deviation of the occupational dimension was 20.32 ± 7.56, the individual dimension was 10.26 ± 4.30, and the physical dimension was 9.92 ± 4.07. Based on the regression results, work experience in the Emergency Department (β = -0.148, 95% CI: -1.163 to -0.094, P = 0.021) and interest in working in the current department (β = -0.131, 95% CI: -10.466 to -0.238, P = 0.04) had a negative and significant effect on workplace bullying.
Conclusion: The findings showed that although the mean bullying scores were at a low level, planning for their further reduction is necessary. These results emphasize the need for preventive measures such as training and retraining, establishing a safe reporting environment, and addressing the perpetrators of bullying.

The role of work schedule characteristics in shaping nurses’ emigration intention in Iran

Fatemeh Heshmati Nabavi

Background: Nurse emigration exacerbates the growing nursing shortage. As undesirable work schedules are linked to job burnout and emigration intention, this study aimed to comprehensively investigate the association between work schedule characteristics and nurses' intent to emigrate in Iran.
Methods: This was a cross-sectional study conducted on 560 nurses working in the medical and surgical wards of four affiliated university hospitals in the eastern part of Iran in 2025. Sampling was performed using a multistage cluster sampling method with proportional allocation, followed by simple random sampling within each ward. Data were collected using a demographic questionnaire, an adapted tool from the Trinkoff instrument for work schedule characteristics, and a dichotomous question (Yes/No) assessing intent to emigrate. Data analysis was performed using logistic regression in Stata software version 17, with a significance level of P < 0.05.
Results: A total of 39.1% of nurses reported an intent to emigrate. In the adjusted model, daily working hours of 13 to 18 hours were associated with a significantly increased intent to emigrate (OR = 2.12; 95% CI: 1.12 - 3.99). Nurses working rotating shifts had a higher likelihood of intent to emigrate compared with those working morning shifts (OR = 2.89; 95% CI: 1.73 - 4.83), and this likelihood was even higher among those working combined morning and night shifts (OR = 5.26; 95% CI: 2.54 - 10.89). Furthermore, quick returns (short rest periods between shifts) were identified as a significant predictor (OR = 2.16; 95% CI: 1.28 - 3.65).
Conclusion: The findings of this study indicate that long daily working hours, rotating and combined shifts, and quick returns are among the most significant factors associated with nurses' intent to emigrate. Recommendations for health policymakers and administrators include implementing strict limits on daily working hours to eliminate quick returns and restructuring schedules to significantly increase predictability and nurse autonomy. Addressing these stressors can reduce emigration intent and enhance healthcare system stability.

Organizational climate and presenteeism orientation in nurses: A cross-sectional study

Reza Jahanshahi

Background: Organizational climate strongly influences job performance and well-being in healthcare. An unfavorable climate may increase presenteeism, defined as attending work despite illness, symptoms, or reduced physical or mental capacity, often resulting in decreased productivity and potential risks to patient safety, particularly among nurses. This study examined the relationship between organizational climate and presenteeism in Iranian nurses.
Methods: A cross-sectional analytical study was conducted in 2025 among 327 nurses working in selected hospitals affiliated with Golestan University of Medical Sciences, recruited through convenience sampling. Data were collected using a demographic questionnaire, the Halpin and Croft Organizational Climate Questionnaire, and the Nursing Presenteeism Questionnaire. Descriptive statistics, Pearson’s correlation, and multivariable linear regression were applied. Model assumptions were examined, and a significance level of P < 0.05 was considered.
Results: The mean age of participants was 33.91 ± 6.75 years, with an average work experience of 9.56 ± 6.30 years. The mean ± SD scores of organizational climates and presenteeism were 99.21 ± 9.24 and 40.89 ± 7.32, respectively. Correlation analysis showed a significant negative correlation between organizational climate and presenteeism (R = -0.156, P = 0.005). Regression analysis (performed on log-transformed presenteeism scores to correct non-normality) indicated that organizational climate was a significant negative predictor of presenteeism (β = -0.220, P < 0.001), whereas older age was associated with higher presenteeism (β = 0.159, P = 0.008).
Conclusion: This study demonstrated that a more positive organizational climate is modestly correlated with reduced presenteeism among nurses; however, the effect size was small. These findings highlight the importance of organizational and managerial strategies, suggesting that improving the work climate may help reduce presenteeism and promote nurse well-being.

Acknowledgment to referees 2025

Leila Jouybari

The Editorial team at the Journal of Research Development in Nursing and Midwifery would like to extend our heartfelt gratitude and recognition to the reviewers who dedicated their time and expertise to review manuscripts for J Res Dev Nurs Midw in 2025. Your commitment and contributions have been invaluable in maintaining the high quality of the articles published in our journal. We express our sincerest appreciation to all the exceptional scientists, researchers, and clinicians who have served as reviewers and have been an integral part of our community.
Editor-in-Chief
Prof. Leila Jouybari

Akram Sanagoo
Associate Professor of Nursing, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran.
Ameneh Mahmoudian
Assistant Professor of Nursing, Nursing care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
Asieh Sedighi-Chafjiri
Instructor of Medical Surgical Nursing, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
Elaheh Sanjari
Phd Biostatistics, Tehran University of Medical Sciences, Tehran, Iran.
Elham Adibmoghaddam
Assistant Professor of Reproductive Health, Department of Midwifery, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran.
Elham Lotfalinezhad
Assistant Professor of Gerontology, Department of Psychiatry and Community Health Nursing, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran.
Farzaneh Barati
Assistant Professor of Nursing, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran.
Fatemeh Mehravar
Assistant Professor of Epidemiology, Department of Biostatistics and Epidemiology, School of Health, Golestan University of Medical Sciences, Gorgan, Iran.
Fereshteh Araghian
Assistant Professor of Nursing, School of Nursing and Midwifery, Mazandaran University of Medical Sciences, Sari, Iran.
Hamideh Mancheri
Assistant Professor of Nursing Education, Department of Psychiatry and Community Health Nursing, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran.
Hadi Raeisi
Assistant Professor of Biostatistics, Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Chaharmahal and Bakhtiari Province, Iran.
Khadijeh Yazdi
Associate Professor of Nursing, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran.
Mahin Nomali
Assistant Professor of Epidemiology, Department of Biostatistics and Epidemiology, School of Health, Mazandaran University of Medical Sciences, Sari, Iran.
Mehdi Rezvaniamin
Assistant Professor of Nursing, Community Nursing Research Center, Zahedan University of Medical Sciences, Zahedan, Iran.
Sepideh Mashayekh-Amiri
Assistant Professor of Midwifery, Education Department of Midwifery, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran.
Razieh Talebi
Assistant Professor of Nursing, Department of Reproductive Health Midwifery, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran.
Soheyla Kalantari
Assistant Professor of Nursing, Department of Operating Room, School of Allied Medical Sciences, Golestan University of Medical Sciences, Gorgan, Iran.
Shohreh Kolagari
Associate Professor of Nursing, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran.
Somayeh Ghorbani
Assistant Professor of Biostatistics, Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran.
Zahra Sabzi
Associate Professor of Nursing, Department of Reproductive Health Midwifery, School of Nursing and Midwifery, Golestan University of Medical Sciences, Gorgan, Iran.