Iran Journal of Nursing

Background & Aims: Failed pregnancy is a destructive and common experience associated with physical, psychological, and cognitive complications, including a negative self-image, doubts about one's fertility, considering the body to be inefficient, and feeling of failure in playing the feminine role and fulfilling the feminine identity adequately, which are manifested through reduced sexual activity and unwillingness to become pregnant again. In addition, the lack of sexual drive causes communicational tensions between parents. Therefore, a failed pregnancy affects the approach and attitude toward parenting, and since attitude is the foremost factor in the development of reproductive behavior, changing attitudes toward childbearing decreases fertility. Repeated pregnancy positively influences the stress caused by a failed pregnancy despite a sense of doubt and hesitation in the parents. After fetal loss, the majority of women need consultations and follow-ups regarding the causes of the incident, estimated risk of future pregnancy, and prevention of recurrence, while they may not be presented with the opportunity and receive no training, and the lack of awareness leads to concerns about the recurrence of the incident, unwillingness for another pregnancy, and even the attempt to conceive inappropriately. Therefore, the provision of an educational, care, and support program for these women with an emphasis on their experience of a failed pregnancy is paramount. Knowledge-based empowerment interventions promote the knowledge of fertility, self-efficacy, self-esteem, and self-control, thereby improving social communication, reducing negative emotions, and creating the right attitude to life experiences; in relation to failed pregnancies, such interventions have not been performed in Iran. The present study aimed to evaluate the impact of empowerment on women with a history of failed pregnancies.
Materials & Methods: This clinical trial was conducted on 80 women with a history of failed pregnancies who were admitted to Shahid Akbarabadi Hospital in Tehran, Iran within the past 3-6 weeks for the termination of pregnancy during January-May 2020. The inclusion criteria were the age of 18-40 years, basic literacy, no medical prohibition for pregnancy, no children, absence of mental disorders, no pregnancy after a failed pregnancy, history of failed pregnancies up to the maximum of two cases, no history of infertility, and intentional failed pregnancy. The exclusion criteria were stressful events during the study, absence in more than one training session, and pregnancy during the study. The names of eligible subjects were extracted from the hospital medical records unit continuously until the completion of the sample size. The women were invited to participate via phone. After obtaining written informed consent from all the subjects, they were assigned to two groups of intervention and control with four random blocks, and each sample was assigned a specific code. In the intervention group, empowerment training was performed based on the steps of threat perception, problem-solving, training participation, and evaluation in four training sessions and group discussions for four consecutive weeks at Akbarabadi Medical Training Center. Before and six weeks after the intervention, data were collected using Soderberg's attitudes toward fertility and childbearing scale, which was completed by both groups. Data analysis was performed in SPSS version 16 using independent and paired t-test, analysis of covariance (ANCOVA), Chi-square, and Fisher's exact test, and the P-value of less than 0.05 was considered significant.   
Results: The intervention and control groups had no significant differences in terms of the mean age of the women and their spouses, women's age upon marriage, duration of marriage, women's age in the first pregnancy, fetal age, education level, occupation status of the spouses, cause of the failed pregnancy, gender of the expired fetus, method of pregnancy termination, and current method of contraception (P>0.05). Before the intervention, no significant differences were observed in the mean scores of attitude toward the fertility and childbearing of the women and all the subscales, with the exception of fertility required for the fulfillment of prerequisites (P=0.032) between the intervention and control groups (P>0.05). Six weeks after the intervention, the results of independent t-test and ANCOVA indicated significant differences in the mean scores of attitude toward fertility, female fertility, and all the subscales between the study groups (P<0.001), and the scores of the intervention group were significantly higher compared to the control group. In addition, the results of paired t-test showed significant differences in the mean scores of attitude toward fertility, childbearing, and all the subscales in the intervention group after the intervention as the scores were higher compared to before the intervention (P<0.001), while the difference was not considered significant in the control group (P>0.05). The results of independent t-test also indicated that the increase in the scores of attitude toward pregnancy, childbearing, and all the subscales was more significant in the intervention group compared to the control group six weeks after the intervention than before the intervention (P<0.001).   
Conclusion: The present study aimed to assess the effects of empowerment on the attitudes toward fertility and childbearing in the women with a history of failed pregnancies. According to the results, the mean total score and mean scores of the subscales of attitudes toward fertility and childbearing were significantly higher in the intervention group after the empowerment training compared to the control group, indicating that the implementation of an empowerment program with the aim of increasing knowledge, motivation, self-esteem, and self-efficacy results in self-control, preventive behaviors, and improved attitudes, which in turn positively influence the promotion of health and quality of life. Although pregnancy could be a pleasurable experience for the mother and family, the awareness of loss and feelings of shock, sadness, anger, and rejection cause tremendous ambiguity and concerns about the consequences of future pregnancies, while also causing negative attitudes toward fertility and childbearing, which may lead to immediate attempts for repeated pregnancy without considering the challenges of a terminated pregnancy and recurrence of failed pregnancy or the unreasonable delay of the next pregnancy regardless of the time limit of female fertility. Therefore, psychological support and training along with physical care by knowledgeable experts could be effective by empowering these vulnerable women through providing correct information to eliminate misconceptions, which in turn enhances healthy fertility by improving the attitudes toward fertility and childbearing. Since midwives have more interaction with these women as one of the most effective healthcare team members, they could use our findings to take effective steps toward improving this crisis and finding proper solutions.
 

Background & Aims: Ensuring patient safety is the first vital step in improving the quality of healthcare services. Patient safety is defined as an event that prevents unwanted injuries to a patient due to functional and unintentional actions. Safety standards are a set of requirements that are critical to implementing patient safety programs at hospitals. These standards provide an operational framework to help the hospitals fully match with the dimensions of patient safety in order to provide quality and patient-centered services. Therefore, 100% compliance with the required standards of patient safety-friendly hospital should be the priority of every hospital. The COVID-19 pandemic is one of the emerging infectious diseases that has affected the whole world in recent months. As its outbreak is an unexpected event or sequence of events of enormous scale and overwhelming speed, it has led to a high degree of uncertainty and has posed a variety of challenges to healthcare systems. Therefore, the realization of this important issue is felt more than ever in the structures and processes of each hospital of the healthcare system, in order to successfully control and efficiently manage this disease and preserve national assets. Therefore, this study aimed to determine the compliance of Imam Khomeini Hospital of Tehran with the patient safety-friendly hospital standards with respect to COVID-19 pandemic in 2020.
Materials & Methods: This descriptive-analytical cross-sectional study was conducted from September- December 2020 in Imam Khomeini Hospital Complex of Tehran during COVID-19 pandemic. 266 nurses with inclusion criteria were selected via stratified random sampling. For this purpose, the required list of 1,200 nurses was received from the nursing office of the complex. 866 nurses from 50 different wards were selected from the list based on the inclusion criteria. Then, the nurses who were in the same wards were placed in one stratum, so that the existing 50 wards including emergency department, operating room, ICU, CCU, NICU, dialysis, internal ward, surgical ward, infectious disease wards, oncology, pediatric ward, VIP and diagnostic wards were finally placed in 13 strata. Therefore, 292 samples were selected based on the quota of nurses from 13 existing strata via simple random sampling to provide a specified sample size of 266 nurses with an additional 10% to manage their attrition. Online sampling was performed by sending the link of the questionnaires through the virtual network of the study. The questionnaires included nurses' demographic information and patient safety-friendly hospital standards (Parvizi et al), including 27 items and five dimensions. The minimum score was 27 and the maximum score was 135. A higher score from the point of view of the research unit meant that the hospital was more in line with the standards of a patient safety-friendly hospital. Item 21 was scored in reverse. Scores 108-135 showed high compliance, scores 80-107 indicated moderate compliance, and scores 27-79 indicated the poor compliance of the hospital with the standards of patient safety friendly hospital. The internal consistency of the instrument was determined to be 0.934 using Cronbach's alpha. After introducing the researcher and explaining the research objectives to the research units, data were collected. Data were analyzed using descriptive statistics including absolute and relative frequency distribution, mean and standard deviation in SPSS software version 16.
Results: The mean and standard deviation of the age of nurses was 38.6 ± 7.94 years and most of them (90.2%) were female. The mean and standard deviation of the total length of service as a nurse and the length of service in the current ward was 13.87 ± 7.41 and 6.87 ± 5.80 years, respectively. ICU nurses had the highest frequency, 25.6%, compared to other hospital wards, and also rotating shifts with 42.4% had the highest frequency. The level of compliance with the standards of patient safety friendly hospitals was 97.35 ± 16.59 from the perspective of most nurses (61.7%) (80-107), and 3.58 ± 0.62 based on a Likert scale, which indicates moderate compliance. Continuing education dimension with the average compliance equal to 3.87 ± 0.69 had the highest mean and governance and leadership with the average compliance equal to 3.41 ± 0.71 had the lowest mean scores. Mean scores of dimensions of a safe environment, participation, and interaction with patients and the community, safe clinical services were 3.45 ± 0.67, 3.44 ± 0.85, and 3.71 ± 0.7, respectively.
Conclusion: Based on the findings of the present study, the level of compliance with the standards of a patient safety-friendly hospital was moderate in the Imam Khomeini Hospital complex during the coronavirus pandemic. The highest and lowest levels of compliance were related to the dimension of continuing education and the dimension of governance and leadership included in the standards of patient safety-friendly hospital. To improve the current situation, purposeful and evidence-based management of organizational resources, attention to "barriers to achievement" dimensions of patient safety, institutionalizing patient safety culture and promoting safety, attention and focus on patient safety indicators, continuous and effective training of educational staff needs are needed to improve the safety of beneficiaries, especially during the COVID-19 pandemic. Relying on the results of the present study, managers can take appropriate corrective measures to achieve 100% compliance with patient safety-friendly hospital standards and national accreditation standards, and achieve patient safety goals and provide quality and patient-centered services in the healthcare system. The results of the present study can provide a basis for examining the patient safety status and monitoring it in future researches. It is recommended that future researchers, in order to ensure patient safety and monitor the quality of healthcare and patient-centered services, analyze non-compliance in mandatory, basic, and advanced standards of patient safety-friendly hospitals using PSFHI checklist of the World Health Organization through the process of observation, interview, and review of documents in the Imam Khomeini Hospital complex.