@article{ author = {Ranjbar, F and Gharacheh, M}, title = {“Letter to Editor” Should women postpone childbearing during the COVID-19 pandemic?}, abstract ={It is not clear whether women can decide to become pregnant during the COVID-19 pandemic or whether they are at risk, because examining the long-term consequences of the virus, especially in the first months of pregnancy, requires further time and research(1). The COVID-19 virus has not been found in the semen and testicles of men infected with the virus in the acute phase or during the recovery period, so it is unlikely that the disease will be transmitted sexually(2). However, it has been reported that the male reproductive system is vulnerable to the infection, and significant changes have been observed in the sex hormones of patients with COVID-19, suggesting damage to gonadal function. Therefore, young men who have recovered from COVID-19 and are interested in having children should receive counseling when deciding to have children(3). Due to damage to cellular immunity and physiological changes, pregnant women are susceptible to respiratory diseases and are more likely to develop severe pneumonia(4). Pregnant women may be at increased risk for severe COVID-19 disease. To reduce severe COVID-19 disease, pregnant women should be aware of the potential risks of the severe form of the disease. Therefore, the need to prevent COVID-19 in pregnant women should be emphasized, and potential barriers to these measures should be identified(5). However, a systematic review study found that pregnant women with COVID-19 had milder symptoms than the general population, and that despite the symptoms of viral pneumonia, their RT-PCR tests may be negative(6). Pregnant women with COVID-19 have a higher prevalence of preterm labor, low birth weight, cesarean delivery, and hospitalization in the NICU than in the general population(6,7). In reproductive-aged women with COVID-19 infection, pregnancy has been associated with increased risk of hospitalization in the intensive care unit and mechanical ventilation, but has not increased the risk of death. Although most mothers have been discharged from the hospital without any serious complications, severe maternal morbidity, multiple maternal deaths, and prenatal deaths due to COVID-19 have been reported. The possibility of vertical transmission of the virus to the fetus has not been ruled out, and therefore careful monitoring of pregnancy in cases of COVID-19 and measures to prevent neonatal infection are essential(8,9). Vertical transmission has been reported in several cases of maternal infection around delivery in the third trimester, suggesting fetal infection but it is not common. In the at risk newborns, neonatal outcomes such as preterm labor or placental abruption have been well reported in the absence of other problems(10). Little is known about the consequences of maternal infection in the first and second trimesters of pregnancy(10). Fever or hyperthermia during the first trimester of pregnancy, when organogenesis occurs, may be an environmental risk factor for fetal abnormalities, especially neural tube defects and miscarriages(11). Given that there is no evidence of maternal teratogenicity or increased risk of miscarriage, mortality, or maternal morbidity, fertility decisions (such as pregnancy decisions, termination of pregnancy) should not be made on the basis of these concerns from the outset(10). It should be noted that some of the drugs used to treat COVID-19 are contraindicated in pregnancy or their effects on the fetus are unknown. Antiviral drugs such as Remedivir and Arbidol have been shown to be effective against COVID-19, but further investigation is needed to assess their effectiveness in pregnancy(4). Pregnant and lactating women have been excluded from these studies(12). There is still no vaccine to prevent coronavirus infection, and few drugs have been shown to reduce mortality and morbidity(13). The COVID-19 crisis may also make it difficult for women to access to information, services, and essential products for sexual and reproductive health(14). The COVID-19 pandemic has reduced the number of pregnancy visits(10). There is still scarce knowledge about the short-term and long-term mental health of mothers and fetuses following maternal experience during the pandemic(15). However, according to the American College of Obstetricians and Gynecologists, pregnancy in the COVID-19 conditions is a personal choice and decisions about becoming pregnant should be made independently and based on their health status, potential risks of COVID-19 and other factors. People with a history of diabetes, lung disease, and heart disease have a higher risk of developing severe COVID-19 disease. Patients should also consider the economic aspect of pregnancy and the increase in family size in the situation that the pandemic has impaired the economy(16). According to the WHO, those who have given birth in the past six months or have experienced conditions such as diabetes, high blood pressure or breast cancer, or who smoke cigarette, should use a safe contraceptive method during the COVID-19 pandemic(17). Given the gap of knowledge, infertile patients should also be consulted about the advantages and disadvantages of initiating infertility treatment during the COVID-19 pandemic. This advice should be given to those who have certain conditions such as high blood pressure, diabetes and obesity that may be at increased risk if they become infected. Also, people with the disease should avoid pregnancy until they are fully recovered, and if they are during the infertility treatment cycle, it is recommended that they freeze their eggs or embryos and do not transmit the embryo until complete recovery(13). It is important to follow the recommendations of the Centers for Disease Control and Prevention (CDC), including washing hands with soap, not touching face, and observing physical isolation in all pregnant women or those planning to become pregnant(18). It is clear that access to contraception must also be maintained, and a range of long-term to short-term contraceptive methods, including emergency contraceptives, must be available to individuals. Preferably, contraceptive methods should be given to people for a few months and, if possible, counseling should be done remotely and people should be directed to self-management(10,14). Considering that we have to live in these certain conditions until the discovery of a vaccine or drug, all couples who want to become pregnant should receive sufficient and up-to-date information about the known risks of COVID-19 infection during pregnancy and how to prevent it. The use of telehealth or telemedicine for pre-conception counseling and other sexual and reproductive health services is a priority.}, Keywords = {COVID-19, Pregnancy, Childbearing}, volume = {33}, Number = {123}, pages = {1-5}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.29252/ijn.33.123.1}, url = {http://ijn.iums.ac.ir/article-1-3140-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3140-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {Lalehkani, M and Davati, A and Isanejad, A and Jadid-Milani, M}, title = {The Correlation between Happiness and Self-transcendence in the Elderly of Khoshkrud, Zarandieh City}, abstract ={Background & Aims: The population of the elderly has been on a rise, which shows more attention to ensuring the health and well-being of the elderly. On the other hand, the growth of the elderly population and its impact on the social and economic conditions of society leads to more attention to the issue of aging in society. In addition, physical and psychological abilities decrease with aging, which affects the quality of life of people. Overall, quality of life and well-being assessed by indicators such as health, happiness, and loneliness. Happiness is one of the most important needs of human beings, which considerably affects their psychological and physical health that helping the elderly cope with stressful situations. Another factor affecting well-being is self-transcendence, which is a powerful coping mechanism and can lead to personal transformation and improvement of the quality of life, thereby facilitating the process of understanding life changes such as aging. Therefore, self-transcendence is defined as a positive trait in relation to the expansion of one’s outlook on life. This issue includes factors such as spirituality, finding a purpose in life, optimism for the future, coping with problems, using power-based approaches, and connecting with others. In the elderly, by restoring the concept of aging and accepting disability, it reduces stress and focuses more on ability than disability. Therefore, happiness and self-transcendence are important factors in the elderly’s health dimensions. The present study aimed to determine the relationship between happiness and self-transcendence in the elderly of Khoshkrud, Zarandieh City. Materials & Methods: This descriptive-correlational research performed on the elderly selected from those who referred to the health center to receive elderly-related care using sequential sampling. Data collection continued for three months (October-December, 2019), and 84 elderlies who were willing to participate in the research were selected. The inclusion criteria were the age of more than 60 years, the ability to respond to questions physically and mentally, having psychological health  which assessed  by Abbreviated Mental Test (obtaining a score above 7) and not losing a family member or experiencing a stressful situation in the past two months. Abbreviated Mental Test used to diagnose cognitive impairment, including dementia and delirium in the elderly, applied to assess concentration, attention, short-term and long-term memory. Notably, the Cronbach’s alpha of the tool was 0.76 in Iranian society. The Oxford Happiness Index has 29 questions that scored in a range of zero to 87 and includes five components of life satisfaction, self-honor, subjective well-being, satisfaction, and positive mood. Internal consistency was used to determine the reliability of the instrument. The Cronbach's alpha coefficient for the components of life satisfaction, self-honor, subjective well-being, satisfaction, and positive mood estimated at 0.85, 0.71, 0.74, 0.79, and 0.77, respectively. On the other hand, the self-transcendence questionnaire included 15 items scored in a range of 15-60, where a higher score was indicative of higher self-transcendence. Internal consistency was used to determine the reliability of the instrument and its Cronbach's alpha coefficient estimated to be 0.69. Researcher with questions from the elderly completed all tools and it took an average of 45 minutes for each elderly person to complete the tools. In addition, data analysis was performed in SPSS version 16 using descriptive statistics (to describe demographic variables and variables of happiness and self-transcendence) and parametric inferential statistics (Pearson’s correlation coefficient, independent t-test, and analysis of variance). Results: In this study, the mean age of the elderly was 65.7±4.8 (60, 79). Moreover, 55 subjects were female (65.5%), 81% were married, 59.5% were illiterate and 64.3% were homemakers. In addition, the mean number of children of the participants was 6.2±1.6 (0, 14). Furthermore, 66.7% had an underlying illness, 56% had a moderate economic status, 61.9% had a family support system and 79.8% lived with their spouse. According to the results, the mean of happiness and self-transcendence in the elderly were 54.42±14.3 and 39.4±5.9, respectively. There was a significant and direct relationship between self-transcendence and happiness (r=0.263, P=0.016), components of life satisfaction (r=0.348, P=0.001) and satisfaction (r=0.325, P=0.003). In addition, a significant difference was observed between the level of education (P=0.038 and P=0.009, respectively) with happiness and self-transcendence and between occupational status and happiness (P=0.039). Moreover, a significant difference was found between the number of children (P=0.037) and residential status (P=0.028) with self-transcendence. Conclusion: According to the results of the study, happiness and its components were more than the average level in the elderlies. In addition, the results were indicative that level of education, job, and economic status had significant differences with happiness. A proper education, job and economic status creates safety in the individual, which improves happiness. Self-transcendence was moderate and economic status, level of education, residential status and number of children had significant differences with elderly’s self-transcendence. Good economic situation causes security in the person and the person can try to help himself without worry and play a role in promoting self-transcendence. On the other hand, the level of education promotes awareness and the ability to obtain information from various sources, which can empower the elderly in self-care and increase their adaptation to old age, and ultimately lead to the promotion of self-transcendence. The presence of children, their support, and care for parents cause security for the elderly, who in return try to adapt to the current situation in order to calm their children and accept their situation and ultimately improve their self-transcendence. In general, self-transcendence promoted by having a good friend and a person to talk to, and in the traditional society of Khoshkroud, communication with children, relatives, and neighbors can promote self-transcendence. Although in the present study, the economic situation was moderate and most of the elderly were illiterate, the level of happiness and self-transcendence of the participants was above average, which can be attributed to the existence of social relations at the family and traditional society and respect for the elderly. These factors played a key role in individual satisfaction and support of the elderly and covered the educational and economic states. Moreover, there was a direct and significant relationship between happiness and self-transcendence. Happy people feel more in control, think more about their abilities rather than inabilities, better cope with life stressors, have higher self-esteem, value themselves, and love themselves. Overall, happiness can affect the scope of life and the way people relate and interact with the environment. As such, happiness promotes other life aspects, including self-transcendence. In Khoshkroud, where the elderly and families adhere to their religious and traditional beliefs and the family has a special position, the elderly enjoy health in all dimensions, and they can accept the conditions of old age and use effective adaptation mechanisms to improve well-being. It recommend that the families and authorities by meeting the economic, social and spiritual needs of the elderly to increase their ability to understand and accept themselves, create a sense of satisfaction and happiness, which increases their health. By creating a happy and lively environment, their performance will be improve, which has positive consequences for the elderly, family, and society. Furthermore, conditions should be provided for them to benefit from each other's experiences and to be present in public to improve their health.}, Keywords = {Happiness, Self-transcendence, Psychological Health, Elderly}, volume = {33}, Number = {123}, pages = {6-21}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.29252/ijn.33.123.6}, url = {http://ijn.iums.ac.ir/article-1-3157-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3157-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {Hezaveh, Z and MardaniHamooleh, M and SeyedFatemi, N and Haghani, SH}, title = {The Effect of Resilience Training on the Psychological Empowerment of ICU Nurses}, abstract ={Background & Aims: Nurses work in stressful and challenging environments, which threaten their mental health. Among nurses, those in the intensive care units (ICUs) of hospitals are more likely to experience occupational, psychological, and physical stress compared to others. Due to their special working conditions (heavy workload, the need for a quick response to emergency situations, heavy responsibilities of care for critically ill patients, frequent contact with emotional situations, and being in unwanted situations to deliver bad news to the families of patients), these nurses are forced to endure more psychological pressures, which brings up the grave concern of their psychological empowerment being jeopardized. Psychological empowerment in nurses could increase organizational trust and commitment, thereby resulting in job satisfaction, productivity, participation in decision-making, provision of high-quality care, patient satisfaction, self-sufficiency, independence, self-confidence, responsibility, job control, and ultimately organizational effectiveness and occupational stress reduction. Therefore, it seems that nurses working in hospitals (especially in ICUs) need to improve their psychological empowerment. Meanwhile, resilience is one of the factors associated with the psychological empowerment of nurses. Resilience results in the better professional performance of nurses and is also a feature to help them adapt to the stresses of their work environment and improve their professional health. In the current century, nurses need to skillfully develop their resilience as it helps them to overcome their negative experiences and turn them into positive experiences. Therefore, nurses who are exposed to high stress levels could be trained to enhance their ability to overcome these pressures and gain a sense of worth. From a deeper perspective, resilience knowledge is a key to professional development in nursing. It has become increasingly important for nurses to be resilient as resilience with a preventative approach improves their mental health. Resilience training also seems to improve the psychological empowerment of nurses. The present study aimed to assess the effects of resilience training on the psychological empowerment of ICU nurses. Materials & Methods: This quasi-experimental study was conducted in the second half of 2019 on 96 nurses working in the ICUs of the teaching hospitals affiliated to Iran University of Medical Sciences. The subjects were selected via convenience sampling. The nurses were non-randomly assigned to two groups of experimental and control (48 ​​per each). Data were collected using a demographic data form to measure age, gender, economic status, marital status, employment status, work experience, and type of shifts. In addition, the psychological empowerment scale was used for data collection with the dimensions of sense of competence, independence, effectiveness, and meaningfulness. The validity of the scale was evaluated using the content validity method, and its reliability was confirmed at the Cronbach's alpha coefficient of 0.84. Initially, pretest was performed on both groups. The resilience educational program was developed by the researcher based on concepts such as optimism, empathy, humor, problem-solving, coping with stress, self-efficacy, social adequacy, emotional management, and spirituality. The program was held for two hours per day for the experimental group during a two-day workshop. In each session, the presentation of the contents was performed in the form of a lecture with questions and answers, group discussions, and slide shows for the nurses. In addition, the nurses were provided with exercises to improve resilience, and their feedback was assessed during each session. The control group received no intervention. One month after the intervention, posttest was carried out on both groups. After the posttest on both groups, the resilience training contents were also provided electronically to the control group. This article was extracted from a research project approved by Iran University of Medical Sciences. During the research process, the ethical policies of the university were observed, including obtaining informed consent from the nurses. Data analysis was performed in SPSS version 16 using descriptive statistics (mean and standard deviation) and inferential statistics (Chi-square, independent and paired t-test, Fisher's exact test, and analysis of covariance). Results: At the pretest stage, significant differences were observed in the scores of psychological empowerment and all its dimensions, with the exception of meaningfulness (P<0.05). At the posttest and after the control of the effects of the confounders, the scores of psychological empowerment and its dimensions were significantly higher in the experimental group compared to the control group (P<0.001). In the experimental group, the scores were significantly higher after the intervention compared to before the intervention (P<0.001), while the scores significantly decreased in the control group (P<0.001). Furthermore, the changes in the scores of psychological empowerment and its dimensions were significantly higher in the experimental group compared to the control group (P<0.001).     Conclusion: According to the results, resilience training could improve the overall psychological empowerment of the ICU nurses in the four dimensions of sense of competence, independence, effectiveness, and meaningfulness. Considering that nursing is a profession that may threaten psychological empowerment, the use of resilience-based training programs that are low-cost, available, and high-performance could enhance the psychological empowerment of the nursing staff in general and ICU nurses in particular and should be considered by nursing managers.}, Keywords = {Training, Resilience, Psychological Empowerment, Nurse, Intensive Care Unit}, volume = {33}, Number = {123}, pages = {22-34}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.29252/ijn.33.123.22}, url = {http://ijn.iums.ac.ir/article-1-3161-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3161-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {Mahmoudiani, S and Khosravi, R and Javadi, A}, title = {The Status and Determinants of Birth Interval in the Rural Women of Fars Province, Iran}, abstract ={Background & Aims: Proper intervals between births have been emphasized as a factor to guarantee the health of the mother and infant. Therefore, reproductive health programs are essential to achieving this important goal. Birth intervals are an effort to maintain a certain interval between births, which is explicitly defined relative to the newborn. Closely birth intervals are referred to as rapid repeated pregnancy in the public health and medical literature and increase the risk of various disorders in the mother and infant. The current literature in this regard indicates that more than 54 million women suffer from health problems during pregnancy and delivery each year, and approximately 1.5 million die, 99% of which occur in developing countries. Since the time and interval of subsequent births are the main determinants of fertility, fertility researchers have widely investigated these factors. In addition, evidence suggests that short intervals between births cause numerous adverse consequences in childhood and adulthood. The present study aimed to investigate the birth intervals and its determinants in the rural women of Fars province, Iran. In general, we sought to identify the vulnerable groups of women that need special attention in health and reproductive health programs, so that the general health of mothers and infants would be promoted in the community. Materials & Methods: This cross-sectional, analytical study was conducted using a researcher-made questionnaire on 882 married women aged 15-49 years with two or more children living in the rural areas of Fars province. The survey was performed using cluster sampling in October 2015. The independent variables included age, age of the spouse, year of marriage, ethnicity, religion, education level, and occupation status. In addition, the birth year of each child was recorded by asking the women, and birth interval was the dependent variable. Based on the fertility level of the women, the intervals between the first and second births, as well as the second and third births, were also considered and emphasized. Data analysis was performed in SPSS version 16 using frequency tables and multiple regression analysis at the significance level of 0.05. Results: The mean age of the participants was 35.29±6.25 years, and the mean age of the spouses was 40.31±6.89 years. The mean age of the women in the first marriage was 19.56±3.95 years. The majority of the respondents were Persians and Shiites, and the majority of the women (53.6%) had two children. Furthermore, 4% of the rural women had academic education or higher educational degrees than diploma, and this rate was estimated at 5.6% for men. The findings also indicated that the largest proportion of the rural women and their spouses had secondary education or lower. In terms of occupation status, 3.3% of the rural women and 94.9% of the spouses were employed. In addition, approximately 83.6% of the rural households earned less than 10 million Rials, and 0.9% earned more than 25,000,000 million Rials per month. According to the results, 31.8% of the women with two children gave birth to their second child less than three years after the birth of the first child. This rate was estimated at 52%, 65.7%, and 80% for the women with three, four, and five children, respectively. The interval between the second and third birth for 25.3%, 50.5%, and 78.8% of the women with three, four, and five children was less than three years, respectively. On the other hand, all the women with four children gave birth to their fourth child less than three years after their last child. The multivariate analysis of the data indicated that ethnicity (P=0.023) and religion (P=0.002) had a significant effect on the birth interval between the first and second births, and the average birth interval in the Persian and Shiite women was higher than the women of other ethnicities and Sunni women. Notably, ethnicity (P=0.001) and religion (P=0.027) were the only significant variables to affect the interval between the birth of the second and third children of the rural women in Fars province. Conclusion: According to the results, demographic and socioeconomic characteristics had relatively similar effects on the birth interval between the first and third children, while the explanatory power of these factors increased relatively with the interval between the second and third births. In other words, the interval between the first and third childbirths in the rural women was relatively the same, and no significant differences were observed in terms of the socioeconomic characteristics of the women. Ethnicity and religion also had significant effects on the birth interval, which could be associated with the socioeconomic status of the rural women. It seems that the employed women had to increase their birth intervals due to the combination of childbirth and occupation. Nevertheless, no significant correlation was denoted between the occupation status of the women and birth intervals, while our findings indicated that the employed women were more likely to give birth to their second child within an increased interval from the first birth compared to the unemployed women, while it was the opposite in the case of the interval between the second and third births. Previous studies have indicated that the education level of women is a significant influential factor in birth intervals, while no such significant correlation was observed in this study. Furthermore, it could be inferred that the Sunni and non-Persian women needed more attention as a vulnerable population, and they should be properly trained on the importance of adequate birth intervals. These women also need more attention to raise their awareness regarding adequate birth intervals. By adopting and implementing the necessary training courses in vulnerable women, the issues associated with birth intervals could reduce, which in turn promotes the general health of these women and their infants.}, Keywords = {Women, Rural Areas, Birth Interval, Birth Order}, volume = {33}, Number = {123}, pages = {35-46}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.29252/ijn.33.123.35}, url = {http://ijn.iums.ac.ir/article-1-3168-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3168-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {NajafiGhezeljeh, T and Rahnamaei, F and Omrani, S and Haghani, SH}, title = {The Effect of Interactive E-learning on the Knowledge of ICU Nurses Regarding Delirium}, abstract ={Background & Aims: Delirium is one of the most acute and prevalent cognitive disorders with complex causes among hospitalized patients and is also considered to be a common issue in the patients admitted to intensive care units (ICUs) worldwide. As the patients admitted to ICUs are exposed to numerous life-threatening physiological diseases and health challenges, their care process is extremely difficult to nurses. As such, the management of delirium as an important component of the routine care of these patients is highly demanding and challenging for ICU nurses. The high incidence and prevalence of this disorder in ICUs imposes significant costs on the healthcare system of countries and is also a strain of care for nurses, which ultimately leads to numerous adverse consequences in the affected individuals. Despite the importance of this syndrome and availability of various screening tools, the care level of these patients by nurses is rather poor. Since the nursing team is a key element in ICUs and in constant contact with patients, nurses could play a key role in the prevention of the clinical consequences and management of delirium since the preventative strategies for the occurrence and development of delirium or shortening its duration is highly effective owing to the provided care by these healthcare professionals, who provide full-time care to critically ill patients. Lack of sufficient and effective knowledge regarding delirium is an important factor associated with poor nursing care to identify this disorder. Therefore, increasing their knowledge could help with the timely identification and accurate and optimal management of the disorder, which in turn prevent the permanent complications, disabilities, and cerebral dementia, lengthy ICU admission, and reducing the associated mortality. Although education is recognized as an important factor in delirium prevention and treatment strategies, the type and methods of education and use of various approaches to the training of nurses on delirium could also be effective in this regard. Today, the advancement in educational technology has prompted the use of new methods as an alternative to traditional methods. Considering the easy access to educational contents and use of interactive feedback mechanisms, interactive e-learning has been described as an alternative approach to the teaching of large groups and offers a more flexible and cost-effective method than traditional teaching methods. The present study aimed to assess the effects of interactive e-learning on the knowledge of ICU nurses regarding delirium. Materials & Methods: This quasi-experimental study was conducted with a pretest-posttest design and a control group on 88 ICU nurses of two teaching hospitals affiliated to Lorestan University of Medical Sciences, Iran in 2019. The subjects were selected via counting sampling. Based on the sampling method and inclusion criteria of the study, the nurses were selected. After obtaining informed consent from the research units, Shahid Rahimi Hospital was selected as the intervention group, and Shohada Ashayer Hospital was considered as the control group. In order to prevent contamination, one hospital was selected as the intervention, and another was selected as the control. The intervention involved the use of interactive e-learning contents in the form of four outputs of the Storyline software with various definitions of delirium and its characteristics, clinical symptoms, and types of delirium (16 minutes), as well as the predisposing and accelerating factors of the disease and preventive methods (20 minutes). In addition, the duration of the treatment was 23 minutes, and the diagnostic strategies and screening tools were presented for 22 minutes, along with the questions of each ward. The educational contents were uploaded on the hospital site that was considered as the intervention environment, and its link was provided to the nurses of the intervention group for two months. Immediately before and two months after enrollment, the obtained data were assessed using the delirium knowledge questionnaire (DKQ) in both groups. After data collection, data analysis was performed in SPSS version 16 using independent and paired t-test, Chi-square, Fisher's exact test, and effect size. Results: The knowledge scores of the ICU nurses and its dimensions were significantly higher in the intervention group compared to the control group after the interactive e-learning (P<0.001). However, no significant differences were observed in the control group in this regard after the interactive e-learning compared to before the intervention (P>0.05). In general, the effect of interactive e-learning on the knowledge of the intervention group (2.22 and 1.29) was 1.75, which showed the large effect of training on increasing the knowledge of the nurses in the intervention group compared to the control group. In addition, the changes in the total score of knowledge in the intervention group were more significant compared to the control group, so that education could increase the knowledge of the nurses. The higher effect size than 0.8 after the intervention in the total score and scores of the subscales of knowledge indicated the large impact of interactive e-learning on the increased knowledge of delirium and its subscales in the nurses. Conclusion: The results of the study showed the positive effect of interactive e-learning on the knowledge of the nurses in the intervention group compared to the control group working in the ICUs of the research environments. Therefore, the use of interactive e-learning was effective in improving the knowledge of the ICU nurses, and this educational method is recommended for the training of health workers, especially nurses and nursing students. Although the changes in knowledge scores and subscale scores of delirium symptoms, signs, and consequences were positive in both groups, the increase in the scores was more significant in the intervention group compared to the control group, which could be attributed to interactive e-learning. Although the knowledge score was observed to decrease in both subscales of the risk factors and causes of delirium and disease management and prevention strategies in the control group, the changes in the knowledge scores of the intervention group increased after training in these subscales. Therefore, the decreased knowledge score in the control group may be due to the lack of interactive e-learning, while the increase in the scores of the intervention group was attributed to interactive e-learning.}, Keywords = {Knowledge, Delirium, Continuing Education, Distance Learning}, volume = {33}, Number = {123}, pages = {47-61}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.29252/ijn.33.123.47}, url = {http://ijn.iums.ac.ir/article-1-3169-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3169-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {Khoshnevisan, M and Seyedfatemi, N and MardaniHamooleh, M and Ranjbar, M and Haghani, H}, title = {The Effect of Anger Management Educational Program on Aggression in the Individuals with the Bipolar Disorder: A Quasi-experimental Study}, abstract ={Background & Aims: In the bipolar disorder, the mood of the individual is damaged and constantly and abnormally changes from very good to very bad and depressed. Outbursts of explosive anger are one of the characteristics of patients with the bipolar disorder, which causes self-harm and harm to others. Aggression occurs in this population due to factors such as the lack of social support, frequent recurrence of the disease, and failure to use medication. The main consequence of aggression in this vulnerable population is that they are pushed toward substance abuse and alcohol consumption, which eventually disrupt their social functioning. Considering the adverse, debilitative effects of aggression on patients with the bipolar disorder, proper measures must be taken for effective management. Since patients with the bipolar disorder experience severe emotional fluctuations that could damage themselves, their families, other patients, and nurses, it is important to reduce the damages to others and replace aggressive behaviors with constructive interactions in the form of anger management programs. Anger management is a skill taught for the control of aggression in bipolar patients. In fact, anger management helps these individuals learn how to stay calm and control their negative emotions before the onset of anger. In other words, the purpose of this psychological training is to increase psychosocial abilities, effectively deal with the conflicts in life, prevent harmful behaviors to health, and promote the mental health of bipolar patients. The present study aimed to evaluate the effect of an anger management educational program on the aggression of individuals with bipolar disorders. Materials & Methods: This single-group, quasi-experimental study was conducted at Iran Psychiatric Center in 2019 on 39 participants, who were selected via continuous sampling from the admitted patients with the bipolar disorder based on the inclusion and exclusion criteria of the study. Data were collected using a demographic questionnaire for the variables of age, gender, marital status, occupation status, education level, and history of admission due to bipolar disorders. In addition, the valid and reliable aggression scale by Buss and Perry was used for data collection, which consisted of for subscales, including physical aggression, verbal aggression, anger, and hostility. Initially, a pretest was performed on the participants. Afterwards, the anger management training program was presented to the participants. Notably, the contents of the educational program were prepared based on the available texts regarding anger management with an emphasis on the psychotherapeutic considerations regarding the aggression of patients with the bipolar disorder. The covered subjects in the program included ways to deal with anger and aggression, teaching effective anger management skills, playing a role in anger, teaching problem-solving skills, and decisiveness training for patients with the bipolar disorder. Following that, the validity of the educational contents was confirmed by psychiatric nursing professors. The training program was presented through lecture by the co-researcher with questions and answers between the researcher and the participants and expressing the experiences and roles played by the participants in the study. The program was implemented for four weeks with two 60-minute sessions each week. Due to the fact that it was not possible to gather all the participants in the training sessions, the sessions were held in small groups with gender segregation for 5-7 participants. The meetings were held after the hour of prayer and lunch in the visiting rooms of the inpatient wards. In addition, a 15-minute break was considered for each session. One month after the intervention, the participants were post-tested. This article was extracted from a research project approved by Iran University of Medical Sciences. During the research process, the ethical policies of the university were observed, including obtaining informed consent from the participants and their voluntary participation. Data analysis was performed in SPSS version 16 using descriptive statistics (mean and standard deviation) and inferential statistics (paired-t test). Results: At the pretest, the mean score of aggression was 99.74±14.73, which reduced to 83.21±11.68 at the posttest. At the pretest and posttest stages, the mean scores of physical aggression, verbal aggression, anger, and hostility were 32.90±8.02 and 28.87±6.86 (P=0.042), 19.41±3.73 and 17.77±3.55 (P=0.814), 22.69±4.47 and 17.85±3.41 (P=0.010), and 24.74±7.55 and 18.72± 6.55 (P=0.032), respectively. In addition, the results of paired t-test indicated significant differences in the scores of aggression at the pretest and posttest in the patients with the bipolar disorder (t=-3.061; P=0.003). The anger management educational program affected all the dimensions of aggression, with the exception of verbal aggression (P=0.814). Conclusion: According to the results, anger management training could reduce the aggression of the patients with the bipolar disorder in the subscales of physical aggression, anger, and hostility. Our findings could be a step toward the implementation of anger management training for this population of inpatients admitted to psychiatric centers in order to improve their aggression. Furthermore, it is recommended that nurses working in psychiatric wards become familiar with the educational contents of anger management for the subjects under study, so that they could perform the program at the bedside of these patients in appropriate situations in admission wards. In addition, the obtained results are useful for nursing managers and psychiatrists to better manage the care of individuals with the bipolar disorder. In the field of clinical education, the content of anger management could be provided to clinical nursing instructors to acquaint their students with such trainings, so that students could use the contents in their care plans for patients with the bipolar disorder.}, Keywords = {Education, Anger Management, Aggression, Bipolar Disorders}, volume = {33}, Number = {123}, pages = {62-72}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.29252/ijn.33.123.62}, url = {http://ijn.iums.ac.ir/article-1-3172-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3172-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {Heidari, H and Khaledifar, A}, title = {The Necessities and Requirements of the Pediatric Angiography Ward from the Perspective of the Healthcare Team: A Qualitative Study}, abstract ={Background & Aims: Pediatric angiography has been widely used for the diagnosis and treatment of congenital heart disorders in children over the past two decades. The work environment of the nurses of pediatric intensive care units is highly stressful due to various technical and medical equipment and patients with life-threatening diseases. In order to improve special pediatric care environments, attention must be paid to the experiences and opinions of the nurses employed in these units. To this end, the prioritization of the health of workplace and applying multidimensional approaches to the health promotion of the workplace are paramount. Considering the teamwork involved in patient care and treatment and increased number of beds in intensive care units, it is critical to evaluate the perceptions of physicians and nurses regarding the aspects of care in intensive care units. The improvement of the performance of pediatric critical care nurses and attention to their experiences and viewpoints are also essential in this regard. To this end, the prioritization of the health of workplace and applying multidimensional approaches to the health promotion of the workplace are paramount. The use of pediatric angiography has increased in the past two decades. In addition, the differences in the culture, environment, and education of nurses in pediatric intensive care units, along with the differences in the hospitalized patients further emphasize on the necessity of qualitative research. However, most of the studies in this regard have been performed with a quantitative approach, while only qualitative research could determine the dimensions of the perceptions of the healthcare team. To date, no qualitative studies have assessed the experiences of the healthcare team in the pediatric angiography ward. The present study aimed to elaborate on the necessities and requirements of the pediatric angiography ward from the perspective of the healthcare team. Materials & Methods: This study was conducted using the qualitative content analysis approach in 2018. The sample population included 20 subjects, including nine nurses, four radiologists, and seven cardiologists, who were selected via purposeful sampling from the angiography unit of Hajar Hospital in Shahrekord, Iran. The inclusion criteria were the nurses and physicians with one year of work experience in the angiography or cardiology ward and willingness to participate in the study, and the exclusion criterion was unwillingness to participate. The duration of the interviews was 35-60 minutes, and the recordings were performed in accordance with ethical principles. Data collection and interviews continued until reaching data saturation. Data collection and analysis continued for four months. The semi-structured, individual interviews were initiated with the nurses and physicians with an open question ("Please explain your experiences of working in the pediatric angioplasty ward."/"What challenges have you faced in performing pediatric angiography?") The interviews continued with probing questions ("Please explain further."/"Please set an example.") The obtained data were analyzed using the qualitative content analysis method. After the researcher listened to the recorded interviews several times, he was immersed in the data to obtain an overview of the interviews. All the interviews were transcribed word-for-word, so that the words containing the key concepts would be highlighted and the codes would be extracted. After extracting the concepts and codes from important sentences and paragraphs, they were classified into categories based on the similarities and differences, and the categories were reduced to a smaller number of categories based on their correlations. In order to maximize the diversity of the participants, the research units were selected from the nurses, physicians (pediatric cardiologists), and radiologists engaged in the angiography ward. To ensure the accuracy and reliability of the research findings, the four criteria of credibility, dependability, transferability, and conformability were considered. To observed ethical considerations, a letter of recommendation was obtained from the Vice-Chancellor of Research of Shahrekord University of Medical Sciences. In addition, written informed consent and permission to record the interviews were obtained from the subjects prior to participation. Results: The mean age of the nurses was 34 years, and the mean work experience in the angiography ward was five years. The mean age of the radiologists was 31.5 years, and the mean work experience in the angiography ward was three years. The mean age of the pediatric cardiologists was 45 years, and the mean work experience in the angiography ward was five years. Data analysis yielded the three categories of the sensitivity of the ward, the necessity of the proper use of specialized equipment, and the need for education and skills training. The category of the sensitivity of the ward had three subcategories of the special conditions of the patients, sterilization of the angiography environment, and the need to become familiarized with the ward. The category of the proper use of specialized equipment had two subcategories of expensive equipment and management regulations of the maintenance of specialized equipment. The category of the need for education and skills training had two subcategories of the need for knowledge skills and the need for communication skills. Conclusion: The three most important findings of this study were the need for familiarity and proper use of specialized equipment and the necessity of education and skills training, which are like a golden treasure, the key to which is in the hands of hospital managers and officials. The training of the healthcare team in the angiography ward is a gradual and continuous process. Among the required skills for practice in the angiography ward are having adequate knowledge and the ability to properly communicate with the patients and their companions and the ability to use the specialized equipment correctly and appropriately, which could be achieved through the implementation of communication and counseling training courses, training on the use of specialized equipment, and the necessary preparations for the personnel of this ward. Considering the sensitivity of the angiography ward, the criticality of the applied procedures in the ward, and important issues such as clinical governance and accreditation, special attention should be paid to educational need assessment in order to implement proper interventions by hospital managers and health planners in terms of the training and skills of the personnel.}, Keywords = {Angiography Ward, Children, Healthcare Team}, volume = {33}, Number = {123}, pages = {73-83}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.29252/ijn.33.123.73}, url = {http://ijn.iums.ac.ir/article-1-3176-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3176-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {Ghodratollahifard, MA and Chinaveh, M and Aminimanesh, S}, title = {Modeling of the Symptom Manifestation of Personality Disorders in Nursing Students and Temporary Nurses within the Human Research Project Based on Childhood Trauma and the Mediating Role of Emotional Cognitive Regulation}, abstract ={Background & Aims: According to the World Health Organization (WHO) statistics, millions of children are victims of abuse each year. Childhood trauma could be physical or psychological abuse, sexual abuse or neglect of a child by the guardian. Abuse has long-lasting and irreversible effects on the psyche of children, which may linger even through adulthood. Among the long-term psychological effects of childhood abuse are major behavioral and psychological disorders in adolescence and adulthood. Such an example is the onset of the symptoms of cluster C personality disorders, which encompass avoidant, dependent, and obsessive-compulsive personality disorders, commonly characterized by anxiety, apprehension, and fear in the affected individuals. Cognitive emotional regulation is a variable that may be influenced by childhood trauma and lead to symptoms of personality disorders. Emotional regulation refers to the process through which an individual recognizes the emotions that are affecting them, how to experience these emotions, and their management. Recent findings suggest that even when child abuse is controlled, the problems associated with emotional regulation persist. Nurses constitute the largest portion of healthcare providers and affect the productivity and progress of the organization more than other hospital staff. In addition, the productivity of nurses ultimately leads to better decision-making in planning healthcare services. Therefore, assessing the predispositions of personality disorders in nursing students and temporary nurses within the program of human research project is paramount. One of these preconditions is the childhood traumas of the nursing students and temporary nurses within the program of human research project . The present study aimed to propose a model of childhood trauma and cognitive emotional regulation to help recognize cluster C personality disorders in the nursing students and temporary nurses within the program of human research project in 2019. Materials & Methods: This cross-sectional, descriptive-correlational study was conducted on the nursing students of Shiraz University of Medical Sciences in 2019 and the temporary nurses within the program of human research project in Shiraz, Iran. The inclusion criteria were consent to participate in the research, no history of psychological treatments for emotional disorders, no use of psychiatric medications for the reduction of anxiety, stress, and depression, living with parents, absence of specific chronic disorders affecting physical and mental health (e.g., migraine, severe lower back pain, diabetes, cardiac and renal diseases, and infertility), and normal course of life within six months before the investigation (i.e., no specific incidents or crisis such as the death of a loved one, an incurable disease of a family member, and change of residence). The subjects with incomplete questionnaires and those using psychiatric medications were excluded from the study. Data were collected using the self-report early trauma inventory-short form, cognitive emotion regulation questionnaire, and Millon clinical multiaxial inventory-III, which was completed in a self-report manner. During the completion of the questionnaires, the researcher, who was experienced in mental illness counseling, accompanied the participants to gain their trust and address their concerns in responding to the questions. The sample size of the study included 291 nursing students and employed nurses, which was estimated using the G-power software. The subjects were selected via simple cluster sampling. After providing the necessary explanations regarding the importance of the research and attracting sincere cooperation, the questionnaires were distributed among the students and nurses. Considering individual differences, the set time for the completion of the questionnaires was 15-30 minutes, and the questionnaires were received after completion. Data collection continued for one week and was performed at the hospital for the temporary nurses within the program of human research project with the coordination of the supervisor and at the nursing school for the senior nursing students. Data analysis was performed in SPSS version 22 using Pearson's correlation-coefficient to describe and analyze the statistical data. In addition, the AMOS-22 software was applied to determine the fit of the studied model based on the structural equation model and analyze the path of the observable variables. Notably, all the calculations were carried out at the statistical inference limit of P<0.05. Results: Childhood general traumas, childhood physical abuse, and childhood sexual abuse could explain the obsessive-compulsive disorder in the nursing students both directly (P<0.01, P<0.0005, and P<0.0005, respectively) and indirectly through adaptive and maladaptive cognitive emotional regulation styles (P<0.01). Moreover, childhood physical abuse could explain the avoidant personality disorder of the students both directly (P<0.05) and indirectly through adaptive and maladaptive cognitive emotional regulation styles (P<0.05). Childhood physical abuse and childhood sexual abuse could explain the dependent personality disorder of the students both directly (P<0.001 and P<0.05, respectively) and indirectly through maladaptive cognitive emotional regulation styles (P<0.05). The statistical findings also indicated that the obtained data supported the theoretical model of explaining personality disorders to a great extent, and all the indicators of fit confirmed that the proposed model is acceptable. Conclusion: According to the results, the senior nursing students and employed nurses within the program of human research project who have been abused as children were more likely to present with symptoms of cluster C disorder in their behaviors in adulthood. Furthermore, cognitive emotional regulation strategies acted as a mediating variable in the association of childhood trauma and cluster C personality disorder; in other words, childhood trauma leads to emotional maladjustment in adulthood, and the lack of appropriate emotional regulation strategies could lead to the symptoms of cluster C personality disorder. Based on the findings, it is expected that training on cognitive emotional regulation strategies would act as an effective mechanism in the modification of cognitive emotional regulation and become an proper approach to the improvement of cluster C personality disorders in nursing students and employed nurses within the program of human research project, thereby preventing mental illnesses and personality disorders.}, Keywords = {Child Abuse, Emotional Regulation, Personality Disorders, Compulsive Personality, Dependent Personality Disorder}, volume = {33}, Number = {123}, pages = {84-107}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.29252/ijn.33.123.84}, url = {http://ijn.iums.ac.ir/article-1-3222-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3222-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} }