@article{ author = {KeyvanlooShahrestanaki, S}, title = {“Letter to Editor” Challenges of Home Care during the COVID-19 Outbreak}, abstract ={The emerging phenomenon of COVID-19 has affected all aspects of life across the world as the disease is spreading rapidly worldwide. The widespread COVID-19 pandemic and its consequences are of great concern to the human community)1(. The pandemic has posed particular challenges to healthcare services(2). Healthcare services in a community consist of various sectors, one of the most important of which is home care. It seems that during the COVID-19 outbreak, attention has mostly been paid to hospital care issues, and the challenges of home care services have been neglected(3-5). The World Health Organization (WHO) has recently focused and published most of its guidelines on infection control and the clinical management of COVID-19 during home quarantine(6). Home care services may act as a supportive part of healthcare services and reduce the burden on the healthcare system(3,7,8). Nevertheless, our knowledge of home care challenges during the COVID-19 pandemic is alarmingly limited(4). Therefore, special attention should be paid to the challenges and issues associated with home care in order to improve such healthcare services, particularly during crises. In the current pandemic, the home care of the patients is divided into two general categories, including the care of COVID-19 patients and care of the patients without this disease(4). Most of the individuals in the second group are vulnerable patients who are cared for at home due to other chronic diseases or complications caused by aging(9). During the current pandemic, the second group has received less attention due to the increased attention to those who have contracted COVID-19(3,4). Prior to the disease outbreak, home care patients were often faced with numerous problems with the provision of medicines due to inadequate insurance coverage(10). The prevalence of COVID-19 appears to have added to this burden, posing countless challenges to these patients(5). Another problem among home care patients in both groups is the complications and challenges associated with the provision of medical supplies and equipment(11). Apparently, the supplied equipment has imposed a heavy burden on these patients and their families(12). The lack or high costs of personal protective equipment (PPE) for home healthcare providers are among the other significant issues in this regard(13). Furthermore, the lack of PPE has been reported among health care providers in various countries(5,13). Early into the pandemic, PPE was mostly provided to hospitals, which led to the shortage of the equipment for home care centers, as well as a large number of the healthcare providers contracting COVID-19(14). Given the issues and challenges caused by the shortage of medical supplies and equipment, a comprehensive plan seems crucial. On the other hand, extensive research is required regarding medicine and home care equipment during the COVID-19 pandemic in Iran. Another challenge for healthcare providers has been to recognize the desires and demands of patients' families during home care provision. Due to the families’ desire to reduce home visits, longer shifts than before have been in place for home care providers. However, measures such as using PPE and proper clothing has become immensely difficult and exhausting(15) as the care shifts of COVID-19 patients at home becomes longer. Meanwhile, less attention has been paid to the physical, mental, and social health of home care providers(4,5), and some have been reported to feel neglected or that they are unsupported during the pandemic(5). Environmental challenges are another hurdle of the patients with COVID-19 at home. For instance, these patient have to be cared for in a separate, well-ventilated room(16), while it may not be feasible for all patients to have such conditions due to limited space or the presence of a large number of family members at home(4), which in turn leads to challenges in infection control for the patients and their families. Due to limited hospital beds, some governments have implemented policies to care for COVID-19 patients at home(3), while these policies are intertwined with the shortage of healthcare providers(17). Among the main responsibilities of home healthcare center managers are effective crisis management and appropriate decision-making regarding the control of equipment and workforce(18). Evidently, training the officials of nursing care centers on crisis management could resolve this issue(19). COVID-19 is yet to be investigated and explored, and the current data on this disease are changing every day(20). To protect themselves and the patient, healthcare providers must constantly receive sufficient and recent information. Inadequate training (especially for home care providers) is considered to be a significant challenge, which could lead to numerous problems in home care(5). The proper and high-quality training of in-home care providers increases the quality of care(21). Planning for adequate and updated training is indispensable and an urgent need in this regard. During the coronavirus pandemic, most educational processes have been adversely affected(22), and healthcare providers have been forced to retrieve credible evidence to update their knowledge of the current circumstances. Evidence-based practice has always been a major challenge for healthcare providers, including nurses(23). With this background, healthcare providers have been made to update their information. Due to the continuous spread and rising prevalence of COVID-19, great strides are required to educate in-home care providers and implement evidence-based practice successfully. In conclusion, prioritizing research on the challenges of home health care during the COVID-19 pandemic could contribute to informing, planning, training, and management in order to control epidemic crisis in the future(24).}, Keywords = {Nursing, Home Care, COVID-19}, volume = {33}, Number = {127}, pages = {1-6}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.52547/ijn.33.127.1}, url = {http://ijn.iums.ac.ir/article-1-3300-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3300-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {Mohagheghi, P and Keramat, A and Chaman, R and Khosravi, A and Mousavi, SA and Mousavi, SS}, title = {Effect of Early Support on the Stress of Mothers with Preterm Infants in Neonatal Intensive Care Units: A Quasi-experimental Study}, abstract ={Background & Aims: During pregnancy, women have expectations of their future baby, and preterm delivery may negatively affect such expectations. On the other hand, postpartum maternal stress is a well-established issue, which intensifies with the birth of a premature infant. Preterm birth is an unexpected experience and a multifaceted incident that leads to two main consequences, which are the medical and neurophysiological complications of the infant (especially in very-low-birth-weight infants weighing less than 1,500 grams and aged less than 32 weeks) and the adverse effects on the mother-infant relationship due to the prolonged admission of the infant to the neonatal intensive care unit (NICU). If the infant is not discharged, the mother will be unable to fully assume their maternal role. Therefore, proper intervention protocols help reduce maternal stress and empower mothers to cope with the complex and technological environment of the NICU. The present study aimed to evaluate the impact of evidence-based early supportive interventions on the maternal stress caused by preterm birth. Materials & Methods: This quasi-experimental study was performed at the NICUs of Mahdieh Hospital and Shahid Akbarabadi Hospital in Tehran, Iran. Sampling started on February 14, 2016 and continued until May 14, 2016. Both centers were teaching, referral hospitals with three levels of NICUs. NICU level one is designed for generally ill and low-birth-weight infants who do not require intensive care (minimal care and basic care following delivery), NICU level two is considered for the infants who need other intensive care than ventilator support and surgical care, and NICU level three is designed for the critically ill infants who require life-sustaining therapies, particularly auxiliary ventilation and optimally tailored neonatal intensive care. In this study, the hospitals were considered as random allocation units, with Mahdieh Hospital assigned to the intervention site and Shahid Akbarabadi Hospital assigned to the control site. The sample population included mothers with premature infants. Preterm infants and their mothers were selected within three months based on the inclusion and exclusion criteria of the study. The inclusion criteria were having an infant with the gestational age of less than 37 weeks, birth weight less than 2,500 grams, and high probability of survival, maternal consent for enrollment, Iranian nationality, and the ability to communicate verbally. The exclusion criteria were infants with abnormalities or severe debilitative conditions (e.g., grade III or IV intraventricular hemorrhage). During the study period, 75 mothers and infants were classified as the intervention group, and 68 mothers and infants were assigned to the control group. The intervention was designed based on the model of the support system of mothers with premature infants. In this model, parents and infants are at the center of the support model and should be supported during critical transitional periods, including pre-fertilization, before delivery, NICU admission, discharge, and at home. Based on the model, various interventions were provided to the mothers at the NICUs, which gradually started upon the admission of the premature infant to the NICU, continued throughout the admission, followed-up the subjects until three months since the birth of the infant. In the intervention group, the mothers were provided with continuous informational support (emphasis on the continuous provision of information to the mothers about the infants' illness, treatment, growth and care, infants' emotional and behavioral needs and responses, and maternal rights and responsibilities during admission). Furthermore, we provided spiritual support (in an illness crisis, spirituality may be essential to coping and have a positive impact on the response of individuals since reliance upon a higher power could become a source of hope for a positive outcome. Fostering spiritual values protects individuals' integrity and gains spiritual perseverance to encounter hardships), appraisal support (strengthening and supporting the maternal role and encouraging mothers to strengthen their relationship with their infants and actively partake in their care since doing their best in the care of the infant makes them feel better. In fact, encouraging mothers to participate in care of preterm infants allows them to conceive their maternal role), and emotional support (addressing the feelings and concerns of the mothers and showing concern for their health and the health of the newborn so that they could adopt to the infant's illness and the other affected aspects of their lives). The control group received routine care. Upon discharge, maternal stress was measured using the parental stressor scale: neonatal intensive care unit (PSS-NICU). The main sources of maternal stress included the NICU environment, infant's appearance, special behaviors of treatment of the infant, mother-infant relationship, and maternal role. Data analysis was performed in the STATA software version 13 using t-test, Chi-square, and inverse probability of treatment weighting (IPTW). Results: After adjusting the pre-treatment variables by the IPTW, the mean difference in the adjusted stress score regarding the NICU environment was estimated at 0.55 (range: 0.89-0.2) (P<0.001), while it was 0.37 (range: 0.68-0.06) regarding the changes in the maternal role (P=0.02), and 0.29 (-0.43-0.37) regarding the infant's appearance and behavior and treatment of the infant (P=0.89). In addition, the total stress score was estimated at 0.25 (range: 0.58-0.07) regarding the NICU environment (P=0.13), and the stress score of the intervention group was significantly lower compared to the control group regarding the changes in the maternal role. Conclusion: For the successful implementation of interventions designed based on scientific evidence and facilities, it is suggested that policy-makers implement these evidence-based interventions to improve the quality of care of premature infants and reduce maternal stress in the form of family-centered support models in NICUs. Furthermore, it is recommended that similar investigations be performed on fathers. Although the results of this study confirmed the effects of the intervention on reducing maternal stress regarding the technological NICU environment and changes in the maternal role, it may not lead to the significant reduction of total stress and stress about infants' appearance, behavior, and treatment in mothers. As such, detailed studies should be conceived based on effective interventions in this regard.}, Keywords = {Intensive Care, Neonatal, Infant, Premature, Mother, Stress}, volume = {33}, Number = {127}, pages = {7-20}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.52547/ijn.33.127.7}, url = {http://ijn.iums.ac.ir/article-1-3336-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3336-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {AliNaghiMaddah, SM and Khaledi-Sardashti, F and Moghaddasi, J and NaseriBorujeni, N and DehghanAbnavi, S and Dadgar, F and SadeghiGandomani, H}, title = {The Relationship between Self-esteem and Perceived Social Support in Ostomy Patients}, abstract ={Background & Aims: Colorectal cancer is a developing gastrointestinal disease that results in an ostomy operation. Meanwhile, stoma-related complications following ostomy surgery are associated with several physical and psychological diseases in patients. The present study aimed to determine the relationship between self-esteem and perceived social support in ostomy patients.  Materials & Methods: This was a correlational-descriptive study performed in 2017. The sample size was estimated at 390 individuals considering a 95% confidence interval, an 80% test power, and r=0.2. The participants were selected by continuous sampling, and those who were a member of the association and met the inclusion criteria (having a file in Iran ostomy association, no diagnosed physical-psychological diseases, not being in the progressive stage of the disease, having the ability to answer the questions of the questionnaire and at least six months of symptoms of the disease) were enrolled in the study. The researcher visited the association on different days of the week and distributed questionnaires among patients following explaining research objectives and how to complete the instrument and receiving written consent from the subjects. In this study, we applied three questionnaires on demographic characteristics (age, gender, marital status, occupational status, level of education, and duration of disease), self-esteem, and social support. The Rosenberg self-esteem questionnaire encompasses 10 items, which are scored based on a four-point Likert scale from zero (completely disagree) to 3 (completely agree). In this regard, the highest score is 30, and scores above 25, 15-25, and below 15 show high, moderate, and low self-esteem, respectively. The content validity of the mentioned tool was approved based on the opinions of its developers and different preliminary studies (26). In a research by Greenberger et al., the internal consistency of the scale was reported at 0.84. In addition, Pullman & Allik reported internal consistency of 0.91 for the mentioned scale. In the current research, the internal consistency of the instrument was approved at a Cronbach’s alpha of 0.90. Designed by Northouse, the perceived social support questionnaire contains 40 items in five sections the spouse, family members, friends, physician, and nurse. Each section includes eight items to assess patients’ social support perceived from their spouse, family members, friends, physician, and nurse. The items are scored based on a five-point Likert scale from 1 (completely disagree) to 5 (completely agree). The perceived social support score from each of the support sources is calculated separately from the total scores obtained for each resource and the overall perceived social support score from the total scores obtained in all sources. The range of changes in the overall perceived social support score of the five sources is from 40 to 200, and the range of changes in the perceived social support score of each resource separately is from 8 to 40. The perceived social support score is divided into three levels of low (40-92), moderate (93-146) and high (147-200), and the perceived social support score of each support source is classified into three levels of low (8-18), medium (19-29) and high (30-40). In Iran, the questionnaire was first applied by Heydari et al. (2005), who used the internal consistency method to confirm the reliability of the tool. In the end, the reliability of the tool was confirmed at a Cronbach’s alpha of 0.92. In the present research, the internal consistency of the questionnaire was approved at a Cronbach’s alpha of 0.80. After receiving approvals from the ethics committee of the university, the researcher received an introduction letter from the officials of Kashan University of Medical Sciences to enter the research setting. Afterwards, the researcher referred to the research center and gained permission from the manager and head of the center to start the research. First, the researcher selected participants based on the inclusion criteria received written consent from them, and ensured them of the confidentiality terms regarding their personal information. In the next stage, he read the questions for the subjects and wrote down their answers without any change. Data analysis was performed in SPSS version 16 using descriptive statistics (to regulate table), independent t-test (to analyze the data), as well as one-way ANOVA, Pearson’s correlation coefficient, and Tukey’s test.  Results: In this study, 350 questionnaires were completed. The mean age of ostomy patients was 37.7 ± 5.87 years. In addition, 52.3% of the subjects were married, 65.4% were female, and 38.6% had a diploma degree. Moreover, 40% of the subjects were dealing with the disease for more than seven years. The mean and standard deviation of patients’ perceived self-esteem and social support were 20.56 ± 5.17 (out of 30) and 131.17 ± 15.47 (out of 200), respectively. The majority of ostomy patients (68%) had moderate self-esteem. In addition, most of the participants (84.3%) had moderate perceived social support. The relationship between the mentioned variables was assessed using a Pearson’s correlation coefficient, the results of which were indicative of a significant and direct association between perceived social support and its dimensions with self-esteem (r=0.20, P=0.001). In addition, there was a significant relationship between the mean score of self-esteem and marital status (P=0.001). In fact, the mean score of self-esteem was significantly higher in married subjects, compared to single and divorced ones (P=0.001). Moreover, we found a significant correlation between self-esteem and level of education (P=0.008), in a way that the mean self-esteem score was significantly higher in the participants with an MSc degree, compared to other levels of education (P=0.008). Furthermore, we detected a significant relationship between perceived social support and level of education (P=0.005), in a way that the mean perceived social support score was higher in those with an MSc or BSc degree, compared to other levels of education (P=0.005). There was also a significant correlation between the mean score of perceived social support and duration of the disease (P=0.005) since the mentioned variable’s score was higher in those who had the disease for two-four years, compared to other participants (P=0.005).  Conclusion: Given the significant impact of perceived social support on self-esteem it is recommended that high-risk groups (in terms of social support perception and receiving) be recognized by nurses and their support needs be assessed constantly. In fact, great attention can be paid to this psychological dimension of patients by improving their psychological health and connecting them to the community, families and friends. }, Keywords = {Ostomy, Self-esteem, Perceived social support, Colorectal cancer}, volume = {33}, Number = {127}, pages = {21-34}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.52547/ijn.33.127.21}, url = {http://ijn.iums.ac.ir/article-1-3353-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3353-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {HassanzadehNaeini, M and Nasiriani, KH and Fazljoo, SE}, title = {Moral Courage of the Nursing Students of Yazd University of Medical Sciences, Iran}, abstract ={Background & Aims: Nursing performance within the framework of professional ethics makes nurses respect their clients' needs, security, and privacy and enhance the welfare criteria. In contrast, lack of commitment to professional ethics in nurses may influence patient satisfaction and improvement, quality of care, standards of nursing services, and promotion of the nursing profession. Today, nurses are faced with spiritual and ethical issues and conflicts in an unprecedented manner due to their professional status and key role in health care. Some of these ethical issues include the use of invasive treatment protocols for dying patients, unnecessary tests, the manipulation and forging of the test reports, lack of complete and sufficient treatment by other employees, and the unjust distribution of power among healthcare employees. In addition, personal and organizational obstacles may often prompt nurses to avoid fulfilling their ethical obligations toward patients, which in turn prevents value-based nursing performance. Therefore, nurses need ethical courage to properly manage the ethical issues arising in the clinical setting. Biological ethics experts believe that professional ethics must be instructed and strengthened through university courses to enable nurses to battle ethical challenges in clinical settings. Clinical settings are considered a basic component of the nursing curriculum, as well as a permanent source of anxiety for nursing students, especially in the cases where they may be confronted with poor performance. Such examples of poor performance in clinical settings are the physical or emotional abuse of patients, violation of patient's privacy, non-standard/outdated care, clinical errors, and the performance of healthcare experts beyond their authority. If nursing students are faced with poor performance in clinical settings, they may internalize their negative feelings and associate them with the nursing profession, questioning whether they must continue their education. Some nursing students question their capability in finding a solution to ethical challenges, which is a major source of diffidence and anxiety in the future. Given the importance of ethical courage in nursing students and its impact on the quality of care in their future profession, the present study aimed to evaluate the ethical courage of the nursing students of Shahid Sadoughi University of Medical Sciences in Yazd, Iran in 2020. Materials & Methods: This descriptive, cross-sectional study was conducted in 2019 at the nursing schools of Shahid Sadoughi University of Medical Sciences. A sample of BA and MA nursing students (n=242) were selected via stratified random sampling. In sampling, the level of the students in the class was considered, and the sample size was determined in proportion to the number of the students in each class. The participants were selected randomly from each class. Data were collected using Sekerka's ethical courage questionnaire, which was developed by Sekerka et al. in 2009 and consists of 15 items. The questionnaire items measure the adherence of nurses to ethical principles despite their intrinsic needs and external pressures. The five dimensions of the questionnaire include ethical aspects, multiple values, tolerance of threat, sensitivity, and ethical objectives. Each dimension has three items, which are scored based on a five-point Likert scale (Never=1, Rarely=2, Sometimes=3. Often=4, Always=5). The minimum and maximum scores of the questionnaire are 15 (low ethical courage) and seven (high ethical courage), respectively. Data analysis was performed in SPSS version 16 using descriptive statistics (mean, standard deviation, percentile) and inferential statistics (Pearson's correlation-coefficient, independent t-test, one-way ANOVA). Results: In total, 242 nursing students aged 18-44 years (mean age: 21.90 ± 3.45 years) were enrolled in the study. The mean score of ethical courage was 55.72 ± 7.84. In Meybod and Yazd, the mean score of ethical courage was 56.98 ± 7.06 and 54.46 ± 8.62, respectively, and no significant difference was observed in this regard (P=0.38). The highest score of ethical courage was denoted in the ethical dimension (11.88 ± 2.21), while the lowest score belonged to the dimension of threat tolerance (10.25 ± 1.90). Moreover, data analysis indicated a significant correlation between ethical courage and gender, and the female nursing students reported a higher ethical courage score compared to the males (P=0.04). However, no significant correlations were observed between ethical courage and other demographic variables, such as marital status and place of residence (P>0.05). Conclusion: According to the results, the mean ethical courage score of the nursing students was average. It seems that nursing students feel responsible when faced with ethical issues. However, optimizing their sense of responsibility requires proper interventions since ethical courage in today's nursing students could result in a favorable ethical atmosphere in the healthcare system, thereby improving the quality of healthcare services and increasing patient satisfaction. Therefore, it is essential for nursing schools to promote ethical responses in the students. Furthermore, instructors should live up to their role and encourage ethical courage in nursing students.   }, Keywords = {Moral, Courage, Nursing, Student}, volume = {33}, Number = {127}, pages = {35-44}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.52547/ijn.33.127.35}, url = {http://ijn.iums.ac.ir/article-1-3359-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3359-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {Inanlou, M and Baha, R and Seyedfatemi, N and FadaeeAghdam, N and Basirinezhad, MH}, title = {Self-efficacy and the Related Demographic Characteristics in Nursing Students}, abstract ={Background & Aims: Self-efficiency refers to the belief of individuals in their abilities for adapting to special conditions. Those with sufficient self-efficacy are better able to adapt with the needs of specific situations, while the individuals who lack high self-efficacy have difficulty performing activities under the same circumstances. Furthermore, individuals with higher self-efficacy are more successful in facing the challenges of future life. Self-efficacy results in independence and increases self-confidence. Job satisfaction and commitment to stay in a profession also depend on self-efficacy. Individuals with a higher sense of self-efficacy have more power to withstand obstacles and failures in life. There is a strong correlation between self-efficacy, motivation, and performance. In the educational setting, self-efficacy refers to a student's belief in the ability to perform tasks. Students with higher self-efficacy beliefs apply more interest, effort, and perseverance in their tasks and are confident in their abilities. They are also more successful in their education and future career. In the nursing profession, nurses with high self-efficacy are able to manage patients under various conditions. Since nurses are in long-term contact with patients, their high self-efficacy and positive belief in their abilities could help them better understand, manage, and cope with the changes in the patient's condition. On the other hand, low self-efficacy is associated with high levels of anxiety, stress, and depression. The level of self-efficacy in nursing students could predict their role in community health. Nurses with low self-efficacy are unable to take the necessary measures for patient care, while the increased risk of nursing errors could jeopardize patient safety and lead to adverse consequences. These issues are more likely in less experienced nursing students. The present study aimed to investigate the level of self-efficacy and the related demographic characteristics in nursing students. Materials & Methods: This cross-sectional, descriptive-correlational study was conducted on 358 nursing students at Tehran University of Medical Sciences, Iran who were selected via stratified random sampling. The total number of the nursing students was 806, which was considered as a class for the sampling of each academic year. Based on the number of the students in each academic year (228 students in the first year, 219 students in the second year, 183 in the third year, and 177 in the fourth year), 100 students were selected from the first year, 99 students were selected from the second year, 79 students were selected from the third year, and 80 students were selected from the fourth year. After obtaining sufficient information from the Department of Education on the number of the classes and students in each class, the researcher randomly selected the classes and used a random number table for the sampling of each class. After receiving information about the objectives of the study, the students provided written informed consent and completed the questionnaires anonymously. In addition, the students were assured of confidentiality terms regarding their personal information and responses, as well as the fact that the data would be analyzed by a computer on a code-specific basis and would not necessarily be a family name. Data were collected using a demographic questionnaire and Sherer general self-efficacy questionnaire. The demographic data included age, gender, marital status, academic year, place of residence, economic status, and work experience. In addition, the general self-efficacy questionnaire developed by Scherer et al. (1982) was used to assess the self-efficacy level of the students. The questionnaire consists of 23 items, 17 of which are focused on general self-efficacy, and the other six items are dedicated to self-efficacy experiences in social settings. We used the 17-item scale in our study to measure the subjects' beliefs about their ability to overcome different situations. Data analysis was performed in SPSS version 16 using one-way ANOVA, independent t-test, Chi-square, and Fisher's exact test at the significance level of P≤ 0.05. In addition, the STROBE checklist was used to report the research. Results: In total, 66.2% of the participants were female aged 20-22 years. The mean score of self-efficacy of the nursing students was 63.69 ± 9.09, and no significant correlations were observed between the self-efficacy level and demographic characteristics (P>0.05). Compared to the other two groups, the students aged 20-22 years would significantly drop out, and if they did not succeed in learning new things, they would simply give up and are unable to handle their problems in life (P<0.05). The female students were significantly more hesitant than the male students about their organized plans and would simply give up (P<0.05). In addition, the students of the third year were significantly less able to concentrate on their tasks compared to the other groups and also unable to face unexpected problems well; in this degree, the students were less self-reliant and would simply give up (P<0.05). The results indicated that the students living in dormitories mostly gave up their part-time job (P=0.042), and those with a poor financial status significantly avoided learning new things if it was difficult compared to the other two groups (P=0.027). The students with work experience could do their job better (P=0.043). Conclusion: According to the results, the mean score of self-efficacy of the nursing students was 63.69. As future nurses, nursing students must have a high level of self-efficacy to properly manage patients, as well as the other members of the treatment team so as to have a better professional life and social satisfaction. Self-efficacy also enhances the tasks undertaken by nurses, thereby reducing errors and increasing the quality of patient care. Given the importance of students in the health care system and considering that the level of self-efficacy predicts their performance and mental health, providing solutions to improve the level of self-efficacy should be prioritized in the programs of the educational systems of nursing schools.  }, Keywords = {Self-efficacy, Nursing Students, Demographic Characteristics, General Self-efficacy Scale}, volume = {33}, Number = {127}, pages = {45-57}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.52547/ijn.33.127.45}, url = {http://ijn.iums.ac.ir/article-1-3372-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3372-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {Mosadeghrad, AM and Abbasi, M}, title = {Managerial Intelligence of Nurse Managers in Sari Hospitals in Iran}, abstract ={Background & Aims: Nurses constitute the largest group of healthcare staff in hospitals. Nursing is a stressful job owing to dealing with critically ill patients, high workload, low salaries, and low appreciation. In addition, patients expect high-quality and safe nursing care; therefore, the management of nursing wards is very important. Nurse managers are responsible for planning, managing resources, organizing nursing care, leading nurses, and evaluating their performance and play a key role in achieving optimal outcomes for patients and the hospital. Furthermore, nurse managers play a vital role in providing effective, efficient and safe care to patients. They should be equipped with intelligence, knowledge and skills in today’s complex, volatile, and unpredictable healthcare environment. The success of nurse managers largely depends on their aptitude and personality. Aptitude encompasses intelligence, knowledge, and skills, and personality refers to the manager's beliefs, values, attitude, and behaviors. In addition to the knowledge, skills, and expertise of nurse managers, their intelligence also plays a pivotal role in improving their knowledge, capability, and behavior to optimally perform managerial tasks. The performance of managers depends on their intelligence, knowledge, skills, personality, and organizational structure, culture, and resources. Managerial intelligence refers to the capacity, ability, knowledge, skills, and experience of managers to analyze and define organizational problems, develop effective communication, create networks, and increase the power for better adaptation to changing environments or create the proper environment to achieve organizational goals. Managerial intelligence also encompasses cognitive, emotional, and political intelligence. Intelligence quotient (IQ) is a manager’s capacity and ability to evaluate and solve organizational problems, which enable them to think, understand, and analyze problems. On the other hand, emotional quotient (EQ) is the capacity of managers to recognize their own emotions and those of others and use the information to regulate their emotions. Political quotient (PQ) refers to a manager’s decision-making capacity, which enables them to pursue and achieve their interests in the competitive positions of leadership and power. The present study aimed to evaluate the managerial intelligence of the nurse managers in the hospitals of Sari, Iran. Our findings provide useful information to the policymakers and senior managers of the healthcare system at the macro level, as well as hospital managers at the micro level, for the recruitment, training, development, performance appraisal, job promotion, and compensation of nurse managers. Materials & Methods: This cross-sectional, and descriptive-analytical study was conducted at seven hospitals in Sari, Iran in 2017. In total, 108 nurse managers including matrons, supervisors and head nurses of clinical wards participated in this study. Data were collected using a valid and reliable questionnaire with three dimensions of cognitive intelligence, emotional intelligence, and political intelligence. Data analysis was performed in SPSS version 16 using descriptive statistics (mean, standard deviation, frequency, and percentage) and analytical statistical tests (Spearman's correlation-coefficient and analysis of variance [ANOVA]). Results: The mean score of the managerial intelligence of the nurse managers was 0.73 (out of 1). In addition, the mean scores of cognitive, emotional, and political intelligence of the nurse managers were estimated at 0.66, 0.77, and 0.74, respectively. A positive, significant correlation was observed between EQ and PQ of nurse managers. The male and married nurse managers, those with an MSc degree, and those working in the social security hospitals scored higher on managerial intelligence. However, no significant correlations were denoted between their managerial intelligence and demographic variables. Conclusion: Nurse managers of Sari hospitals scored high in managerial intelligence. The ability to analyse and solve problems plays a key role in the success of managers. Therefore, nurse managers must have high intelligence to define and analyse various problems and identify, evaluate, and select the optimal solutions. Emotions also play a pivotal role in organizational behavior. Emotional intelligence and social intelligence are essential to improving the performance of managers as they must be able to manage their own and others' emotions properly. The nursing profession is generally full of emotions, and the high emotional intelligence of nursing managers leads to a positive direction of the emotions of the nursing staff, thereby filling the work environment with meaning and strengthening the emotional commitment of nurses. Therefore, emotional intelligence training should be implemented for nurses and nurse managers. Emotional intelligence is a learned skill through education, counseling, practice, and feedback. As such, emotional intelligence training enhances the communication skills between nurses and results in better patient outcomes. Training and practice also promote values ​such as self-confidence, honesty, fairness, self-sacrifice, criticism, support, cooperation, and patience in managers, which are a prerequisite for emotional intelligence and largely influence their leadership success. Hospitals are highly complex and multidisciplinary social organizations, which have evolved in an ever-changing environment. The nature and type of the services provided in these organizations require managers to make complex decisions within a short period. Political intelligence helps managers to network and build alliances, while also increasing their power in the organization to make important decisions quickly and obtain the necessary authority to implement their decisions. Nursing managers need political skills to optimize their organization and become the 'agents of change' to improve hospital performance. Therefore, hospital managers should provide the required training to improve the political intelligence of nurse managers. Measuring the managerial intelligence of nurse managers, identifying their strengths and weaknesses, and taking proper measures are among the significant influential factors in their performance and increasing the productivity of a hospital. Furthermore, developing the competency of nurse managers is essential to the sustainability and improvement of healthcare outcomes. Managerial intelligence is not static and could be taught and enhanced constantly. Therefore, nurse managers are expected to improve their social, emotional, and political skills given the unique nature of the nursing profession. Managerial intelligence should also be considered as an important competency in the recruitment of efficient nurse managers and administrators. Nursing administrators should consider cognitive, emotional, and political intelligence while hiring nurse managers. Effective nurse managers should utilize a blend of various aspects of intelligence (i.e., cognitive, emotional, and political) in this regard. Emotional intelligence is essential to effective team interactions and productivity.  }, Keywords = {Managerial Intelligence, Emotional Intelligence, Hospitals, Nursing Administrators, Cross-sectional Studies}, volume = {33}, Number = {127}, pages = {58-71}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.52547/ijn.33.127.58}, url = {http://ijn.iums.ac.ir/article-1-3373-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3373-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {Gharacheh, M and Mazari, Z and HasanpoorAzghady, SB and Haghani, SH and Azadi, SH}, title = {Relationship between Domestic Violence and Mother-Infant Attachment in Mothers Referring to Comprehensive Health Centers affiliated to Iran University of Medical Sciences}, abstract ={Background & Aims: Infancy is the most important time for the formation of emotions and emotional development, and mother-infant attachment is of special importance during this period. Domestic violence seems to be one of the factors relating to the mother- infant attachment. In fact, domestic violence is an attack on the mother-child relationship and the child care system. Violent fathers directly and indirectly weaken the emotional bond between mother and child. Those women who are the victims of domestic violence often live in fear and anxiety to protect their children's mental health and safety, and this fear may be inadvertently transmitted to children, forming undesirable attachment patterns; as some children perceive their mothers as a source of fear and anxiety, and eventually the child will suffer from unresolved trauma by perceiving a threat to its mother. Consequently, unresolved fear and trauma results in disorganized attachment. However, most studies have examined attachment at different stages of life from pregnancy to infancy, childhood, and adulthood, and the emotional relationship in infancy is neglected. Therefore, considering the role of mother-infant behavior and attachment and the effects of father's violence on the health of mother and child, the present study was conducted to determine the relationship between domestic violence and mother-infant attachment. Materials & Methods: This was a cross-sectional study conducted on 320 mothers referring to the comprehensive health centers affiliated to Iran University of Medical Sciences in Tehran in 2019. Multistage sampling method was employed to select the subjects. First, the comprehensive health centers were divided into two groups (west and northwest). The comprehensive health centers located in the west covered four districts (9-18-21-22) and Northwest centers covered three districts (2-5-6). Then, two centers were selected from each district by simple random sampling method and 320 mothers, referring to the health centers, meeting inclusion criteria were selected continuously. Sampling lasted approximately 3.5 months (from November 29, 2019 to February 15, 2019). The inclusion criteria were the Iranian nationality, mothers aged 18 to 45 years, monogamy status, minimum literacy, having a seemingly healthy infant aged one month to one year, infant birth weight more than 2500 grams and wanted pregnancy, no history of severe stress during the last year (death of a first-degree relative, serious illness of mother or father, decision to separate, severe family conflicts), no drug addicted parents, no history of severe psychological disorders in the last year (history of referring to the doctor, medication, or hospitalization), no mother- child separation for more than 24 hours in the early hours following delivery, and no history of parental infertility. Demographic and Fertility Questionnaires, the Maternal Attachment Inventory (MAI), and revised Conflict Tactics Scales (CTS2) were used to collect data. The MAI was used to measure mother- infant attachment. The questionnaire has 26 items and each item has four options rated on the 4- point Likert scale, including almost always (4), usually (3), sometimes (2), and never (1). The scores of the questionnaire range from 26-104. The revised Conflict Tactics Scales used to measure domestic violence had 36 items including the areas of negotiation (6 items), physical violence (12 items), psychological violence (8 items), sexual violence (4 items), and injury (6 items). Each item has eight options rated on a 7- point scale. The scores of the different scales are not added up in this questionnaire, and finally the samples receive zero for the absence of violence and one for the existence of violence, thus the overall prevalence of domestic violence and the relative prevalence of each type of domestic violence or subscales are shown in frequency and percentage. Descriptive statistics were used to describe the data and Chi-square, independent t-test, and analysis of variance were calcualted in the SPSS software version 16 to examine the relationship between the variables. Significance level was considered at P <0.05. Results: The results showed that the mean of mother- infant attachment was 97.78 ± 7.56. Overall domestic violence in the mothers participated in the study was 42.2%. Among the studied mothers, 53.8% experienced violence in domains of negotiation, 24.7% physical violence, 75.6% psychological violence, 12.5% ​sexual violence, and 31.6% injury. Thus, the areas of psychological violence and negotiation had the highest frequency and the areas of sexual violence and physical violence had the lowest frequency among the dimensions of domestic violence. Based on the overall results of the two groups; abused and non-abused women (P = 0.010), there was a statistically significant difference between the groups in terms of mother- infant attachment in all areas of negotiation (P = 0.014), physical violence (P = 0.043), psychological violence (P = 0.014), and injury (P = 0.010), except sexual violence (P =0/356). None of the demographic variables of mothers was significantly related to mother- infant attachment (P> 0.05) and also domestic violence (P> 0.05). Conclusion: The findings of the study showed that overal domestic violence was significantly related to mother-infant attachment and mother-infant attachment was lower in mothers experiencing violence. Domestic violence was significantly related to mother-infant attachment in all areas except sexual violence. Therefore, the present study showed that domestic violence against mothers during infancy can undermine the mother-infant attachment. Since the formation of attachment during infancy is a good starting point for improving the role of fathers in building social and emotional relationships with their children and, consequently, the growth and health of emotional relationships and family members' attachment, it is necessary that officials and care systems pay more attention to mothers' mental health and family status by identifying, counseling, and adopting timely preventive and supportive strategies through active participation of fathers in physical and emotional wellbeing of their infants to improve mental health of family members and mother-infant attachment by reducing domestic violence. Midwives and healthcare providers can use special tools and perform psychological screening for early and timely referral during postpartum care to reduce all types of domestic violence and harms to families experiencing violence. Also, timely detection of parent-child attachment disorder and the factors affecting it and eliminating it through educational and counseling interventions and parental support in this area can help to prevent the loss of economic and human capital. Also, in terms of the quality of parental attachment, this research can provide the basis for interventional research or subsequent studies to identify other factors affecting attachment. This study suggests that more studies investigate the relationship between the violence of other people, other than the husband, and the mother- infant attachment. It is also recommended to study the relationship between mother's violence against the father and the mother-infant attachment. It is suggested to conduct a study that can examine the effect of parents' violence against each other on the mother- infant attachment. More studies are also needed to be performed on a larger sample size in order to generalize the results. Moreover, this study suggests that an extensive research project be conducted to investigate the relationship between other factors related to mother-infant attachment such as marital satisfaction, social support, and parental personality traits.}, Keywords = {Mother-Infant Attachment, Domestic Violence, Spouse Abuse}, volume = {33}, Number = {127}, pages = {72-88}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.52547/ijn.33.127.72}, url = {http://ijn.iums.ac.ir/article-1-3378-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3378-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} } @article{ author = {Olyaiekhachic, R and Bozorgnejad, M and Haghani, SH and Khayeri, F and Seyedfatemi, N}, title = {Evaluating the Effect of Positive Self-Talk on Job Stress among Nurses Working in the Emergency Wards}, abstract ={Background & Aims: Nursing, by its nature is ranked as one of the most stressful jobs. Emergency nurses are exposed to more stress. A lot of studies have shown that nurses who work in critical care environments; such as emergency departments experience high levels of occupational stress during working time. Job stress may result in anxiety, restlessness, hate of working, absenteeism, and even a lot of illnesses. Interventions to manage nurses’ stress are required in order to improve patient care. Positive self-talk is a psychological skill. In this technique, the person commands the mind to direct its own thoughts and behaviors and to prepare all sources in order to achieve success. This study was carried out to evaluate the impact of positive self-talk on the job stress of nurses working in emergency wards. Materials & Methods: In this evaluation study, 62 nurses working in emergency wards of three teaching hospitals affiliated to Iran University of Medical Sciences, including Hazrat Rasool-e- Akram (PBUH), Firoozgar, and Shohada-ye Hafte Tir hospitals participated in this study and were divided into two groups; control group and intervention group. Data collection was started in September and finished at the end of December 2019. At first, the list of nurses working in the emergency department was prepared by referring to the nursing offices of each center, and then, considering the inclusion criteria (at least one year of experience in the emergency department), the list was reviewed again. Then, based on the final list of samples from each center, 11 were randomly assigned to the control group and 11 to the intervention group using lottery. Finally, 33 were placed in the intervention group and 33 in the control group. Towards the end of the study, 32 were in the control group and 30 in the intervention group due to attrition. After identifying the groups, the researcher first introduced himself / herself to the samples of the control group of all 3 centers, and after explaining the objectives of the study and ensuring the confidentiality of information and obtaining informed written consent, asked them to fill the demographics questionnaire form and Expanded Nursing Stress Scale (ENSS) (French et al, 2000). No intervention was provided to the control group. 3 weeks after the pretest, ENSS (posttest) was completed again by the control group. In the next stage, the nurses of the intervention group were selected and after completing the data collection tools, the experimental group participated in a positive self-talk workshop at the School of Midwifery Nursing for two weeks (one session per week) from 8 am to 2 pm. The workshop was administered through lecturing about positive self-talk with presenting scenarios and group discussion as well as role play. One week after the workshop, the data collection tools were completed again by the intervention group. Data analysis was performed using independent t-test and chi-square in SPSS software version 16. The Expanded Nursing Stress Scale (ENSS) (French et al., 2000) was used in this study. This is a self-administered instrument. The ENSS is an expanded and updated version of the classic Nursing Stress Scale (NSS), which contains 57 items in 9 subscales related to physical, psychological, and social working environments. 9 subscales include: death and dying, conflict with physicians, inadequate emotional preparation, problems with peers, problems with supervisors, work load, uncertainty concerning treatment, patients and their families, and discrimination. The 57 items were arranged in a 5 point Likert  scale including ‘does not apply’ (0) , “never stressful” (1), “occasionally stressful” (2), “Frequently stressful” (3), “extremely stressful” (4). The total and subscale mean score was derived from this instrument which ranged from 0-4. The score range was 0-228. The higher scores indicated that the situation was highly stressful. Results: Findings showed no statistically significant difference between the two groups in terms of demographic characteristics. The results of paired t-test indicated a statistically significant difference between stress and its 5 dimensions in the intervention group before and after the intervention, so that the total stress before the intervention was (119.5 ± 36.02) which decreased to (95.86 ± 40.08) after the intervention (P = 0.001). The results also showed that the mean stress score in the intervention group after the intervention (95.86 ± 40.08) was significantly lower than the control group (129.06 ±40.52), indicating that with positive self-talk training, the stress of the intervention group is reduced  significantly (P = 0.002). Also, the results of independent t-test showed a statistically significant difference between the two groups in terms of subscales of job stress, which indicates the effect of positive self-talk on reducing job stress. Conclusion: It is important to know that stress might be to some extent productive, whereas higher stress in staff costs a lot in terms of individual well- being and quality of health care services. Therefore, it must be managed effectively. Positive self-talk reduced nurses' job stress in emergency departments. Given the significant decrease in the nurses’ stress using positive self-talk strategies, this approach can be suggested to nurses in critical care units in order to reduce their stress and increase their efficiency. It is suggested that managers and nursing officials hold cognitive-behavioral stress management workshops, including positive self-talk for nurses working in different wards, and help them to improve the quality of nursing services. Researchers suggest that future studies investigate the comparative effect of positive self-talk with other psychological intervention on problem-solving and decision making skills in nurses working in emergency departments.  }, Keywords = {Job Stress, Emergency Nurses, Positive Self-Talk}, volume = {33}, Number = {127}, pages = {89-102}, publisher = {دانشگاه علوم پزشکی ایران}, doi = {10.52547/ijn.33.127.89}, url = {http://ijn.iums.ac.ir/article-1-3392-en.html}, eprint = {http://ijn.iums.ac.ir/article-1-3392-en.pdf}, journal = {Iran Journal of Nursing}, issn = {2008-5931}, eissn = {2008-5931}, year = {2020} }