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   Table of Contents - Current issue
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May-June 2019
Volume 24 | Issue 3
Page Nos. 159-242

Online since Monday, April 22, 2019

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REVIEW ARTICLE  

The maternal near miss incidence ratio with WHO Approach in Iran: A systematic review and meta-analysis Highly accessed article p. 159
Sedigheh Abdollahpour, Hamid Heidarian Miri, Talat Khadivzadeh
DOI:10.4103/ijnmr.IJNMR_165_18  PMID:31057630
Background: Maternal near miss (MNM) is one of the important criteria for checking the quality of care in maternal health. This systematic review and meta-analysis study was conducted in 2017 to evaluate the incidence ratio of MNM using the World Health Organization approach in Iran. Materials and Methods: This study was designed based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist for systematic reviews, and Web of Science and PubMed databases were searched systematically, which, respectively, yielded 171 and 137 papers published before June 9, 2017. To include papers written in Persian by Iranian scholars, Google Scholar database was searched and 542 papers were retrieved. Finally, 12 papers which had covered the topic more appropriately were included in the study. Random-effects meta-analysis was used to pool the incidence ratio. Heterogeneity was explored using formal tests and subgroup analyses, then the study quality was also explored. Results: The pooling of overall potentially life-threatening conditions ratio was I2 (97.60%, p < 0.001, ratio = 2.50/1000 live births [LBs] [95% CI: 2.00-3.00]), which is divided into two indicators: severe complication ratio (2.40/1000 LBs) and critical intervention ratio (2.54/1000 LBs). The pooling of overall life-threatening conditions ratio was I2 (95.10%, p < 0.001, ratio = 0.86/1000 LBs [95% CI: 0.64-1.07]). Conclusions: The incidence ratio of MNM needs more attention in Iran. Therefore, it is necessary to identify the factors related to MNM and then implement suitable strategies to reduce the risk factors of the maternal morbidity and improve the quality of maternal care in facilities.
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ORIGINAL ARTICLES Top

Inner voice of pregnant women: A qualitative study p. 167
Arpi Manookian, Mansooreh Tajvidi, Nahid Dehghan-Nayeri
DOI:10.4103/ijnmr.IJNMR_105_18  PMID:31057631
Background: Spirituality becomes more significant and evident during crises like pregnancy; therefore, it is crucial for healthcare providers to be supportive during pregnancy through exploring and understanding the meaning of spirituality for pregnant women. This study aimed to discover the experiences of Iranian pregnant women regarding spirituality. Materials and Methods: This qualitative, inductive, content analysis study was performed in 11 pregnant women (28–36 weeks' gestation) who attended the healthcare centers of Karaj, Iran. The subjects were selected by purposive sampling and invited to participate in the study. The data were collected through semi-structured, face-to-face, and in-depth interviews and were analyzed using the inductive content analysis approach. Results: Three major themes emerged during data analysis: “permeable transcendence,” including “spiritual awareness of mother,” “spiritual light of baby,” and “personal transformation and improvement.” “Doubled responsibility” comprised two subthemes of “spiritual nourishment for mother” and “spiritual nourishment for child,” and “spiritual circumstance” consisted of two subthemes of “religious background” and “spirituality of healthcare provider.” Conclusions: Considering the importance of spirituality and religion in gestational health promotion, the results of this study can assist healthcare providers in recognizing the women's spiritual needs and valuing the protective role of religious/spiritual well-being during pregnancy.
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The Iranian Psychiatric Nurses' perception of transition in psychiatric wards: A qualitative study p. 172
Narges Rahmani, Eesa Mohammadi, Masoud Fallahi-Khoshknab
DOI:10.4103/ijnmr.IJNMR_115_18  PMID:31057632
Background: Transition means moving from one period to another and it is usually associated with significant changes in objectives, roles, and responsibilities. Considering the challenges of the psychiatric ward, psychiatric nurses experience numerous problems, especially at the early stages of their job engagement. This study aimed to examine the perception of the Iranian psychiatric nurses in psychiatric wards and their transition period. Materials and Methods: The study was designed as a qualitative content analysis study in three referral hospitals in Mazandaran and Tehran, Iran 2016. Participants included 18 nurses who had experienced transition at the psychiatric ward and had at least 3 months job experience in three referral hospitals of Iran and were selected purposefully. Data were collected using unstructured interviews and analyzed using the inductive approach and conventional content analysis. To ensure the trustworthiness of the data, Guba and Lincoln's criteria were used. Results: The major themes of transition among the nurses of psychiatric wards included “inadequate preparation,” “mental stress,” “self-awareness and capabilities,” and “the effective role of nurses' full support in adjustment.” Conclusions: The findings revealed that nurses did not have a decent transition. In this regard, educational systems must provide training courses to prepare nurses to support them in their arrival stage and to facilitate their transition. The findings of this study can help mentally prepare nurses for their preparation to perform their role and improve the quality of care.
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Exploring the barriers to sexual and reproductive health education for men in Iran: A qualitative study p. 179
Khadigeh MirzaiiNajmabadi, Leila Karimi, Abbas Ebadi
DOI:10.4103/ijnmr.IJNMR_132_18  PMID:31057633
Background: Considering the obvious reasons for the necessity of men's sexual and reproductive health education, the present qualitative study aims to identify and contextualize the barriers to sexual and reproductive health education to men in Iran. Materials and Methods: This qualitative research was conducted using conventional procedures of content analysis. A total of 34 participants consisting of authorities in health organizations, healthcare providers, clergies, and adult men in a general population were interviewed in two large cities of Iran including Tehran and Mashhad in 2016. Purposive sampling continued until data saturation was ensured. Data were collected through individual in-depth semi-structured interviews. All interviews were tape-recorded and transcribed in verbatim. Finally, the data were analyzed using conventional qualitative content analysis. Results: Participants' experiences were categorized into three main themes including (1) individual barriers, (2) sociocultural barriers, and (3) structural barriers along with seven subthemes including low perceived threat, unwillingness to learn, sociocultural taboos, family's lack of knowledge and malperformance, policy-making barriers, executive barriers, and health system deficiency barriers. Conclusions: Considering the results obtained, many barriers to men's sexual and reproductive health education could be eliminated through overcoming the individual and structural barriers and sociocultural taboos, as major obstacles. The findings suggest overcoming these barriers and promoting men's health require raising awareness overcoming sociocultural taboos. In this regard, policy-makers should provide sexual and reproductive health education programs and create opportunities and facilities along with appropriate learning environments for men.
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Comparing the effects of two methods of group education and peer education on sexual dysfunction of menopausal women: A randomized controlled trial p. 187
Zahra Vakili, Mahnaz Noroozi, Soheila Ehsanpoor
DOI:10.4103/ijnmr.IJNMR_160_18  PMID:31057634
Background: Sexual problems could cause severe personal discomfort and affect interpersonal relationships. Considering that selection of appropriate methods has an important role in success of the education, this study was conducted to compare the effects of two methods of group education and peer education on sexual dysfunction of menopausal women. Materials and Methods: In this randomized controlled trial, 108 menopausal women were allocated into three groups in the health centers of Isfahan, Iran. After educating four menopausal women, educational sessions were conducted by them for the participants (36 women) in the peer groups. Two educational sessions were conducted by the researcher in the group education. The control group received no intervention. Before and 1 month after the intervention, female sexual function index was completed by the participants. Data were analyzed using descriptive and inferential statistics (one-way analysis of variance, paired t-test, Chi-square, Kruskal–Wallis, and Post hoc LSD test). Results: The total mean score of sexual function and its domains in the peer education and group education groups was significantly higher than the control group after the intervention (F2, 93= 23.52, p < 0.001); but the difference between the peer education group and the group education group was not statistically significant. Conclusions: Both methods of peer education and group education have been effective in improving the sexual function of menopausal women. So, considering the advantages of peer education such as its low cost, affordability, and no need to train specialized individuals, its implication in educational programs for menopausal women is recommended.
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Effect of a supportive training program on anxiety in children with chronic kidney problems and their mothers' caregiver Burden p. 193
Niloofar Bahrami, Saeid Pahlavanzadeh, Maryam Marofi
DOI:10.4103/ijnmr.IJNMR_88_18  PMID:31057635
Background: Chronic problems have a long course of treatment and are one of the important causes of the childhood hospitalization. The aim of this study was to determine the effect of a supportive training program on the children's anxiety and their mothers' caregiver burden. Materials and Methods: This study was a randomized controlled clinical trial, performed on two groups in three stages in the autumn of 2017 on 112 individuals. The study population consisted of all children with chronic kidney problems who hospitalized in Emam Hossein Hospital (Isfahan, Iran) and their mothers. Sampling selection method was convenient. Participants were randomly assigned to experimental (n = 56) and control (n = 56) groups and the supportive training program, that was a self-regulating program, was done for the experimental group. The Face Anxiety Scale and the Zarit Caregiver Burden Scale were completed by both groups before, after and 1 month after the intervention. Statistical significance was set at 5%. Results: There was a significant difference in the mean scores of anxiety and caregiver burden in the experimental group preintervention [anxiety: (t54= 0.31, p = 0.75); caregiver burden: (t54= 1.34, p = 0.18)], postintervention [anxiety: (t54= 5.30, p < 0.001); caregiver burden: (t54= 2.72, p = 0.009)], and follow-up [anxiety: (t54= 2.39, p = 0.01); caregiver burden: (t54= 3.06, p = 0.003)], whereas there was no significant difference in the mean scores of anxiety and caregiver burden in the control group. In order to controlling for pretest scores, the repeated measure analysis of covariance was adopted. Conclusions: The results showed that the supportive training program can reduce children's anxiety and their mothers' caregiver burden and suggesting to nurses, an effective program to reduce the negative effects of hospitalization on children and their mothers.
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The Effect of the cool dialysate on the restless leg syndrome in hemodialysis patients: Randomized triple-blind clinical trial p. 200
Ehsan Kashani, Zahra Mirhosseini, Sedigheh Rastaghi, Mostafa Rad
DOI:10.4103/ijnmr.IJNMR_133_18  PMID:31057636
Background: Restless leg syndrome (RLS) is a common symptom of some diseases specially observed during hemodialysis. Cooling the dialysate is a safe and nonpharmacological method. The aim of this study was to assess the effect of cool dialysate on RLS in hemodialysis patients. Materials and Methods: A total of 79 patients were selected for screening based on the four main criteria set by the RLS International Association. Finally, in line with the inclusion and exclusion criteria, 63 hemodialysis patients were recruited and participated in this clinical trial. The patients were randomly assigned to the intervention group (n = 32) and the control group (n = 31). The intervention group received 35.5°C dialysate and the control group received 37°C dialysate three times a week for a period of 1 month. The severity of RLS was measured in both groups using a standardized RLS questionnaire. Using R software version 3.3.1, the data were analyzed using the Student's t-test, and Wilcoxon test, at 95% confidence interval. Results: In terms of RLS severity, there was no significant difference between intervention and control groups before the intervention (t = -2.11, p > 0.05). After the intervention, the mean (SD) of RLS severity in the control group was 28.77 (5.45) and in the intervention group was 11.66 (4.69), in which t test showed a significant difference between two groups (t = 14.03, p= 0.001). Conclusions: Using cool dialysate as a nonpharmacological treatment may reduce the severity of RLS in patients on hemodialysis. Therefore, using this method to improve RLS in hemodialysis patients is recommended.
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Self-Actualization: Self-Care outcomes among elderly patients with hypertension p. 206
Hanieh Gholamnejad, Ali Darvishpoor-Kakhki, Fazlollah Ahmadi, Camelia Rohani
DOI:10.4103/ijnmr.IJNMR_95_18  PMID:31057637
Background: This study aims to analyze the experiences of older patients with hypertension to realize the outcomes of their self-care behaviors for controlling hypertension. Materials and Methods: This is a qualitative research with a conventional content analysis approach. The participants consisting of 23 people were selected through purposive sampling. Data were collected through semi-structured interviews until data were saturated. Granheim and Lundman's conventional content analysis was applied to analyze the data. Results: After data analysis, four main categories including self-efficacy, active lifestyle, spirituality, and stress management were obtained. These categories show the experience and outcomes of self-care behaviors among elderly patients with hypertension. Conclusions: Awareness of the elderly of their potentials and role in disease control in addition to relying on the power of spirituality provides positive results in hypertension management. Self-actualization of the elderly resulted in resisting against the destructive effects of internal and external stress and moving in the direction of growth. Health professionals should be vigilant to encourage and promote education about the importance and advantages of self-care for elderlies.
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Compassionate care challenges and barriers in clinical nurses: A qualitative study p. 213
Sima Babaei, Fariba Taleghani
DOI:10.4103/ijnmr.IJNMR_100_18  PMID:31057638
Background: Compassion is the heart of nursing care. Barriers to compassion in nursing may be influenced by the prevailing culture and religion of a society. Determining the barriers to providing compassion-based care would help nurses to plan better and more appropriate interventions. This study aimed to explore the challenges and barriers to compassionate care in nurses. Materials and Methods: This ethnographic study was performed in 2014–2016. The study participants consisted of 40 nurses, 16 patients, and 8 family members in medical and surgical wards. Data collection was performed through observations and interviews. Data analysis was performed based on Strauss and Corbin's constant comparative method. Results: Data analysis defined three themes as the challenges and barriers to compassionate care; challenges and barriers related to the contextual environment of hospitals, sociocultural challenges and barriers, and challenges; and barriers related to staff. Conclusions: This study described the challenges and barriers to compassionate care. Therefore, to eliminate these barriers and challenges, corrective action should be taken by managers. Attention to teaching the concept of compassion and patient-centered care and increasing the number of nurses and positive attitude toward the nursing profession in clinical environment can be effective in providing compassionate care.
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Effect of nursing intervention integrating an Islamic praying program on labor pain and pain behaviors in primiparous Muslim women p. 220
Desmawati , Waraporn Kongsuwan, Warangkana Chatchawet
DOI:10.4103/ijnmr.IJNMR_36_18  PMID:31057639
Background: Labor pain has always been a priority issue for primiparous women. Pain behaviors appear as a response to labor pain. This study aimed at examining the effect of nursing interventions integrating an Islamic praying (NIIIP) program on labor pain and pain behavior. Materials and Methods: In this experimental design, 42 women in the control group received the usual care; 41 in the experimental group received the usual care and an NIIIP program from the 32nd week of pregnancy. This was done by providing childbirth education which they then practiced at home every day until they entered the labor room in the Bhinneka Bhakti Husada Hospital and Community Health Center Pamulang, Indonesia. They conducted 30 min of reciting from the Quran, stroking, positioning during their inter contractions, just breathing during contractions at the 1st, 2nd, 3rd h after cervical dilation of 3–4 cm. The visual analogue scale (VAS) and pain behaviors observation scale (PBOS) were used to measure pain and pain behaviors. Repeated measures of the ANOVA and t test were used to analyze the data. Results: There were significant differences in experience of labor pain ([F = 113.07, df (1, 81), p < 0.001] and pain behavior ([F = 147,49 df (1, 81), p < 0.001] between the control and experimental groups. There were significant statistical differences of over four times at the points of pain [F = 82.84, df (2, 182), p < 0.001] and pain behaviors [F = 165.55, df = (2, 189), p < 0.001]. Conclusions: The program effectively resulted in lower pain and increased pain behaviors.
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Coping Strategies of Pregnant Women with Detected Fetal Anomalies in Iran: A Qualitative Study p. 227
Morvarid Irani, Talat Khadivzadeh, Seyyed-Mohsen Asghari-Nekah, Hosein Ebrahimipour
DOI:10.4103/ijnmr.IJNMR_97_18  PMID:31057640
Background: Progressing technology has increased the detection of fetal abnormalities in the pregnancy. Detection of fetal abnormalities during pregnancy can cause significant social, physical, psychological, and emotional stress. The aim of this study was to explore the coping strategies of Iranian pregnant women with detected fetal anomalies. Materials and Methods: This qualitative content analysis study was conducted on two referral centers for fetal anomaly. The data were collected from April 2017 to January 2018 in Mashhad (Iran) through individual, semistructured, in-depth interviews with 25 pregnant women with a prenatal diagnosis of fetal anomalies. Data were analyzed using conventional content analysis based on Graneheim and Lundman's approach. Results: As a result of data analysis, the four categories of seeking information, religiousness and spirituality, cognitive avoidance, and seeking social support, and 12 subcategories emerged. Seeking information consisted of the four subcategories of personal search, visiting different doctors, performing various diagnostic tests and sonography, and seeking peers' experiences. Religiousness and spirituality contained the three subcategories of praying, acceptance of destiny, and reliance on faith. Cognitive avoidance consisted of the two subcategories of avoiding negative information and avoiding situations that remind them of their problem. Seeking social support contained the three subcategories of getting support from family, getting support from friends, and getting support from others. Conclusions: The findings showed that pregnant women with detected fetal anomalies reported a variety of coping strategies. Therefore, it is important that healthcare providers encourage mothers to use strategies that are likely to be more effective.
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The effect of education program on health promotion behavior on successful aging p. 234
Mehrnoosh Shirani, Gholamreza Kheirabadi, Gholamreza Sharifirad, Mahrokh Keshvari
DOI:10.4103/ijnmr.IJNMR_31_15  PMID:31057641
Background: A successful aging pattern indicates a change in attitudes toward aging and life quality improvement, which include the components of general health and life satisfaction. The current study aimed to evaluate the effects of an educational program on successful aging components in the elders. Materials and Methods: A three-stage empirical study was conducted on 72 individuals of 60-75 years old who were randomly divided into two experimental and control groups. A 9-session educational program presenting health-related behaviors, including stress management and interpersonal relationships, was held for the experimental group. Two sessions of neutral topics group discussion were held for the control group. A Demographic Information Questionnaire, General Health Questionare-28 (GHQ-28), Diener's Satisfaction with Life Scale (SWLS) were used and completed before, immediately after, and two months after the intervention. Independent t-test was used for analysis of obtained data via SPSS software. Results: The mean (SD) score of general health in the two groups had no significant differences before the intervention [32.40 (14.70) vs. 30.8 (10.04)] (p = 0.60). The mean (SD) scores of general health immediately after intervention and two months later in the experimental group [20.2 (8.8) and 24.1 (8.05)] were significantly lower than control group [31 (9.8) and 30.9 (9.8)] (p < 0.05). The mean (SD) scores of life satisfaction in the both groups showed no significant difference before the intervention [16.8 (5.8) vs. 17.3 (5.5)] (p = 0.39), but were significantly different immediately after [20.4 (5.1) vs. 17.03 (5.1)] and two months after [19.8 (5.1) vs. 17.1 (5.1)] (p = 0.004). Conclusions: This study confirmed the effectiveness of health-related educational programs in improving elders 'general health and life satisfaction'.
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LETTERS TO THE EDITOR Top

Assignment of Health Care to Family Caregiver p. 239
Mostafa Roshanzadeh, Somayeh Mohammadi, Nematullah Shomoossi, Ali Tajabadi
DOI:10.4103/ijnmr.IJNMR_176_18  PMID:31057642
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The challenges of Clinical Engagement of Nursing Students in Iran p. 240
Mohammad-Reza Ghasemi, Hossein Karimi-Moonaghi, Abbas Heydari
DOI:10.4103/ijnmr.IJNMR_140_18  PMID:31057643
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Weakened health outcomes associated with outpatient cardiac rehabilitation for cardiovascular patients with sleep apnea p. 241
Habibolah Khazaie, Behzad Heydarpour, Saeid Komasi
DOI:10.4103/ijnmr.IJNMR_79_18  PMID:31057644
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ERRATUM Top

Erratum: Investigation of eating disorders in cancer patients and its relevance with body image p. 242

DOI:10.4103/1735-9066.256650  PMID:31057645
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