Background: Family caregivers of patients with mental disorders play the most important role in the care of psychiatric patients (PPs) and preventing their readmission. These caregivers face different challenges in different cultures. We conducted this study to determine the challenges of caregivers of patients with mental disorders in Iran. Materials and Methods: This study is a narrative review with a matrix approach conducted by searching electronic databases, SID, IRANMEDEX, MAGIRAN, PUBMED, SCOPUS, Web of Sciences, from February 2000 to 2017. Searched keywords include challenges, family caregivers of psychiatric patient, family caregivers and psychiatric patient, mental illness, families of psychiatric patient, and Iran. One thousand two hundred articles were found in English and Farsi, and considering inclusion and exclusion criteria, 39 articles were examined. Results: The results of the studies show that not meeting the needs of caregivers, burnout and high burden of care, high social stigma, low social support for caregivers, and low quality of life of caregivers were among the most important challenges faced by caregivers. Conclusions: Despite the efforts of authorities in Iran, family caregivers of patients with mental disorders still face challenges. Therefore, the need for all-inclusive support for family caregivers of patients with mental health problems is necessary.

Background: Individual barriers can affect the provision of preconception care (PCC). The aim of the present study was to determine the rank of importance of individual barriers (care recipients) in the provision of PCC among diabetic women from the viewpoints of care providers. Materials and Methods: The present cross-sectional study was conducted on 212 health managers, physicians, and midwives from December 2015 to March 2016. The data collection tool was a two-part researcher-made questionnaire consisting of a demographic characteristics and viewpoints scored on a five-point Likert scale (range: 0–4). Data were analyzed in Statistical Package for the Social Sciences software. Results: The mean (SD) individual barriers score of physicians, midwives, and health managers were 57.33 (15.63), 61.53 (17.81), and 54.57 (16.95), respectively (range: 0–100). A significant difference was observed between the three groups in terms of the mean score of importance of individual barriers (F = 2.54, df = 2, p = 0.040). Insufficient understanding of the importance of PCC by diabetic women and their families obtained the highest mean rank of importance in all groups. Conclusions: Although individual barriers had more importance in access to PCC by diabetic women in the view of midwives compared to the other groups, the viewpoints of the three groups were similar in most cases regarding the rank of importance of items. In order to improve the quality of PCC, the necessary measures must be taken by authorities and care providers to eliminate important barriers.

Background: Shared governance is a decentralized structural model that gives individuals the right to make decisions and a position analogous to managers. The shared governance is different based on context in every organization. This study identified the characteristics of shared governance in Iranian nursing schools. Materials and Methods: In this qualitative research, 11 participants were selected using purposive sampling method. Deep semi-structured interviews were conducted, and the data were analyzed using conventional content analysis. Lincoln and Guba's criteria were used to verify the accuracy and trustworthiness of the data. Results: Through data analysis, the theme of “several souls in one body” was achieved in addition to the seven categories of “climates based on common interests,” “conscious participatory decision-making,” “mutual accountability,” “multiplicity of ideas,” “decentralized structure,” “interrelationship,” and “sublime organization.” Conclusions: According to the findings, the characteristics of shared governance in the social culture of Iran are like several souls in one body, emphasizing all aspects of participation and morality in the organization. Managers and administrators in higher education and nursing faculties need to pay attention to all aspects of shared governance, including spirituality in managing the covered institutions.

Background: The quality of inhaler use can significantly affect the effectiveness of inhalation medications. This study was done to compare the effects of face-to-face and video-based education methods on inhaler use. Materials and Methods: A quasi-experimental, pretest/posttest clinical trial study was conducted on 120 patients with respiratory diseases who were under treatment with metered-dose inhalers. Patients were randomly allocated into two groups to receive either face-to-face (n = 60) or video-based education (n = 60) about correct inhaler use. Inhaler use was assessed using a 15-item checklist before, 2 weeks, and 1 month after the education. Chi-square and independent sample t-test as well as repeated-measures analysis of variance were used for data analysis. Results: At baseline, the groups did not differ significantly in inhaler use as shown by the mean score (t = 0.81, p = 0.33). Repeated-measures analysis showed that the mean score of inhaler use significantly increased in both groups 2 weeks and 1 month after the intervention (F = 585.07, p < 0.001). The t-test showed that at 2 weeks and 1 month after intervention the amount of increase in the face-to-face group was significantly greater than the video-based group (t = 3.31 and 5.93, p < 0.001). Conclusions: Both face-to-face and video-based education methods significantly improve inhaler use, even though the effects of the face-to-face method are significantly greater. Nurses can use either of these two methods or both for education of patients about inhaler use.

Background: Using mechanical ventilation devices has unique advantages for the patient; however, it can also cause various problems. This study aimed to determine the effect of using communication boards on the ease of communication and anxiety in mechanically ventilated conscious patients admitted to intensive care units (ICUs). Materials and Methods: In this quasi-experimental study, 30 conscious patients undergoing mechanical ventilation were enrolled using consecutive sampling method and assigned to experimental (n = 15) and control (n = 15) groups. The control group included patients receiving primary communication methods, whereas the experimental group included patients who used the communication board for communication. The Hospital Anxiety and Depression Scale (HADS) and Ease of Communication Scale (ECS) were completed for both groups. Data were analyzed using descriptive-inferential statistics. Results: Communication scores of the patients indicated that there was no significant difference between the control and experimental groups before the intervention (z = −1.77; p = 0.070). However, after the intervention, there was a significant difference in communication scores between the two groups (z = −4.69; p = 0.001). The anxiety scale scores showed a significant difference between the control and experimental groups after the intervention, and patients' anxiety had significantly decreased in the experimental group (z = −2.98; p = 0.003). Conclusions: The results showed that the use of the communication board is possible in mechanically ventilated conscious patients and may contribute to ease of communication and decrease patients' anxiety during mechanical ventilation.

Background: The health system in Iran faces specific challenges as the managerial role of head nurses have changed. The importance of this role cannot be underestimated for the healthcare organizations' success. The present study was conducted to explore the meaning of managerial competence of head nurses in intensive care units (ICU) in Iran. Materials and Methods: This study used a qualitative approach. We extracted the lived experience of ten Iranian ICU head nurses. Data were collected through unstructured in-depth interviews from 2014 to 2015. Interviews were recorded and transcribed verbatim and were interpreted using Van Manen's six-step approach. Results: The expansion and clustering of 442 initial themes led to the emergence of 35 secondary themes, nine subthemes, and three main themes. Managerial competence – theme included “self-excellence,” “ward excellence,” and “intensive care excellence.” Conclusions: The “managerial competence of ICU head nurses” is a dynamic concept that reflects the psychological and functional capability of head nurses in contributing towards excellence in their own critical care practice as well as that of the ward. A competent head nurse has outstanding personal and nursing attributes and holistic knowledge, and is also committed to the ongoing professional improvement of him/herself. Using their ability to facilitate interpersonal and interprofessional communication effectively, a head nurse seeks the psychological, physical, and human optimization of the ward in which he/she works. Therefore, the goal of providing insightful critical care through smart organization and planning of nurses and other personnel can be achieved.

Background: Reflexology is an interventional method which may lead to improved breast milk. Because the mechanism of milk production is complex, detailed research is required on the relationship between lactation and reflexology. Therefore, the aim of the present study was to determine the effect of reflexology on the volume of milk among mothers with premature infants. Materials and Methods: This clinical trial was conducted among 50 mothers with premature infants in two groups of 25 patients admitted to the neonatal intensive care unit of Alzahra and Shahid Beheshti hospitals of Isfahan, Iran from August 2015 to November 2015. The patients were selected through convenience sampling method and divided into control and reflexology groups through random allocation. In the reflexology group, massage of the sole of the foot and foot was done in six sessions. The control group received regular breastfeeding training. Data were analyzed using descriptive and inferential statistics. Results: Repeated-measures analysis of variance test indicated that the mean volume of breast milk in reflexology group (F = 44.002, p < 0.001) and control group (F = 43.09, p < 0.001) differed significantly at different times. Independent t-test showed that the mean increase in milk volume from day 1 to day 5 after the intervention compared to before the intervention was significantly higher in the reflexology group compared to the control group 1days after the intervention (t=5.25, p<0.001), 2 days after the intervention (t= 4.81, p<0.001), 3 days after the intervention (t=3.55, p=0.001), 4 days after the intervention (t= 2.98, p=0.004), 5 days after the intervention (t= 2.50, p=0.020). Conclusions: The results indicate that reflexology is effective on the volume of milk of mothers, and this low-cost and easy procedure can be used along with regular lactation training.

Background: Women, who are in a critical situation like infertility, are more prone to depression, anxiety, and low self-esteem than other people. The aim of this study was to explore the deep experience of anxiety in infertile women who received acupressure during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Materials and Methods: This qualitative, conventional content analysis study was performed on 14 infertile female participants in the Milad IVF Center in Mashhad, Iran, from September 2015 to August 2016. The study subjects included Iranian women, aged 20–45 (mean [standard deviation, SD] 29.07 [4.06]) years with primary infertility. Acupressure was performed on the Heart 7 and Pericardium 6 acupoints in 12 sessions. Data were gathered through semi-structured interviews, and transcribed, coded, and organized in different categories based on three primary phases of preparation, organization, and reporting. Results: The results showed the two major categories of “body perceptions of anxiety diminution” and “mind experiences.” The body perceptions category consisted of three subcategories, namely, reduction of nervous, cardiovascular, and gastrointestinal signs and symptoms. The subcategories of the mind experiences category consisted of emotional and cognitive consequences. Conclusions: The qualitative findings showed a number of positive outcomes in the physical and mental signs and symptoms of anxiety in infertile women undergoing IVF/ICSI, so acupressure can be used for reducing the unpleasant feelings and body perceptions of these women.

Background: Needlestick injuries (NSIs) among healthcare workers (HCWs) pose an important health challenge and several pieces of evidence show that in many cases HCWs do not report the injury. Materials and Methods: This multicenter descriptive cross-sectional study was performed in eight teaching hospitals of Rasht, Iran. Using consecutive sampling methods, 1010 nurses were enrolled from October 2014 to January 2015. A three-part self-administered questionnaire was used. It included questions on demographic features, NSI-related questions, and questions on the knowledge of hepatitis B and C viruses (HCV, HBV). Results: Among the 1010 participants, 580 (57.42%) showed a positive history of NSI; the total number of occurrences of NSI was 914. The major item causing NSI was the syringe with needle (315; 34.47%). In this way, NSIs occurred most frequently during recapping and injection [339 (37.10%) and 147 (16.10%), respectively]. Only 92 (10.07%) of all NSI positive participations had referred to the infection control units of their hospitals. The others mostly answered the question of “Why did you not report the incident?” with being too busy at work at the time of injury (140; 27.58%). The results showed that among participants with <5 years elapsed since their vaccination, the risk of NSI reduced to 60% [p < 0.02, odds ratio (OR) = 0.40, 95% confidence interval (CI) = 0.20–0.80]. Conclusions: It seems that NSI is still a major problem among nurses. Correspondingly, HCWs do not take the reporting system seriously and training them requires an ongoing activity in all hospitals.

Background: Many patients undergoing hematopoietic stem cell transplant (HSCT) experience fatigue due to their disease process and its long period of treatment. Using nonpharmacological methods to help reduce their fatigue is a reasonable endeavor. The present study was conducted to investigate the effect of Benson's relaxation technique on fatigue levels in patients after HSCT. Materials and Methods: Thirty-seven patients were randomly selected to the intervention (n = 19) and control group (n = 18). In the intervention group, the participants performed Benson's relaxation exercises for 20 min twice per day over a period of 15 days. The data collection tools used included a demographic and medical information form and the Brief Fatigue Inventory, completed by both groups on three different occasions (upon admission and days 8 and 14 after the HSCT). The data obtained were analyzed in Statistical Package for the Social Sciences version-20 using statistical tests. Results: The results of the independent t-test showed no significant preintervention differences in fatigue levels between the two groups. On days 8 (t = 11.21, p < 0.001) and 14 after the transplant (t = 15.62, p < 0.001), a significant difference was observed in the mean level of fatigue between the two groups. Conclusions: These findings indicate that Benson's relaxation technique would improve fatigue in HSCT patients.

Background: Postpartum depression (PPD) is one of the most common problems in women of childbearing age. This study was conducted to evaluate the efficacy of aromatherapy on PPD. Materials and Methods: In this study, 105 pregnant women at 35–37 weeks of pregnancy were enrolled using convenient sampling and randomly assigned to three groups. The intervention group dropped 7 drops of lavender oil and 1 cc rose water at the concentration of 100%, and the placebo group dropped 7 drops of odorless sesame seed oil, with 1 cc of musk willow sweat at the concentration of 100% by dropper on a special cloth. They put the cloths on their mouths and took 10 deep breaths before sleeping and then placed them next to their pillows. The control group only received the routine care. The intervention lasted from 38^th week of pregnancy until 6 weeks after delivery. Then depression level was determined before the intervention, 35–37 weeks of pregnancy, 2 and 6 weeks after delivery using Edinburgh questionnaire. Results: The mean of depression score in the intervention group decreased significantly compared to the placebo and control groups, 2 weeks (F = 9.412, p < 0.001) and 6 weeks after delivery (F = 7.813, p < 0.01). Conclusions: This study provides valid evidence for the effect of aromatherapy on PPD. Therefore, the use of aromatherapy can be recommended in high-

Background: Elderly people are among the most vulnerable groups in natural disaster events. Although old age is responsible for them becoming unequally vulnerable, understanding the different aspects of vulnerability can help health care providers, especially nurses, to manage disaster risk for this increasing number of people. This study intended to explore disaster-related vulnerability and its contributing factors based on older adults' perceptions and experiences. Materials and Methods: This qualitative content analysis study was performed in Iran in 2016. The study was conducted by semi-structured interviews of 24 participants, and purposeful sampling with maximum variation continued until data saturation. Results: By analyzing primary codes two main themes were extracted through content analysis, namely personal factors and social factors, from experiences of two experts in the field of health in emergencies and disaster management among 22 Iranian elderly participants. Conclusions: This study indicated that age is not the only criteria that makes an elderly person vulnerable, but their lifetime achievements and experiences can determine their level of vulnerability. The results of this study will help health service providers as well as disaster nurses to identify and moderate the factors affecting the vulnerability of the elderly, and by using their rich experience, enhance senior citizens' resilience to disasters.