Background: Randomized Controlled Trials (RCTs) are reliable methods for the evaluation of treatment effectiveness, which should be rigorous and must report with clarity. This study aimed to assess the compliance of published RCTs about the effect of physical activity on primary dysmenorrhea with the CONSORT 2017 statement. Materials and Methods: In this study, the review of literature was carried out based on Consolidated Standards Of Reporting Trials (CONSORT). All the clinical trials focused on the effect of the physical activity on primary dysmenorrhea indexed in Web of Science, Pubmed, Scopus, Google Scholar, Science Direct, Embase, Magiran and Scientific Information Database (SID) were searched using keywords of dysmenorrhea, randomized clinical trial, physical activity and exercise from 2000 to 2019. Out of 1423 articles, 30 RCTs were critically appraised using CONSORT 2017 checklist. The reporting quality score of articles was identified between zero and 43. Results: The compliance rate with the CONSORT checklist was 55.58%. The mean (SD) score of the reporting quality was 23.37 (-5.15) with a minimum of 16 and a maximum of 37. The maximum weakness was in reporting the sample size and full trial protocol 23.33% and 6.67% respectively. Regarding new items of the consort 2017, if the blinding was not possible, the description of any attempts to limit bias was not described in 70% of articles. Conclusions: Reporting sample size, trial protocol, method of blinding, and control of bias are issues that require more attention in reporting of RCT studies. We recommend that the authors use the CONSORT 2017 statement for conducting and reporting the clinical trials.

Background: Numerous studies have been conducted on the effect of acupressure on labor pain, some of which have reported conflicting results. Thus, the present study was performed to critically review the previous studies related to the effect of acupressure administered during labor for relieving labor pain. Materials and Methods: In this study, databases of the Cochrane Central Register of the Controlled Trials, PubMed/MEDLINE, Scopus, and Web of Science were searched from their establishment until November 5, 2019. All the Randomized Controlled Trials (RCTs) that had compared the use of acupressure with either placebo or nonintervention for relieving the labor pain were included in the study. Meta-analysis was performed using the Comprehensive Meta-Analysis (CMA) software Version 2. The random-effects model was used for pooling the effect sizes across the included studies. The p value <0.05 was considered as statistically significant. Results: Totally, 5853 primary papers were identified in the search, which were narrowed down to 22 studies. The results of meta-analysis showed that the acupressure decreased the labor pain in the intervention group vs. control (-1.67 [-2.29 to -1.05], z = -5.25, p < 0. 001) (Q-value = 788.98, p < 0.001, I-squared = 96.83). No publication bias was found in the included studies (Egger's regression intercept = -1.02, p = 0.76). Conclusions: Although the findings of this meta-analysis showed that the acupressure significantly reduced the labor pain during the active phase of labor compared to the nonintervention or placebo; considering that the quality of the included studies was generally moderate, rigorous RCTs with better design and higher quality are needed to obtain definitive conclusions.

Background: Postpartum period is associated with stress and pressure, and the woman must adjust herself to these changes. This study aimed to review the factors affecting women's adjustment to postpartum changes in conducted studies. Materials and Methods: This review was conducted by searching databases such as ISI Web of Science, Science Direct, Scopus, Cochrane, PubMed and Scientific Information Database (SID), Iranian Medical Articles Database (IranMedex), Iranian Research Institute for Information Science and Technology (IranDoc), and the Iranian Magazine Database (MagIran), as well as searching through Google Scholar (as a Web search engine) in December 2019. Publications from July 2004 to October 2019 were reviewed and limited to Persian and English. The keywords used included “Postpartum”, “Women's needs”, “Adjustment” and “Coping”. After reviewing the articles, out of 60 original articles, 17 articles were selected for final evaluation. Results: Factors affecting adjustment to postpartum changes were divided into personal and social factors. Personal factors included previous experiences, coping styles and strategies, personality traits, self-efficacy and awareness, and social factors included family and relatives, healthcare providers, cultural context, and laws and regulations. Conclusions: Adjustment to postpartum changes depends on the personal and social factors that can interact with each other. Women's awareness enables them to use positive coping strategies in this critical situation. Educating women's spouse and family members can contribute to increase the women's social support. Additionally, the law support guarantees the implementation of many interventions in promoting the mother's health.

Background: Patient satisfaction is currently accepted as an outcome criteria and standard instrument to gauge the quality of nursing care. The aim was to assess the level of patients' satisfaction with nursing care quality in medical wards. Materials and Methods: A cross-sectional descriptive study was conducted with 124 samples in medical wards of a tertiary care teaching hospital in South India in 2016. Convenience sampling technique was adopted. Self-administered “Patient Satisfaction with Nursing Care Quality Questionnaire” (PSNCQQ) was used to collect data on the day of discharge. The analysis was done by frequency, percentage, mean, standard deviation, independent t-test, and ANOVA. Results: Out of 124 participants, the level of satisfaction was excellent for 28.23%, very good for 58.06% and good for 13.71% with regards to overall quality of nursing care in medical wards. The mean (SD) value for overall patients' satisfaction with nursing care quality was 78.88 (4.84) out of 95 with the mean percentage of 83.03% which shows excellent patient satisfaction. The patients' perception component mean (SD) 18.35 (5.09) gained highest satisfaction than nurses' communication and nursing care components. The satisfaction of nursing care mean (SD) 46.46 (3.38) was higher than satisfaction of nurses' communication mean (SD) at 32.42 (2.57). Conclusions: The patients admitted and treated in medical wards were most satisfied with nursing care quality they received. The results showed that the communication component can be improved. There was no statistically significant association between patient satisfaction of nursing care quality and background variables.

Background: The use of mobile health has a pivotal role in the prevention and treatment of many diseases. This study aimed at determining the affecting factors in acceptance of mobile health by using a modified acceptance model, among medical sciences students in the south-west of Iran. Materials and Methods: This cross-sectional, analytical study was conducted in 2017. The research population included all the students of Lorestan University of Medical Sciences (LUMS). The 352 of students selected as the samples of study through a stratified sampling method. Data gathering was done through a valid and reliable questionnaire. The data was analyzed using Linear Structural Relations (LISREL) and Statistical Package for the Social Sciences (SPSS) software. Results: The findings showed that perceived usefulness (t_{7, 38}= 2.16, p = 0.03), performance expectancy (t_{7, 70}= 3.18, p = 0.01), facilitating conditions (t_{10, 61}= 4.17, p < 0.001), and attitude to use (t_{7, 14}= 5.49, p < 0.001) were effective in the behavior intention of mobile health. Moreover, the results showed that the behavior intention of mobile health applications (t_{10, 77}= 8.10, p < 0.001) is effective on its user behavior. Conclusions: The results of our study showed that perceived usefulness, performance expectancy, facilitating conditions, and attitude to use of technology were the affecting factors in the acceptance of mobile health by the students. It is suggested that the policymakers and authorities comprehensively consider these important factors when introducing new technologies.

Background: Considering the importance of family participation in patients' treatment and the positive effects of simultaneous patient and family education, this study was conducted to determine the effect of a family and patient-oriented empowerment program on depression, anxiety, and stress in patients with Obsessive-Compulsive Disorder (OCD) and their caregivers' burden. Materials and Methods: This quasi-experimental study was conducted on 50 OCD patients along with their primary caregivers. The intervention group participated in eight sessions of training, each lasting from 60 to 90 min (twice a week), and the control group received the usual treatment. The Depression, Anxiety and Stress Scale, Maudsley's Obsessive-Compulsive Inventory, Goldberg's General Health Questionnaire, and Zarit's Burden Inventory were used to collect the data before, immediately after and 1 month after the intervention, and then the gathered data were analyzed with t-test and analysis of variance using the Statistical Package for the Social Sciences software, version 21. Results: The changes in the mean scores of depression (F_2,48= 21.02, p < 0.001), anxiety (F_2,48= 29.72, p < 0.001), and stress (F_2,48= 16.52, p < 0.001) of the patients in the intervention group showed significant decrease over time; however, in the control group, there was no significant decrease in the mean scores of depression (F_2,48= 1.69, p = 0.19), anxiety (F_2,48= 0.47, p = 0.62), and stress (F_2,48= 1.09, p = 0.34) over time. The changes in the caregiver's burden score in both groups indicated a significant decrease over time in the intervention group (F_2,48= 24.70, p < 0.001) and the control group (F_2,48= 33. 30, p < 0.001). Conclusions: The findings of this study revealed that concurrently training the patients and caregivers could reduce the negative emotions of the patients and their caregivers' burden.

Backgrounds: Fear of compassion is one of the psychological variables in the nursing profession that can be a barrier to providing appropriate services to patients. This research was done in order to assess psychometric properties, construct validity, reliability of fear of compassion scales and to introduce suitable measures for experts and researchers in the healthcare-related fields. Materials and Methods: In this study, 216 nurses (117 males and 99 females) were chosen with a multistage cluster sampling method between June 2016 and Feb 2017. Lisrel-8 and SSPS-18 were used for data analysis. The construct validity of the fear of compassion scales was assessed using confirmatory factor analysis. To assess the divergent and convergent validity of the fear of compassion scales, the compassion for others, depression, anxiety, stress, burnout, and cognitive emotion regulation questionnaires were used. Results: The results of confirmatory factor analysis showed that the single-factor model of fear of compassion scales (for others, from others, and for self) is a better fit to the data. Furthermore, these three scales had a positive and significant correlation with anxiety, depression, stress, burnout, and unhealthy cognitive-emotion regulation strategies, and negative and significant correlation with compassion for others and healthy cognitive-emotion regulation strategies. In addition, the Cronbach's alpha coefficient for fear of expressing compassion to others was 0.85, and 0.95 and 0.96 for fear of responding to compassion from others and fear of self-compassion, respectively. Conclusions: This study provides additional evidence for the psychometric properties of fear of compassion scales in Iranian nurses.

Background: Use of Central Venous Catheters (CVC) can be associated with increased incidence of Catheter-Related Bloodstream Infections (CRBSIs). The present study assessed the impact of open versus closed catheter access system of CVC on infection prevention in critically sick patients admitted in the Intensive Care Unit (ICU). Materials and Methods: After obtaining ethical clearance and consent of relatives of the patients admitted in ICU of our institute, the present study was carried out as a randomized, prospective, double-blind trial with parallel group design (of 200 patients in each group). In study group (Group I), closed catheter access system (Luer access split septum) was used, while open access (three-way) system was used in the control group. Among clinical parameters, if any patient developed fever, his/her blood, urine, and tracheal secretions were sent for culture and sensitivity. Collected data were analyzed using descriptive and inferential statistics. Results: Demographic profile was similar in both the groups. Significant clinical and statistical differences were observed in blood culture values (χ² = 58.30, df = 1, p < 0.001) as well as Total Leukocyte Counts (TLC) on day 1, 4, and 8 (F_2,260= 80.61, p < 0.001). However, no statistically significant (t₃₉₀= 0.90, p = 0.367) difference was found in the duration of hospital stay among patients in both the groups despite significant differences in various clinical parameter. Conclusion: Luer access split septum connectors along with appropriate training of the nursing personals decrease CRBSI.

Background: The natural childbirth instruction program, which aims to reduce the cesarean section (C-section) rates in the country and pay attention to demographic policies, has achieved significant accomplishments in the short time span since it was implemented throughout the country. In the present study, the advantages and challenges of the implementation of this program have been analyzed. Materials and Methods: This qualitative study carried out with the participation of 32 knowledgeable individuals who were selected using purposeful sampling and snowball sampling methods among the personnel of Kerman University of Medical Sciences, and it's affiliated educational (university) hospital. The data were collected through semi-structured interviews based on the research objectives, review of texts, and experts' experiences. Data analysis was performed using content analysis method in MaxQDA software. Results: Data analysis provided the 5 main categories of implementation instructions' strengths, implementation instructions' defects, implementation instructions' achievements, implementation instructions' challenges and threats, and suggestions. Conclusions: Accountability in the system that provides health care services for pregnant mothers in public hospitals has been created through the implementation of the natural childbirth promotion package. If managerial barriers and executive and legal inefficiencies are followed up and suitable measures are taken for solving the intra-system conflicts, we can hope that the package, which has been one of the most serious efforts made by the Ministry of Health over the past decades to reduce cesarean delivery, will achieve significant accomplishments.

Background: Procrastination in the general population is a prevalent phenomenon. Procrastination in midwives, who are responsible for health care services, can have serious consequences and reduce health care productivity. Cognitive Behavioral Group Therapy (CBGT) is believed to reduce procrastination, but few studies have investigated its effectiveness. The aim of the present study was to determine the effect of CBGT on the workplace and decisional procrastination of midwives. Materials and Methods: This randomized, controlled trial was conducted on 47 participants who were eligible to participate in the study. The participants were randomly assigned to the CBGT (n = 24) and control (n = 23) groups. The intervention group received 7 sessions of CBGT and the control group received no intervention. Decisional and workplace procrastination were assessed at the pre-treatment, post-treatment, and 2-month follow-up phases. Repeated measures Analysis of Variance (ANOVA) and Analysis of Covariance (ANCOVA) were used for data analysis. Results: At the posttest and follow-up phases, workplace procrastination (Post-test: F_1,40= 11.78, p = 0.001; Follow-up: F_1,40= 11.12, p = 0.002), soldiering (Post-test: F_1,40= 13.77, p = 0.001; Follow-up: F_1,40= 4.15, p = 0.049), cyberslacking (Post-test: F_1,40= 4.20, p = 0.047; Follow-up: F_1,40= 13.34, p = 0.001), and decisional procrastination (Post-test: F_1,40= 6.66, p = 0.014; Follow-up: F_1,40= 6.12, p = 0.018) significantly decreased in the CBGT group compared to the control group. CBGT explained 23% of the changes in the total workplace procrastination score and 22% of the changes in the component of soldiering (p < 0.05). Conclusions: CBGT significantly reduced workplace and decisional procrastination in midwives.

Background: Hemodialysis patients are faced with challenges in carrying out their daily activities. Self-efficacy is a social cognitive concept that can affect behavioral control in these patients. Hence, the purpose of the present study was to investigate the effects of exercise training on physical performance and self-efficacy in hemodialysis patients. Materials and Methods: This randomized controlled clinical trial was conducted on 60 hemodialysis patients who visited hospitals affiliated to Mazandaran University of Medical Sciences in Sari, Iran. The participants were randomly divided into two groups. The patients in the intervention/exercise group received the 8-week exercise program. Patients in the control group received routine care. The Six-Minute Walk Test (6MWT) was used to assess the patients' functional ability and the Exercise Self-Efficacy Scale (ESES) and Chronic Disease Self-Efficacy Scale (CDSES) were used to assess their self-efficacy before and 2 and 8 weeks after the intervention. For statistical analysis, independent t-test and paired t-test were used. Results: The comparison of self-efficacy between the exercise group and control group after 8 weeks of intervention showed a significant difference between the groups in terms of the CDSES (F_1,43= 22.92, p < 0.001) and ESES (F_1,38= 10.84, p < 0.001) results. Moreover, the comparison of mean distance walked based on the 6MWT showed significant changes in this variable (F₁= 2.05, p = 0.015). Conclusions: The designed exercise program can improve self-efficacy and physical performance in hemodialysis patients. This intervention is recommended for hemodialysis patients due to its effectiveness, simplicity, and uncomplicated characteristics

Background: Medication error is one of the most important and most common events threatening patient safety. This study was conducted with the aim to determine the effect of asynchronous hybrid/blended learning on the rate of medication administration errors of nurses in medical wards. Materials and Methods: This quasi-experimental study was conducted with a pretest-posttest design in 2019. The participants of this study included 57 clinical nurses working in the medical wards of a selected educational hospital affiliated to Lorestan University of Medical Sciences, Khorramabad, Iran. The study participants were selected through census method. An asynchronous hybrid/blended learning program was used in this study. Data collection was performed using a two-section researcher-made checklist. The collected data were analyzed using descriptive [Mean (SD)] and inferential (paired sample t-test) statistics in SPSS software. A p value of less than 0.05 was considered statistically significant. Results: The results showed that the mean score of total errors in medication administration in the medical wards after the intervention was significantly lower than before the intervention; the mean score of errors before and after the study was 61.67 and 50.09, respectively (t₅₆= 11.41, p < 0.001). Conclusions: Asynchronous hybrid/blended learning as a type of e-learning, simple, relatively inexpensive, and new educational strategy can improve nurses' performance and reduce medication errors.

Background: Moral distress and moral courage among healthcare professionals have received considerable attention in recent years. However, there is a paucity of studies investigating these topics among nurses. Thus, the present study aimed to evaluate the association between moral distress and moral courage among nurses in an Iranian sample population. Materials and Methods: The present cross-sectional study was conducted during February–December 2018. Corley's Moral Distress (MDS-R) and Sekerka's moral courage scales were used to collect the data. MDS-R is a 21-items scale which includes frequency and intensity ranges from 0 (never) to 4 (very frequently) and 0 (none) to 4 (great extent), respectively. In addition, the moral courage scale contains 15 items ranging from “never true” (1 point) to “always true” (7 points). In total, 225 eligible nurses were entered into this study. Finally, SPSS-16 was used for statistical analysis at the α = 0.05 level. Results: The mean scores of the frequency and intensity of moral distress and moral courage were 45.41 (95% CI = 43.37-47.45), 44.24 (95% CI = 42.98-45.42), and 59.63 (95% CI = 58.50-60.87), respectively. Eventually, a significant relationship was found between the moral courage and frequency of moral distress (r = 0.46, p < 0.001) and the intensity of moral distress (r = 0.73, p < 0.001). Conclusions: In general, encouraging healthcare managers and administrators is considered as crucial for developing supportive structures and highly sensitive management which promotes moral courage while reducing moral distress in nurses' work setting.