Background: Castor oil is used in some countries to induce labor, but results on its effectiveness and safety is controversial. This systematic review and meta-analysis aimed to evaluate the effect of castor oil on labor induction and prevalence of vaginal delivery along with investigating its safety. Materials and Methods: PubMed, Scopus, Web of Science, and Google Scholar were searched systematically up to September 2020. Observational studies and Randomized Clinical Trials (RCTs), which assessed the effect of castor oil on labor induction in English and Persian languages using different combinations of the related key terms and Medical Subject Headings (MeSH) terms were collected and analyzed independently by two authors. Random effect model was used for meta-analysis. The studies were included in which the Relative Risk (RR) had been reported with 95% Confidence Intervals (CIs). Results: A total of 12 studies consisting 1653 pregnant women were included. The mean age of women who used castor oil was 24.72 years and in control group was 24.67 years. Results showed that labor induction was significantly higher in castor oil group than control group (RR: 3.27; 95% CI (1.96, 5.46)). Prevalence of vaginal delivery was 81% in the castor oil group and 69% in the control group. Conclusions: It can be concluded that use of castor oil has positive effect on labor induction and increases the prevalence of vaginal delivery. None of the studies considered in this meta-analysis reported any serious harmful effects for the use of castor oil.

Background: Delirium is one of the most common complications of cardiac surgery, and only a small percentage of nurses are able to diagnose and manage it. The aim of this study was to determine the effect of Scenario-Based Learning (SBL) on the performance of nurses in the management of delirium in Cardiovascular Intensive Care Units (CICUs). Materials and Methods: A quasi-experimental research with a pretest-post-test design was conducted on 36 nurses of the cardiac surgery ICUs of Isfahan′s therapeutic-educational center from October 2019 to January 2020. The SBL↱ was held in the form of a 2-day workshop. The study data collection tools included a demographic questionnaire, researcher-made knowledge questionnaire, and performance checklist. The data were analysed using descriptive statistics (frequency, mean, and standard deviation), and inferential statistics (repeated measures one-way analysis of variance ANOVA and Fisher′s Least Significant Difference (LSD post hoc test). Results: The mean score of performance of nurses differed significantly different between the three study stages (before the intervention, immediately, and 3 weeks after the intervention) (F_2,30 = 139.41; p < 0.001). LSD post hoc test showed that the mean score of performance was significantly higher immediately after the training program compared to before the intervention and 3 weeks after the SBL (p < 0.001). Conclusions: Based on the results of this study, it can be concluded that SBL↱ improved the delirium care performance levels of nurses in the cardiac surgery ICU. Thus, it is recommended that SBL be used as a method for training nurses.

Background: Heart Failure (HF) is a chronic disease that appears to affect resilience. One of the important programs that may affect resilience is a spiritual care program. As a result, the present study was conducted to determine the effect of a spiritual care program on the resilience of patients with HF. Materials and Methods: This randomized clinical trial study was performed at Rajaie Cardiovascular Medical and Research Center in Tehran, Iran in 2020. Eighty-four patients were selected by convenience sampling method and randomly divided into two groups using a block size of 6. Connor-Davidson Scale and Parsian and Dunning Spirituality Questionnaire were completed by both groups before and after the intervention. For the experimental group, two educational sessions were carried out in one hour and thirty minutes and then continued three times a week for 1 month in order to practice spiritual care via WhatsApp. The control group did not receive the intervention that is done for the experimental group during performing intervention. In the end, the data related to 74 patients in each group (n = 37) were analyzed using Multivariate Analysis of Covariance (MANCOVA). Results: Dimensions of individual competence (F = 12.85, p = 0.001) and negative emotion tolerance of resilience (F = 8.71, p = 0.005) increased significantly in the experimental group compared to the control group and caused a significant increase in the total resilience score of the patients (F = 7.78, p = 0.007). Conclusions: Results of the study showed that a spiritual care program has a great role in improving the total resilience score and can be considered as a part of the holistic treatment program.

Background: Heart failure is the leading cause of readmission in all medical and surgical patients. Home care studies have reduced hospitalization in heart failure. This study aimed to investigate the effect of home care program on readmission in advanced heart failure. Materials and Methods: The study was a randomized clinical trial conducted at the Rajaie Cardiovascular, Medical and Research Center from September 2017 to March 2018. Ninety-eight patients with advanced heart failure were selected using census method and were randomly divided into experimental and control groups. For the experimental group, the home care program was implemented for 6 months. The date and frequency of hospitalization were recorded during 30, 90, and 180 days before and after the home care program. The quantitative data analysis was performed using Mann–Whitney and Wilcoxon's signed-rank tests and qualitative data analysis was performed using the Chi-square test. Results: The number of hospitalization and length of hospital stay 30, 90, and 180 days after implementation of the home care program in the experimental group was significantly less than the control group (p < 0.001). The number of hospitalizations and length of stay in the experimental group decreased significantly after the program (p < 0.001). In the control group, 90 days after the intervention, the number of hospitalizations (p = 0.013) and length of stay increased significantly (p < 0.001), and 180 days after the intervention, increased significantly (p < 0.001). Conclusions: The implementation of a designed home care program reduces readmission and the length of hospital stay in advanced heart failure.

Background: Lower Urinary Tract Symptom (LUTS) are common among female nurses. High levels of job stress in nurses may be associated with the prevalence of these symptoms. This study aimed to investigate the prevalence of LUTS and factors related to these symptoms in female nurses. Materials and Methods: A cross-sectional study in which 460 nurses and nursing assistants participated was conducted. A questionnaire consisting of socio-demographic data, International Consultation on Incontinence Questionnaire – Female Lower Urinary Tract Symptoms, and Toileting Behavior – Women's Elimination Behavior Scale was used. Data analysis was performed by descriptive and inferential statistical tests at a significant level of p < 0.05. Results: The highest and lowest scores of LUTS were related to the urgency and nocturnal enuresis with a mean (SD) score of 1.85 (1.03) and 0.05 (0.26), respectively. Concerning toileting behaviors, the highest score was for the place preference for voiding with a mean (SD) score of 4.13 (0.66), which correlated with LUTS. Among controllable variables, years of practice, urinary tract infections, use of perineal pads for urinary leakage, lifting heavy objects at work, and medical history were identified as predictors of LUTS (p < 0.05). Conclusions: LUTS was highly prevalent in the female nurses. The results revealed that unhealthy toileting behaviors may contribute to the prevalence of LUTS. Early identification of these symptoms and the development of an educational intervention program to enhance the knowledge of healthy toileting behaviors may prevent the occurrence of urinary symptoms.

Background: Operating Rooms (ORs) are complicated environments that necessitate the improvement of OR staff's knowledge and skills to remain clinically competent and secure patient safety. The aim of this study was to assess clinical competence of OR staff in accordance with some related factors. Materials and Methods: This descriptive analytical cross-sectional study was conducted on 227 OR staff in nine academic hospitals. Sampling was performed from the beginning to the end of May 2019 and the samples were selected by quota sampling. Data were collected using a researcher-made questionnaire encompassing six dimensions of competency including general knowledge, specialized knowledge, general practical skills, specific practical skills, personality, and motivation. Data analysis was performed using descriptive and interpretive statistics. Results: The mean (SD) total score of competence was 80.99, which was optimal (11.28). The lowest score was related to the dimension of general practical skills with the mean (SD) score of 53.32 (10.26). The mean score of specialized practical skills was significantly higher in single-specialty ORs (F = 21.53, p < 0.001). Based on multiple linear regression test, it was possible to predict clinical competency through the age and work experience (R-squared = 0.96, beta = 0.31, p = 0.022). Conclusions: Specialized training has overshadowed the general practical skills that are related to the observation of basic principles of patient safety apart from surgical specialization. Strengthening of competence in general practical skills need to be prioritized in empowerment programs. We need a fixed and permanent space for the continuation of educational programs designed to promote perioperative general practical skills.

Background: Midwives are at the frontlines of the fight against the Coronavirus Disease (COVID-19) pandemic. Working under these circumstances threatens their lives and that of their family members; midwives' adjustment to work increases their efficiency in providing care services to pregnant mothers, but midwives' coping process is ambiguous and complex. Thus, the aim of this study was to explore the coping process of midwives with their professional roles following COVID-19. Materials and Methods: This study was conducted using grounded theory during 2020 to 2021. For this purpose, 30 midwives were purposively and theoretically selected from two educational hospitals and health centers in Mashhad and Torbat Heydarieh cities, Iran. The data were collected using in-depth semi-structured interviews. The collected data were analyzed using the Strauss and Corbin method (2008) in MAXQDA software. Results: The main concern of the participants was “perception of the threats to their health” and the core category revealed from the data was “trying to control the situation.” Midwives coped with the COVID-19 pandemic in four steps, namely early initial confrontation, reaction to the COVID-19 pandemic, management of challenges, and reconstructing. Support from family and the health system and religious belief were the interventional conditions in this theory. Conclusions: Results of this study can be used to provide health managers with a better understanding of the conditions affecting the coping strategies of midwives with their professional roles during COVID-19. Therefore, this study provides the required data for developing an effective intervention to help nurse midwives to cope with this issue.

Background: Assessing the progress of labor is a primary step in intrapartum care. This study was performed to assess comparison of the effects of date syrup with saffron–honey syrup on the progress of labor in nulliparous women. Materials and Methods: A randomized single-blind clinical trial study was conducted on 189 women who were referred to Bea'sat Hospital of Sanandaj from October 2019 to March 2020. Patients were randomly divided into three groups saffron–honey syrup, date syrup, and placebo syrup each including 63 cases. Each participant in the intervention and control groups received a maximum volume of 150 ml of saffron–honey syrup, date syrup, or placebo syrup. The syrups were given at the 4 cm dilation, and every 30–60 min until the end of the active phase of the first stage of labor. Data collection tools included a two-part questionnaire and a partograph form. The results were analyzed by Statistical Package for the Social Sciences (SPSS) 24 using Chi-squared test, analysis of variance, and last significant difference as a post hoc test, the significance level was set at 0.05. Results: The duration of the active phases of the first (F₂ = 92.70, p < 0.01), second (F₂ = 66.76, p < 0.01), and third (F₂ = 12.34, p < 0.01) stages of labor was shorter in the date syrup and saffron–honey syrup groups than in the control group (p < 0.01). Additionally, both experimental groups exhibited no significant difference in terms of duration between the first (p = 0.312), second (p = 0.724), and third (p = 0.911) stages of labor. Conclusions: Date syrup and saffron–honey syrup can be used as one of the safe and available herbal methods to facilitate labor.

Background: The deadly novel Coronavirus Disease 19 (COVID-19) epidemic has sickened and killed millions of people around the world. Accordingly, Iran has had the second highest incidence rate of COVID-19 deaths in the world. Because this disease affects all individual, familial, and social aspects, there is not enough information about experiences of COVID-19 patients. However, these experiences could be a missing link in explaining their attitudes, beliefs, and concerns for improving care and treatment processes during and after the disease. Materials and Methods: Descriptive phenomenological research was conducted in 2020 to explain experiences of 21 COVID-19 patients after post-hospitalization recovery. Semi-structured interviews were used as the data collection tool via purposeful sampling, which were continued until data saturation and analyzed using Colaizzi's seven-step method. Results: The main theme of “value of health” and the seven categories of (1) inefficient self-care, (2) overcoming the catastrophic crisis, (3) the shadow of death, (4) coping behaviors and resilience, (5) the need for support and accountability, (6) sympathy, and (7) new insights as well as 38 main codes were extracted. The patients' general explanation in the early stages of the disease, recovery, and subsequent periods included transition from the crisis to new insights into physical, mental, sexual, familial, and economic dimensions that finally led to the review value and concept of their life. Conclusions: The findings of this study can be used to fulfil care and treatment needs of the patients, their families as well as caregivers, psychologists, counselors, health planners, and managers presently and in the future for similar diseases.

Background: Adherence to treatment is highly important in the management of Cardiovascular Diseases (CVD). Barriers to effective and long-term adherence to treatment by the patient make achieving care and treatment goals challenging. The aim of this study was to identify the adherence barriers to the treatment plan in patients with CVD. Materials and Methods: A qualitative content analysis study was conducted to explore the experience of patients, family caregivers, and healthcare professionals (n = 35) using qualitative content analysis. The study was carried out between 2019 and 2020 in Isfahan, Iran. Purposive sampling was performed. Data collection was conducted through in-depth interviews and semi-structured until data saturation. Graneheim and Landman content analysis was performed simultaneously with data collection. Results: After data analysis, 3 themes and 6 categories were identified and named. Themes (and categories) include “Patients unreadiness to change” (misunderstanding of conditions and consequences and deterrence cultural practices and beliefs); “gap in healthcare services” (lack of adequate support for patients and discordance between healthcare professionals); and “limited access to healthcare services” (limited physical access and financial burden). Conclusions: The findings of the present study can provide a framework for healthcare professionals to employ preventive strategies, reduce disease complications, decrease unhealthy behaviours, and increase prolonged adherence to treatment recommendations in patients with CVD.

Background: Despite the high prevalence of Colorectal Cancer (CRC) in Iran and the need to pay more attention to the Palliative Care (PC) needs of patients with this disease, a few studies have previously examined the PC needs of them by gaining the patients', family members', and treatment team's views. This study aimed to investigate the challenges in the way of meeting the PC needs of CRC patients. Materials and Methods: This study was a qualitative content analysis study conducted on 43 participants (including 15 patients, 20 health care providers, and eight family members) through purposive sampling and semi-structured individual interviews in Omid Educational and Medical Center and Iranian Cancer “Control Center (MACSA) in Isfahan from May 2020 to December 2021. Data analysis was performed simultaneously with data collection using conventional qualitative content analysis with the Graneheim and Lundman approach. In order to assess the trustworthiness of the obtained data, credibility, dependability, confirmability, and transferability criteria were used.Results: Data analysis led to the production of 615 primary codes, 16 sub-categories, and five main categories. These five main categories included “Lack of facilities and equipment”, “Lack of quality of services provided by the treatment team”, “Insufficient financial support to the patient and family”, “Insufficient psychological and emotional support from the patient and family”, and “Inefficiency of the patient and community awareness process”. Conclusions: To improve the quality of care and increase patients' satisfaction with the provided services, it is recommended that policymakers should meet the challenges of the PC.

Background: Chronic Obstructive Pulmonary Disease (COPD) is an irreversible condition and it is of great importance for the patients to practice self-care. Given the impact of inadequate health literacy on people's self-efficacy in a self-care program, the aim of this study was to improve health literacy and self-efficacy in people with COPD. Materials and Methods: The present quasi-experimental study was conducted on 70 patients with COPD admitted to Shahrekord educational hospitals in 2019. Using random allocation software, the samples were randomly divided into intervention and control groups. Data collection tools included three questionnaires including demographic, health literacy, and perceived self-efficacy questionnaires. A training program, with three weekly sessions of theoretical and practical trainings, was conducted for the intervention group in classes in the hospital. The time of each session was 40 min. Data were collected three times i.e., before, immediately after, and three months after the trainings. Data were analyzed by means of SPSS 21 statistical software using descriptive and inferential statistics. Results: Before the intervention, the mean scores of perceived self-efficacy and health literacy did not differ significantly between the two groups, but after the intervention, the scores of the members in the intervention group increased significantly (f = 62.15, p < 0.05). Conclusions: The results of the study indicated an increase in the scores of perceived self-efficacy and health literacy in people with COPD. The use of targeted educational interventions can have a positive effect on the treatment and control of the disease.

Background: A growing body of evidence is showing that Preconception Care (PCC) can increase the health and well-being of women and couples and improve subsequent pregnancy and child health outcomes. The present study aimed to determine the quality of preconception care from women's and care providers' perspectives. Materials and Methods: This qualitative study was conducted in 2020 using conventional content analysis approach. Face to face Semi-structured interviews were conducted with 13 reproductive age women and 12 midwives recruited from urban health centers across Shahroud, Iran. Data were analyzed using qualitative content analysis. Results: Three major themes based on Donabedian's model emerged during data analysis: structure, process and outcome of care. Midwives and women's experiences of quality of preconception care included problems in organizing care, poor education performance of personnel and low-sensitivity about importance of preconception care in women. Conclusions: The findings suggest key considerations for the organizing and delivery of preconception care. Most especially, it seems necessary to adopt appropriate strategies to improve public awareness about the importance of pre-pregnancy care.

Background: Severe pain is the most prevalent complication after Coronary Artery Bypass Grafting (CABG). The aim of this study is to compare the impact of two methods using ear protective devices on pain intensity in patients undergoing CABG. Materials and Methods: The present randomized clinical trial was conducted between October 2019 and February 2020. The participants included 84 patients undergoing CABG, who were randomly divided into two intervention groups (A, B) and a control group. On the first night after the heart surgery, ear protective devices were used for the patients in group A during the evening and night sleep, while they were used in group B only during the night sleep. A demographic questionnaire and Visual Analog Scale (VAS) were the data collection tools used in this study. Data were analyzed using Chi-square test, paired t-test, and one-way Analysis of Variance (ANOVA) in Statistical Package for the Social Sciences (SPSS) software. Results: Before the intervention, the mean (SD) of pain intensity in the two intervention groups (A, B) and the control group was 6.46 (1.71), 6.32 (1.36), and 6.54 (1.45), respectively, and there was no significant difference between the groups (F_2,81 = 0.14; p = 0.86). However, after the intervention, the mean (SD) of pain intensity in the two intervention groups (A, B) and the control group was 3.39 (1.87), 4.46 (1.55), and 6.39 (1.54), respectively, which showed a significant difference (F_2,81 = 23.37; p < 0.001). Conclusions: The use of ear protective device is recommended as a non-invasive and accessible way of reducing pain intensity in patients after CABG.