Background: Pain resulting from muscle cramps is one of the most common outcomes of hemodialysis. One of the mechanisms associated with muscle cramps is unnatural muscle metabolism. Because acupressure improves muscle metabolism through the releasing of energy, this study was performed with the purpose of determining the impact of acupressure on muscle cramps. Materials and Methods: This study was a single-blind clinical trial. Accordingly, 64 patients were selected and intensity and frequency of muscle cramps were determined by randomly categorizing them into two groups. The intervention group received 9 sessions of acupressure and the control group received 9 sessions of placebo intervention. The intervention was performed 15 min before hemodialysis in both groups. In both the groups, average intensity of pain and the frequency pain was compared before, after, and 1 month after completion of the intervention. Results: Data analysis revealed that there were no significant statistical differences between the two groups in terms of mean value of intensity (P = 0.586) and frequency (P = 0.780) of muscle cramps before the intervention. We observed a significant difference after completion of intervention sessions (P < 0.001). Moreover, there were no significant differences between mean value of intensity (P < 0.001) and frequency (P = 0.030) of muscle cramps in the control group before, after, and 1 month after the completion of 9 sessions of placebo intervention. Conclusions: Employing acupressure may result in decrease of muscle cramps in patients undergoing hemodialysis.

Background: In the age of communication and media that families are rapidly driven towards using satellite channels and other media, considering family health in this regard is essential. A determinant of health is marital satisfaction. The aim of this study was to investigate the relationship between watching satellite channels and intimacy and marital satisfaction in Isfahan, Iran. Materials and Methods: This cross-sectional and correlational study was conducted on one group of 480 couples (n = 960) participating from 8 health-treatment centers in Isfahan. Multi-stage cluster sampling was used in this study. Inclusion criteria included at least 2 years of marriage. After completion of Bagarozzi's Marital Intimacy Questionnaire and ENRICH Marital Inventory, the couples were divided into two groups based on watching satellite networks. Data were analyzed using SPSS 18. Results: There was a significant relationship between intimacy and marital satisfaction in both viewers and non-viewers of satellite channels (P < 0.050). Average duration of couple's interaction in the satellite viewing group was 22.4 minutes and in non-viewers group was 47.95 min. In addition, the duration of interaction had a significant relationship with marital satisfaction and intimacy (P < 0.050). Conclusions: This study showed that watching satellite channels reduced the intimacy and marital satisfaction of the couples, and duration of interaction among the couples.

Background: Lack of spiritual health in patients with hypertension leads to many mental, social, and physical effects, On the other hand, considering the prevalence of hypertension among the elderly, interventions to enhance their spiritual wellbeing is essential. Therefore, the aim of this study was to examine the effect of religious programs based on Islam on spiritual wellbeing in elderly patients with hypertension who referred to the health centers of Isfahan in 2014. Materials and Methods: This study was a randomized clinical trial. The participants (52 elderly patients with hypertension) were randomly divided in to experimental and control groups. Religious program was implemented for the experimental group in eight sessions in two Isfahan health centers. Spirituality wellbeing survey (SWB) questionnaire was completed in three steps, namely, pretest, posttest and follow-up (1 month) in two groups. In the study, Chi-square test, independent t-test, and repeated-measures analysis of variance were performed for analyzing the data. Results: Before the intervention, there was no significant difference between the mean scores of spiritual wellbeing, the religious dimension, and the existential aspect of spiritual wellbeing of the two groups. However in the posttest step and follow-up stage, the mean scores of spiritual wellbeing, the religious dimension, and the existential aspect of spiritual wellbeing in the experimental group was significantly higher than in the control group (P < 0.001). Conclusions: The religious program based on Islam promoted the SWB of elderly patients with hypertension; further, nurses can use these programs to promote the SWB of elderly patients with hypertension.

Background: The parents of autistic children suffer from anxiety and tension. Unawareness of parenting skills required for autistic children (parenting) doubles their anxiety. Researchers have recently considered research on mobile education, especially mobile text messages. The present study aimed to investigate the effect of mobile parenting skills education on the anxiety of mothers with autistic children. Materials and Methods: This is a clinical trial conducted on 64 mothers of children suffering from autism who had a medical file. The participants were recruited by convenient sampling in selected autism centers in Isfahan, Iran. Then, the participants were randomly assigned into two 32-subject groups of study and control. Spielberger Anxiety Inventory was adopted for the mothers. The book “Parenting skills for the mothers with autistic children” was distributed in the study and control group, and then, the study group underwent a structured mobile text messages education. Sixty text messages were sent daily to the participants in the study group for two months. Data were analyzed by Mann–Whitney, Chi-square, independent t-test, and paired t-test using Statistical Package for the Social Sciences version 16. Results: The obtained results showed a significant decrease in mothers' anxiety mean score after intervention in the study group compared to control group (P = 0.04). There was also a significant reduction in mothers' anxiety mean score after intervention, compared to before intervention (P < 0.001). Conclusions: Mobile parenting skills education, especially through text messages, could reduce the level of anxiety among the mothers with autistic children.

Background: Hemodialysis is the most common renal replacement therapy in the world, and hemodialysis adequacy is an important and influencial factor in the reduction of various complications experienced by these patients. Multiple factors influence hemodialysis adequacy. This study was conducted to determine hemodialysis adequacy and its relationship with individual and personal factors in patients undergoing hemodialysis in three hemodialysis centers of Isfahan, Iran. Materials and Methods: This descriptive, cross-sectional study was conducted in partnership with 202 patients undergoing hemodialysis in three hemodialysis centers of Isfahan. The data were collected using a researcher-made questionnaire, and hemodialysis adequacy was measured using the urea reduction ratio (URR). Data analysis was conducted using Spearman's correlation coefficient, Mann–Whitney and Kruskal–Wallis tests, and descriptive statistics (frequency distribution). In this study, the level of significance was considered to be 0.05. Results: Hemodialysis adequacy in 56.4% of patients was optimal, in 29.7% near optimum, and in 13.9% less than optimal. Statistical tests showed a significant correlation between hemodialysis adequacy and age (P = 0.05), prehemodialysis systolic blood pressure (BP) (P = 0.02) and diastolic BP (P = 0.04), the duration of hemodialysis in months (P = 0.02), and patients' sex (P = 0.01). There was no significant correlation between hemodialysis adequacy and the number of hemodialysis cessations per week (P = 0.20), interdialytic weight gain (P = 0.40), prehemodialysis blood urea nitrogen (P = 0.40), creatinine (P = 0.10), hemoglobin (P = 0.20), hematocrit (P = 0.08), venous access type (P = 0.30), needle distance and direction (P = 0.70), underlying causes of end-stage renal disease (P = 0.50), and personnel's shift (P = 0.90). Conclusions: The results of the study showed that approximately half of the patients did not have an optimal level of hemodialysis adequacy, and multiple individual and personnel factors affect hemodialysis adequacy directly or conversely.

Background: During recent decades, various factors have modified the nurse–physician professional relationship pattern in hospital settings. The present study investigates the typology and dynamics of this relationship as well as the effects of social structures and the actors' agency by considering the gender variable in two professional groups of nurse and physician. Materials and Methods: A survey was conducted in 2009 using a quota sampling method of 100 female nurses and male physicians in four hospitals in Tehran. Results: The study revealed three distinct patterns of nurse–physician professional relationship including “dependence–independence,” “nondominance–dominance,” and “cooperation–participation.” Occupational socialization, gender stereotypes, organization support, and actors' agency were discovered as the most effective factors. Conclusions: Observing caution in generalizing the results, the predominant relationship pattern was derived from the persistence of gender stereotypes in the occupational context. Although there is a paradigm shift in the relational and embodied structures, balancing power resources are being formed by younger nurses who require more organizational support to improve the professional fulfilment and authority.

Background: Regarding the importance of health care providers such as nurses who are always in stressful environments, it is imperative to better understand how they become more engaged in their work. The purpose of this paper is to focus on health care providers (nurses), and examine how the interaction between spiritual intelligence and psychological empowerment affect job engagement. Materials and Methods: This descriptive and quantitative study was conducted among nurses at the Faghihi Hospital in Shiraz, Iran in 2010. A sample of nurses (n = 179) completed standard survey questionnaire including spiritual intelligence, psychological empowerment, and job engagement which included 5 questions for each dimensions. For testing the hypotheses of the study, results were analyzed through structural equation modeling (SEM) using LISREL 8.8. Results: SEM revealed that psychological empowerment could fully mediate the relationship between spiritual intelligence and job engagement. However, the correlation between spiritual intelligence and job engagement was significant but weak using Pearson coefficient method. This can imply that psychological empowerment plays a crucial role in the relationship between spiritual intelligence and job engagement. Conclusions: This paper indicates that spiritual intelligence might affect different organizational parameters, directly or indirectly. Therefore, it is recommended that the researchers evaluate probable relationships between spiritual intelligence and other variables.

Background: Beginning and continuing pregnancy with obesity and being overweight has some known side effects for the mother and the fetus. Preventing these complications requires medical interventions before pregnancy. Because designing health improvement interventions requires understanding of the related factors of the behavior, the aim of this study was to determine the relation between health beliefs of women regarding the risks of obesity for pregnancy and stages of behavioral changes in women under preconception care. Materials and Methods: This study was a cross-sectional study that was conducted on 120 obese and overweight women under preconception care. Health belief structures including perceived sensitivity/intensity, perceived benefits, perceived barriers, and perceived self-efficacy were measured using a questionnaire, and its relation with stages of nutrition and physical activity behavior changes was evaluated according to a transtheoretical model. Results: Results showed a significant correlation between the stage of nutrition behavioral change and perceived sensitivity/intensity, perceived benefits, and self-efficacy (P < 0.05). In addition, the stage of physical activity behavioral change showed a negative and significant correlation with perceived barriers and a positive and low-to-moderate significant correlation with other health belief structures (P < 0.05). Furthermore, the relation of perceived sensitivity/intensity with perceived benefits and self-efficacy was positive and significant, and that with perceived barriers was negative and significant (P < 0.01). Conclusions: Results showed that a health belief model could be a predictor of weight adjustment behaviors including nutrition and physical activity behaviors. Therefore, educational interventions based on a health belief model could be effective for improvement of these behaviors in obese and overweight women under preconception care.

Background: Physical activities among adolescents affects health during pubescence and adolescence and decrease in physical activities among adolescents has become a global challenge. The aim of the present study was to define the relation between the level of physical activity among adolescent girls and their health beliefs as personal factor and level of observational learning as environmental factor. Materials and Methods: The present study was a cross-sectional study that was conducted on 400 students aged from 11 to 19 years in Isfahan, Iran. Information regarding the duration of physical activity with moderate/severe intensity was measured in four dimensions of leisure time (exercising and hiking), daily activities, and transportation-related activities using the International Physical Activity questionnaire. Health belief structures included perceived sensitivity, intensity of perceived threat, perceived benefits, and barriers and self-efficacy; observational learning was measured using a researcher-made questionnaire. Results: Results showed that perceived barriers, observational learning, and level of self-efficacy were related to the level of physical activity in all dimensions. In addition, the level of physical activity at leisure time, transportation, and total physical activity were dependent on the intensity of perceived threats (P < 0.05). Conclusions: This study showed that the intensity of perceived threats, perceived barriers and self-efficacy structures, and observational learning are some of the factors related to physical activity among adolescent girls, and it is possible that by focusing on improving these variables through interventional programs physical activity among adolescent girls can be improved.

Background: Studies have shown that, with regard to social, cultural, and institutional contexts, several factors affect family decision-making on organ donation. This study aimed to investigate the effective factors in organ donation by family members with brain-dead patients. Materials and Methods: This was a descriptive-comparative study in which a researcher-made questionnaire was used to collect data. The reliability of the questionnaire was obtained as 0.81 using Cronbach's alpha. The study sample consisted of 85 members of families with brain-dead patients in Isfahan, Iran in 2012–13. The collected data were analyzed using the Statistical Package for the Social Sciences version 20.0, and the level of significance was considered as <0.05. Results: The obtained results indicated that factors such as age, marital status, level of education, and cause of brain death did not have any effect on their families consent, whereas factors such as gender, duration of hospitalization, having an organ donation card, personal view of the brain-dead patient, and the number of patient's children had a significant relationship with the consent on organ donation. In addition, the care and treatment team were effective in family decisions regarding organ donation. Conclusions: In general, the necessary culture and increasing the population awareness and their knowledge can be a positive step in this regard and may bring about an easy and rapid acceptance of organ donation by the involved families.

Background: Childbirth is accompanied with enormous physical and emotional changes in mothers. Anxiety is the most common problem among these patients. This study was aimed to determine the effect of the presence of trained husbands beside their wives during childbirth on their anxiety. Materials and Methods: In a randomized control trial, 84 primiparous women were enrolled in childbirth educational classes. Anxiety score was compared among three groups; without accompaniment (control), with accompaniment (doula), and with trained husband's support before hospitalization at the time of admission and during the 4^th stage of delivery. Data was analyzed using one-way analysis of variance and least significant difference tests. Results: The level of anxiety before hospitalization was not significantly different among the three groups (38.6, 39.2, and 38.4, respectively, in without accompaniment, with accompaniment (doula), and with trained husband's support groups). This level was significantly different among groups during hospitalization (36, 42.1, and 59.1, respectively, as per previous groups' order). The level of anxiety in the intervention group at 4^th stage of delivery was significantly lower than other groups (31.4 versus 43.3 and 69.2, respectively with P< 0.001). Conclusions: According to the results of this study presence of trained husbands beside their wives during delivery decreased mother's anxiety. It is recommended to use this intervention during childbirth.

Background: Nowadays, prevalence of addictive behaviors among bipolar patients is considered to be a serious health threat by the World Health Organization. The aim of this study is to investigate the role of behavioral activation and inhibition systems in predicting addictive behaviors of male patients with bipolar disorder at the Roozbeh Psychiatric Hospital. Materials and Methods: The research method used in this study is correlation. The study population consisted of 80 male patients with bipolar disorder referring to the psychiatrics clinics of Tehran city in 2014 who were referred to the Roozbeh Psychiatric Hospital. To collect data, the international and comprehensive inventory diagnostic interview, behavioral activation and inhibition systems scale, and addictive behaviors scale were used. Results: The results showed that there is a positive and significant relationship between behavioral activation systems and addictive behaviors (addictive eating, alcohol addiction, television addiction, cigarette addiction, mobile addiction, etc.). In addition, correlation between behavioral inhibition systems and addictive behaviors (addictive eating, alcohol addiction, TV addiction, cigarette addiction, mobile addiction) is significantly negative. Finally, regression analysis showed that behavioral activation and inhibition systems could significantly predict 47% of addictive behaviors in patients with bipolar disorder. Conclusions: It can be said that the patients with bipolar disorder use substance and addictive behaviors for enjoyment and as pleasure stimulants; they also use substances to suppress unpleasant stimulants and negative emotions. These results indicate that behavioral activation and inhibition systems have an important role in the incidence and exacerbation of addictive behaviors. Therefore, preventive interventions in this direction seem to be necessary.

Background: Breast cancer is the most common malignancy and a major cause of cancer deaths among women. Breastfeeding is presented as a probable protective factor against breast cancer, however, the effect of different breastfeeding patterns and duration of breastfeeding on this factor is not well determined. Thus, the aim of this research was to evaluate factors related to breastfeeding and breast cancer. Materials and Methods: This case–control study was conducted on 98 women with breast cancer and 198 healthy women who were selected through systematic random sampling method. Studied variables included demographic characteristics, reproduction characteristics, duration of breastfeeding, and breastfeeding pattern. The study variables were measured using a researcher-made questionnaire through self-report method. The two groups were matched in terms of place of residence and age. The data analysis was performed using logistic regression. Results: A relationship was observed between breast cancer and marital status (P = 0.04), education level (P = 0.02), individuals' perspectives of their economic status (P = 0.001), and lack of breastfeeding (P = 0.006). However, no relationship was found between breast cancer and reproductive factors. Moreover, multiple logistic regression analysis results showed that breast cancer only had a relationship with individuals' perspectives of their economic status with OR of 0.31 (95% CI: 0.16–0.59). Conclusions: The results showed that there was no relationship between breast cancer and reproductive factors and breastfeeding pattern. Due to the difference between the findings of this research and other researches, genetic, epigenetic, and cultural differences must be considered in the evaluation of risk factors for breast cancer.

Background: Clinical education in some countries applies a hospital-based learning approach where each student rotates to one division to another division (call of shifting). However, for clinical midwifery education in Indonesia each student remains in a community midwifery clinic (call of nonshifting). Because of the differences in the shifting system used, the question of “How is feedback in the nonshifting context of the clinical midwifery education being given?” needs to be explored. Materials and Methods: This was a mixed methods study and was carried out in a School of Midwifery in Indonesia during 2014 and 2015. We explored the supervisors' and students' perception on the feedback delivery. Students' perceptions were collected through focus group discussions whereas supervisors' perceptions were recorded through interviews. The quality of feedback was observed using a checklist. Qualitative data were analyzed using Atlas Ti and quantitative data were analyzed using a descriptive statistic method. Results: From the qualitative data, students and supervisors perceived their feedback as “more intensive.” They reported authenticity in the monitoring and feedback from the day-to-day delivery of patient care with their supervisors. Students and supervisors also described their feedback as “more integrated.” The feedback process stimulated students to value history taking, physical examination, and midwifery care. On the other hand, quantitative data from observations presented that “intensive and integrated feedback” were not supported by the quality of the feedback based on literature of the theory of facilitating learning (the mean was 4.67 on a scale of 0–9). Conclusions: The nonshifting clinical midwifery education can be a better alternative for facilitating the process of providing integrated and intensive feedback. To improve the quality of the feedback, training on providing feedback in a nonshifting context is fundamental in Indonesia.

Background: The goal of hospitals, as the most important health care providing centers, is to improve the health level of the society. Achieving this goal is directly related with performance of the managers. This study was conducted to evaluate the performance of operational managers of obstetrics and gynecology service providing wards from the point of view of the staff at educational hospitals of Isfahan University of Medical Sciences in 2015. Materials and Methods: In this descriptive study, target population comprised all supervisors and the staff working at obstetrics and gynecology and maternity wards. Data were collected through a researcher-made questionnaire after evaluation of its reliability and validity using questions on managerial performance (planning, organizing, leadership, and control dimensions) and demographic characteristics of the managers and staff. Data were analyzed using independent t-test, one sample t-test, Spearman and Pearson coefficient tests, and one-way analysis of variance. Results: The total mean score of staff's point of view toward performance of managers' performance was significantly higher than the average level (P < 0.001, t = 13.2). In addition, mean scores of managerial performance in planning (P < 0.001, t = 14.93), organizing (P < 0.001, t = 11.64), leadership (P < 0.001, t = 11.16), and control (P < 0.001, t = 13.75) dimensions were significantly higher than the moderate level. Conclusions: With respect to the fact that maintaining and improving the health of mothers and neonates depends on the management and managers' performance in obstetrics and gynecology service providing wards, more than moderate managers' performance need to be improved. It is recommended that higher-level managers pay special attention to the empowerment of managerial skills among operational managers.

Background: Multiple sclerosis (MS) is a chronic degenerative disease of the central nervous system (CNS) that can reduce health promoting behaviors in patients. One method of increasing health promoting behaviors is motivational interviewing that can explore and resolve client ambivalence. Materials and Methods: The present clinical trial was carried out among 60 patients with MS. The participants were selected through convenience sampling, and then, allocated to two groups using Mini Pay software. The intervention group participated in three sessions of motivational interviewing per week (1 session every 2 days, and each session lasting 1 h). A two-part questionnaire consisting of demographic data and the Health Promoting Lifestyle Profile (HPLP) II questionnaire was used for data collection. The collected data were analyzed using statistical tests such as independent t-test, and Mann–Whitney and Chi-square tests. Results: No statistically significant difference was observed between the groups in terms of the demographic variables (P > 0.05). The results also showed no significant difference in the overall score of the health promoting behaviors and its dimensions between the two groups before the intervention (P > 0.05). However, 2 weeks and 1 month after the intervention, there was a significant difference between the groups in terms of the overall score and the scores of dimensions, except the spiritual growth dimension (P > 0.05). Conclusions: The findings of this study showed that motivational interviewing can improve health promoting behaviors in patients with MS. Therefore, this method can be used by nurses to improve health promoting behaviors among these patients.

Background: Infertility and errors in the process of its treatment have a negative impact on infertile couples. The present study was aimed to identify and assess the common errors in the reception process by applying the approach of “failure modes and effects analysis” (FMEA). Materials and Methods: In this descriptive cross-sectional study, the admission process of fertility and infertility center of Isfahan was selected for evaluation of its errors based on the team members' decision. At first, the admission process was charted through observations and interviewing employees, holding multiple panels, and using FMEA worksheet, which has been used in many researches all over the world and also in Iran. Its validity was evaluated through content and face validity, and its reliability was evaluated through reviewing and confirmation of the obtained information by the FMEA team, and eventually possible errors, causes, and three indicators of severity of effect, probability of occurrence, and probability of detection were determined and corrective actions were proposed. Data analysis was determined by the number of risk priority (RPN) which is calculated by multiplying the severity of effect, probability of occurrence, and probability of detection. Results: Twenty-five errors with RPN ≥ 125 was detected through the admission process, in which six cases of error had high priority in terms of severity and occurrence probability and were identified as high-risk errors. Conclusions: The team-oriented method of FMEA could be useful for assessment of errors and also to reduce the occurrence probability of errors.