Journal of Hayat

The effect of e-learning on childbearing tendency in childless and single-child women: An experimental study

Zohre Maryami

Background & Aim: Fertility is one of the most important phenomena determining population changes and fluctuations. Therefore, considering the population decline in the world, including in Iran, this study aimed to determine the effect of e-learning on childbearing tendency in childless and single-child women.
Methods & Materials: In this experimental study, two-stage random sampling was performed on 128 childbearing-age women without children or with only one child (64 in the intervention group and 64 in the control group) from four health centers in Marand County in 2023–2024. The intervention group received e-learning in four sessions (one session per week) remotely via the Eitaa messenger. The control group received routine care. Childbearing tendency before and after the intervention was evaluated in both groups using Mann-Whitney and Wilcoxon statistical tests in SPSS version 24.
Results: The median scores of childbearing tendency in the intervention group before the intervention were 59.0 (range: 52.5-64.5) and one month after e-learning were 68.5 (range: 62.0-73.0). In the control group, the median scores were 64.0 (range: 58.0-69.0) before and 64.5 (range: 58.0-69.0) after the intervention. Statistical tests showed a significant improvement in childbearing tendency after the training (P<0.001).
Conclusion: The improvement in childbearing tendency resulting from e-learning can help enhance women's inclination toward childbearing.
Clinical trial registry: IRCT20190826044621N2

The effect of a self-management program based on social cognitive theory on anxiety and sleep quality in patients with acute coronary syndrome: A randomized clinical trial

Reyhaneh Eskandarian

Background & Aim: Anxiety and sleep disorders have adverse effects on the well-being of patients with acute coronary syndrome. This study aimed to determine the effect of self-management based on Social Cognitive Theory on anxiety and sleep quality in patients with acute coronary syndrome.
Methods & Materials: This clinical trial was conducted in 2024 on 72 patients with acute coronary syndrome hospitalized in the cardiac intensive care units of Hajar Hospital, Shahrekord. Participants were enrolled sequentially and conveniently and were randomly assigned to two groups of 36 (intervention and control). They completed the Beck Anxiety Inventory and the Pittsburgh Sleep Quality Index. The intervention group received virtual education in six 30-minute sessions. The control group received routine care. Data were collected before, immediately after, and 8 weeks after the intervention. Data analysis was performed using chi-square and Mann-Whitney tests in SPSS version 20.
Results: Before the intervention, there was no significant difference in anxiety scores or sleep quality between the two groups (P>0.05). After the intervention, sleep quality showed a significant difference compared to before the intervention (P<0.05). However, anxiety levels did not show a significant difference after the intervention compared to before (P>0.05).
Conclusion: Considering the effect of the intervention based on Social Cognitive Theory on sleep quality in patients with acute coronary syndrome, this intervention is recommended in addition to conventional care for these patients. Further studies are needed to reduce their anxiety levels.
Clinical trial registry: IRCT20240626062258N1

Diagnostic accuracy of early warning scores in trauma monitoring from pre-hospital care to the intensive care unit

Mahboubeh Shali

Background & Aim: Determining the amount of risk that threatens patients can lead to making correct treatment decisions. This study aimed to determine the diagnostic accuracy of early warning scores in prehospital care for diagnosing traumatic brain injury and the need for intensive care unit admission.
Methods & Materials: This descriptive-analytical study was conducted in 2024 among patients referred to the emergency department of selected hospitals affiliated with Tehran University of Medical Sciences. Using convenience sampling, 250 trauma patients were enrolled in the study. Data collection was carried out utilizing a demographic questionnaire and various scoring systems, including the National Early Warning Score 2 (NEWS2), Modified Early Warning Score (MEWS), Triage Early Warning Score (TEWS), and Modified Emergency Medical Score (MREMS). SPSS version 16 software and sensitivity, specificity, area under the curve, and confidence interval tests were used to analyze the data.
Results: The mean age of the patients was 40.90±15.78 years. According to the findings, 217 patients (86.8%) had a diagnosis of traumatic brain injury and 70 patients (28%) required intensive care unit admission. The National Early Warning Score 2 showed the highest diagnostic accuracy with sensitivity (82.2%), specificity (81.1%), and area under the curve (0.88).
Conclusion: The higher diagnostic accuracy of the National Early Warning Score 2 makes it a valuable tool for identifying patients who have sustained traumatic brain injury and require intensive care unit admission.

The effect of short-term solution-focused group counseling on the resilience of women experiencing spousal abuse

Sakineh Taherkhani

Background & Aim: Violence against women is associated with adverse outcomes. Resilience can be associated with reducing the amount of harm experienced by abused women. The solution-focused approach has been considered as an intervention to promote resilience. This study aimed to determine the effect of short-term solution-focused group counseling on the resilience of women experiencing spousal abuse.
Methods & Materials: In this randomized clinical trial, 60 women experiencing spousal abuse were selected through multistage sampling from health centers affiliated with Arak University of Medical Sciences in Arak, Iran in 2024 and were divided into intervention and control groups using the block randomization method (30 people in each group). For the intervention group, six group counseling sessions with a solution-focused approach were conducted. The control group received no intervention. Data were collected using the Personal and Health Characteristics Questionnaire, the Revised Conflict Tactics Scale, and the Connor-Davidson Resilience Scale before the intervention. The Resilience Scale was then completed again by both groups at the end of the intervention, four weeks, and 12 weeks after the end of the intervention. Data were analyzed using SPSS software version 25 with descriptive and inferential statistics. P<0.05 was considered statistically significant.
Results: The mean and standard deviation of the resilience score for the intervention group increased from 34.64±8.91 before the intervention to 63.03±6.30, 71.78±4.78, and 75.25±10.52 in the post-test and first and second follow-up periods. For the control group, these values were 33.66±8.65, 35.30±7.31, 38.83±6.39, and 40.50±5.99, respectively. Based on the results of two-way repeated measures ANOVA, there was a statistically significant difference in the mean resilience score between the two groups and across the four time points examined (P<0.001).
Conclusion: The implementation of short-term solution-focused group counseling can improve the resilience of women experiencing spousal abuse. Therefore, this intervention can be used in mental health promotion programs for women who have experienced spousal abuse.
Clinical trial registry: IRCT20240704062329N1

Association between intolerance of uncertainty and treatment adherence in patients with diabetes

Zahra Rooddehghan

Background & Aim: Intolerance of uncertainty is an emerging psychological construct that may influence health-related behaviors, particularly treatment adherence. The present study aimed to determine the association between intolerance of uncertainty and treatment adherence in patients with diabetes.
Methods & Materials: This cross-sectional descriptive-correlational study was conducted in 2024 on 103 patients with diabetes referred to Imam Khomeini Hospital in Tehran. Samples were selected using a convenience sampling method. Data were collected using a demographic and clinical characteristics form, the Morisky Medication Adherence Scale, and the Intolerance of Uncertainty Scale developed by Freeston et al. Data were analyzed using descriptive (mean, standard deviation, and frequency) and inferential statistics (independent t-test, Pearson correlation coefficient, and one-way ANOVA) in SPSS version 16.
Results: Intolerance of uncertainty showed a significant positive correlation with age (r=0.27, P=0.006) and a significant negative correlation with diabetes duration (r=-0.27, P=0.006). Single participants had significantly higher levels of intolerance of uncertainty compared to married participants (P=0.005). Furthermore, treatment adherence demonstrated a significant positive relationship with age (r=0.34, P<0.001) and was higher among women (P=0.021) and single individuals (P=0.032). Among the participants, 50 individuals (48.5%) had high intolerance of uncertainty, and 44 individuals (42.7%) had low treatment adherence. A significant positive correlation was observed between intolerance of uncertainty and treatment adherence (r=0.65, P<0.001).
Conclusion: The findings of the present study indicate that diabetic patients who experience higher levels of intolerance of uncertainty are more likely to adopt treatment adherence as a coping strategy when faced with uncertain circumstances and unpredictable outcomes of their disease. This behavior serves as a means to reduce psychological distress and regain a sense of control. These findings underscore the importance of addressing psychological dimensions, particularly intolerance of uncertainty, by nurses and other healthcare team members. However, due to the cross-sectional nature of this study and other limitations, the interpretation of the results should be approached with caution.

Challenges facing new graduate nurses in choosing teaching hospitals for healthcare service delivery: A qualitative study

Nasrin Nikpeyma

Background & Aim: Newly graduated nurses play a vital role in fulfilling hospital workforce requirements; however, their transition into teaching hospitals is accompanied by numerous challenges. Thus, this study aimed to explore the challenges faced by newly graduated nurses when selecting teaching hospitals for healthcare service provision.
Methods & Materials: This descriptive qualitative study was conducted in 2023 with the participation of 36 undergraduate nursing students from Tehran University of Medical Sciences, who were recruited through purposive sampling. Data were collected via semi-structured individual interviews. The data were analyzed manually using framework analysis, and the trustworthiness of the data was established based on Guba and Lincoln’s criteria.
Results: Data analysis led to the extraction of 11 subcategories and 5 main categories. The identified categories included: challenges related to nursing services (e.g., heavy workload); human relations challenges (e.g., lack of choice in preferred wards); financial challenges (e.g., salary and benefit delays); accessibility challenges (e.g., long commuting distance); and challenges related to the low priority of hospital employment (e.g., due to the intention to continue education).
Conclusion: The findings revealed that newly graduated nurses face a range of challenges throughout the process of selecting teaching hospitals. These results underscore the need for health policymakers and hospital managers to focus on improving working conditions, enhancing financial and human support, facilitating easier access, and offering motivational incentives. Utilizing these findings can contribute to the development of effective strategies for attracting and retaining newly graduated nurses in teaching hospitals.

Investigating the relationship between professional autonomy, moral courage, and job self efficacy among nursing managers in teaching hospitals affiliated with Shahid Beheshti university of medical sciences

Parastoo Oujian

Background & Aim: Achieving autonomy remains a significant challenge within the nursing profession. Nurses must possess moral courage to attain professional autonomy, which should consequently enhance their job self‑efficacy. This study aimed to investigate the relationship between professional autonomy, moral courage, and job self‑efficacy among nursing managers.
Methods & Materials: This descriptive‑correlational study was conducted on 200 nursing managers, including senior nursing managers in organizational positions, middle managers serving as supervisors, and operational managers working as head nurses across eleven teaching hospitals affiliated with Shahid Beheshti University of Medical Sciences in 2024. Data were collected using a demographic and professional characteristics form, Jung's Professional Autonomy Questionnaire, Sadoughi‑Asl's Nurses' Moral Courage Questionnaire, and Riggs' Self‑Efficacy Scale. Data analysis was performed using SPSS version 21 and LISREL version 8, employing Pearson's correlation coefficients and path analysis.
Results: The mean scores were as follows: professional autonomy was 26.92±6.6 (moderate level), moral courage was 422.11±39.52 (high level), and job self‑efficacy was 114.98±11.38 (high level). Professional autonomy demonstrated a direct and significant positive correlation with moral courage (r=0.187, P=0.008), and moral courage showed a significant positive correlation with job self‑efficacy (r=0.41, P<0.001). The structural model analysis revealed that all path coefficients were significant (P<0.001), except for the path from professional autonomy to job self‑efficacy (P=0.635).
Conclusion: The findings of this study suggest that enhancing professional autonomy can improve the moral courage and job self‑efficacy of nursing managers. This important finding can serve as a foundation for designing effective programs and interventions in this field.

Exploring the educational needs of breastfeeding mothers for the management and optimization of educational consultative services: A qualitative content analysis study

Malihe Rezvanifard

Background & Aim: Breastfeeding is a health promotion priority due to its short‑term and long‑term health implications for both mothers and infants. However, breastfeeding rates have consistently declined worldwide. Therefore, the protection, promotion, and support of breastfeeding are considered public health priorities. This study aimed to explore the educational needs of breastfeeding mothers to inform the management and optimization of educational‑consultative services.
Methods & Materials: This qualitative content analysis study was conducted between 2019 and 2021 in five health centers and four hospitals affiliated with Mashhad University of Medical Sciences. A total of 25 breastfeeding mothers, 2 family members, and 9 health personnel were selected through purposive sampling and participated in semi‑structured in‑depth interviews. Sampling continued until data saturation was achieved. Data were analyzed using the Elo and Kingas approach with the assistance of MAXQDA 2010 software. Trustworthiness was established based on Guba and Lincoln's criteria.
Results: The category of "educational‑consultative services" emerged from the analysis, which comprised two main subcategories: "management and optimization of education" and "comprehensive consultative services". These two subcategories reflected the perceived educational and consultative needs of mothers, encompassing five sub‑subcategories: "the need for education at the appropriate time and place", "the need for combined educational approaches", "the need for breastfeeding counseling", "the need for psychological counseling during breastfeeding", and "the need for sexual counseling during breastfeeding".
Conclusion: Mothers require educational‑consultative services to sustain breastfeeding. Addressing these needs in the planning and management of educational‑consultative services can contribute to the optimization of breastfeeding care.