Journal of Hayat

Cyber and human resilience: Preparing the health system for future crises

Fatemeh Bahramnezhad

The recent war between Iran and Israel exemplifies modern hybrid warfare, combining traditional and emerging threats, including cyberattacks, psychological and informational warfare, and biological operations. The healthcare system, as a critical target in such conflicts, is highly vulnerable both humanly and digitally, and any disruption to its infrastructure or digital systems can have severe human, social, and economic consequences. Experiences from countries like Ukraine, and South Korea demonstrate that enhancing cyber, human, and managerial resilience in healthcare—including establishing backup facilities, multi-skill training, advanced cybersecurity, and rapid response protocols—is crucial to ensure continuity of medical services and minimize damage. Therefore, developing national policies and programs to strengthen the resilience of healthcare systems against hybrid threats is essential, as preparedness today guarantees the continuity of health tomorrow.

The impact of self-care education in a retrospective manner on health-promoting behaviors in patients with Asthma

Masoomeh Mahdavifar

Background & Aim: Asthma is a prevalent respiratory disease, and encouraging health behaviors is a crucial preventive strategy for managing the condition. This study aimed to assess the impact of self-care education delivered retrospectively on health-promoting behaviors in patients with asthma.
Methods & Materials: This two-group randomized clinical trial with a pre-test-post-test design was conducted on 100 asthma patients visiting Shahid Mofatteh Clinic in Yasuj in 1402. Participants were selected through convenience sampling and randomly assigned to either the intervention or control group. The intervention group received three individual training sessions, one per week lasting 60 to 90 minutes each, delivered retrospectively. The control group did not receive any training. Data was collected using questionnaires on personal and disease information, as well as health-promoting lifestyle. Data analysis was conducted using descriptive and inferential statistical methods in SPSS version 26.
Results: Prior to the intervention, the mean health behavior scores in the experimental group were 124.52±16.05, and in the control group were 121.82±16.61, showing no statistical significance (P=0.411). However, following the intervention, the scores increased to 135.60±10.57 in the experimental group and 123.26±8.92 in the control group, with a statistically significant difference (P<0.001) indicating a significant improvement in the experimental group.
Conclusion: Self-care education delivered in a retrospective manner is recommended as a simple, practical, and cost-effective educational approach for individuals with asthma to enhance health behaviors.
Clinical trial registry: IRCT20230529058325N1

The impact of Gottman couple therapy on marital intimacy, life satisfaction, and psychological well-being among working couples: A quasi-experimental study

Nahid Hossein Abbasi

Background & Aim: Intimacy and satisfaction in marriage, along with psychological well-being, are crucial for maintaining healthy marital and family relationships. The present study aims to examine the effectiveness of Gottman couple therapy on marital intimacy, life satisfaction, and psychological well-being among working couples.
Methods & Materials: This quasi-experimental study with a control group and a follow-up period was conducted on 40 working couples in Ahvaz in 2023. The sample was selected through convenience sampling and randomly assigned to intervention (20 couples) and control (20 couples) groups. Data were collected using demographic questionnaires, the Bagarozzi Marital Intimacy Scale (MINQ), the Diener et al. Life Satisfaction Scale (SWLS), and the Ryff Psychological Well-being Scale (RSPWB). After obtaining pre-test data, the Gottman couple therapy protocol was implemented over 14 sessions of 60 minutes each, held two to three times per week for the intervention group. Data were analyzed using descriptive statistics and analysis of covariance (ANCOVA) with SPSS version 25.
Results: The results showed a significant increase in mean scores for the intervention group compared to pre-intervention scores and to the control group in marital intimacy (from 128.45±13.04 to 178.90±30.55), life satisfaction (from 13.60±2.70 to 17.77±5.01), and psychological well-being (from 55.85±6.12 to 64.95±7.83) (P<0.01).
Conclusion: Gottman couple therapy is effective in enhancing marital intimacy, life satisfaction, and psychological well-being among working couples in Ahvaz. Therefore, this intervention can be applied to strengthen and enrich marital relationships.

Comparison of the effect of mHealth and face-to-face education on treatment adherence among patients with hypertension

Mahnaz Ghaljeh

Background & Aim: Hypertension is a common, often asymptomatic chronic disease that can lead to severe complications if not properly controlled. Patient education plays a vital role in improving blood pressure management and preventing related complications. This study aimed to compare the effects of mobile health (mHealth) and face-to-face education on treatment adherence among patients with hypertension.
Methods & Materials: This quasi-experimental study was conducted on 110 patients with hypertension referred to teaching hospitals in Zahedan, Iran. Participants were selected using convenience sampling and randomly assigned to two groups. Data were collected using a demographic questionnaire and the Hypertension Treatment Adherence Questionnaire. In the mHealth group, patients received educational content via the Eitaa messaging application, and the adherence questionnaire was completed six weeks after the final message. In the face-to-face group, educational sessions were held once a week for three consecutive weeks, and the same questionnaire was administered six weeks after the last session. Data were analyzed using SPSS version 26 with independent and paired t-tests, chi-square test, Fisher’s exact test, and analysis of covariance (ANCOVA). A P-value<0.05 was considered statistically significant.
Results: Before the intervention, there were no significant differences between the two groups in total adherence scores and most of its subdimensions (except for dietary adherence). After the intervention, however, the difference between the two groups became statistically significant (P=0.001).
Conclusion: Both mHealth-based and face-to-face education effectively improved treatment adherence among patients with hypertension. However, mHealth-based education provides the additional advantage of flexible and continuous access to educational materials anytime and anywhere, making it a practical alternative for patient education.

The relationship between knowledge management factors and nursing performance among nurses of Valiasr hospital, Borujen, in 2023

Mostafa Roshanzadeh

Background & Aim: Nurses need up-to-date professional knowledge to deliver high-quality performance. Since knowledge within healthcare organizations requires effective management, identifying the level and relationship between knowledge management and nursing performance can play an important role in bridging the gap between knowledge and practice. Therefore, this study aimed to determine the relationship between knowledge management factors and nursing performance among nurses.
Methods & Materials: This descriptive-analytical study was conducted in 2023 at Shahrekord University of Medical Sciences. A total of 200 nurses working at Valiasr Hospital in Borujen were selected through simple random sampling. Data were collected using a demographic questionnaire, the Choi Knowledge Management Standard Questionnaire, and the Ko Nursing Performance Questionnaire. Data analysis was performed using SPSS version 16, employing independent t-tests, one-way ANOVA, and linear regression.
Results: The mean and standard deviation of knowledge management factors were 98.55±15.8, and the mean and standard deviation of nursing performance were 105.74±25.7. Pearson’s correlation coefficient indicated a significant positive relationship between knowledge management factors and nursing performance (r=0.72, P<0.001). The coefficient of determination (R²=0.518) showed that approximately 52% of the variance in nursing performance could be predicted by knowledge management factors (P<0.05).
Conclusion: Training in the knowledge management process and emphasizing dimensions such as promoting a culture of knowledge sharing, improving nursing management systems with a focus on process enhancement, and fostering creative management approaches can enhance knowledge management and thereby improve nursing performance.

Assessing the relationship between nursing process competency and nurses' perception of patient safety culture

Behrouz Dadkhah

Background & Aim: The nursing process provides a structured and evidence-based framework for delivering comprehensive, individualized, and high-quality care. As a fundamental component of healthcare systems, patient safety culture plays a pivotal role in ensuring the safety and well-being of patients. Given the importance of these two constructs, this study aimed to examine the relationship between nursing process competency and nurses' perception of patient safety culture.
Methods & Materials: This descriptive-correlational study was conducted in 2023 on 266 clinical nurses working in educational-treatment centers in Ardabil, Iran, using a stratified random sampling method. Data were collected using the Nursing Process Competency Questionnaire (NPCQ) and the Hospital Survey on Patient Safety Culture (HSOPSC). Data analysis was performed using SPSS version 26 through descriptive statistics and inferential tests.
Results: Among the participants, 177 nurses (66.5%) were female and 164 (61.7%) were married. Most nurses reported a good level of nursing process competency (175, 65.8%) and a moderate level of perceived patient safety culture (264, 99.3%). Marital status and employment status were significantly associated with both nursing process competency and patient safety culture (P<0.05). Additionally, a significant positive correlation was observed between nursing process competency and patient safety culture (r=0.315, P<0.001).
Conclusion: The results highlight the essential role of nursing process competency in fostering positive perceptions of patient safety culture. They also emphasize the importance of considering personal and employment-related factors when designing interventions. Policymakers are encouraged to develop integrated strategies that simultaneously enhance nursing process competency and strengthen patient safety culture to promote safer and higher-quality patient care.

The effect of foot reflexology massage on the breathing patterns of children hospitalized with diabetic ketoacidosis

Narges Sadeghi

Background & Aim: Diabetic ketoacidosis is a serious and potentially life-threatening complication of diabetes mellitus. Exploring non-pharmacological interventions that may support standard care in children with this condition is crucial for improving clinical outcomes. This study aimed to evaluate the effect of foot reflexology massage on the respiratory patterns of children hospitalized with diabetic ketoacidosis.
Methods & Materials: This clinical trial included two groups with pre- and post-intervention assessments. The study was conducted on children admitted with diabetic ketoacidosis to Imam Hossein Specialized Hospital in Isfahan in 2023. Participants were selected using convenience sampling and randomly assigned to either an experimental or a control group. The intervention consisted of foot reflexology massage administered every two hours, with each session lasting ten to fifteen minutes per leg, from admission until recovery from diabetic ketoacidosis. Data were analyzed using analysis of covariance and two-way repeated measures analysis of variance, with a significance level of 0.05, using SPSS software version 26.
Results: After controlling for blood glucose, blood PH, and bicarbonate levels, the mean recovery time from diabetic ketoacidosis was significantly shorter in the experimental group compared to the control group (P<0.001). Following the intervention, both groups exhibited a significant increase in blood PH and bicarbonate levels (P<0.001). Moreover, the experimental group demonstrated a significantly higher mean bicarbonate level compared to the control group after the intervention (P=0.009).
Conclusion: Foot reflexology massage was associated with a shorter duration of diabetic ketoacidosis in children, independent of blood glucose, PH, and bicarbonate levels. These findings suggest that incorporating foot reflexology massage as an adjunct to standard care may enhance patient recovery and improve clinical outcomes in pediatric diabetic ketoacidosis.
Clinical trial registry: IRCT20130812014333N202

Effect of auricular acupressure on fatigue and sleep disorders in hemodialysis patients in Ahvaz: A clinical trial study

Shahram Molavynejad

Background & Aim: The most common problems in patients undergoing hemodialysis are sleep disturbances and fatigue, which affect their quality of life. Auricular acupressure, as a non-pharmacological method, can be effective in controlling these issues. The aim of this study was to evaluate the impact of auricular acupressure on sleep disturbances and the severity of fatigue in hemodialysis patients in Ahvaz.
Methods & Materials: In this clinical trial, 40 hemodialysis patients visiting the hemodialysis centers of Imam Khomeini and Golestan hospitals, affiliated with Jundishapur University of Medical Sciences in Ahvaz in 2021, were randomly assigned to two groups: the test group and the control group. The test group received auricular acupressure at true acupressure points, while the control group received acupressure at false points over a two-week period. Data collection tools included the Pittsburgh Sleep Quality Index and the Numeric Rating Scale to assess fatigue severity. Data analysis was performed using SPSS version 17 with descriptive and inferential statistical tests at a significance level of 0.05.
Results: In the intervention group, the mean sleep quality score before the intervention were 11.75±1.51, and 6.20±1.43 which decreased to 8.60±1.04 and 5.00±1.21 after the intervention, and this difference was statistically significant (P<0.0001).
Conclusion: The findings showed that auricular acupressure improves sleep quality and reduces sleep disturbances and fatigue severity in hemodialysis patients. Therefore, auricular acupressure can be used as an easy, safe, and inexpensive method alongside routine care for hemodialysis patients to reduce fatigue and sleep disturbances.
Clinical trial registry: IRCT20201021049102N1