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Background & Aim: Self-care activity is a key factor in managing Rheumatoid Arthritis (RA) in order to reduce disability caused by the disease. Predisposing factors including knowledge, attitude, and self-efficacy are introduced as determinants of self-care behaviors in the forth phase of PRECEDE model, i.e., ecological and educational assessment. This study aimed to assess the relationship between the predisposing factors and self-care behaviors in patients with RA in Yazd, Iran.

Methods & Materials: In this cross-sectional study, a convenience sampling was used to recruit 181 outpatients with RA referred to a rheumatology clinic in Yazd, Iran. Data were collected by conducting interviews with the participants using a survey questionnaire included knowledge, attitude, and self-efficacy, as predisposing factors and self-care behaviors items. Reliability and validity of the instruments were examined and approved. The statistical tests included bivariate correlations, Mann-Whitney U test, and linear regression.

Results: Knowledge, attitude, and self-efficacy scores were 71.7%, 66.9%, and 47.5%, respectively. The total predisposing factors score was 62.3%. There was a significant positive correlation between the self-care behaviors with attitude and self-efficacy. However, there was no significant correlation between the patients&apos knowledge and self-care behaviors. Totally, the measures explained 39.3% of total self-care behaviors variance within which the self-efficacy was the strongest predictor (β=0.41).

Conclusion: Regarding the high power of predisposing factors, especially self-efficacy, in predicting self-care behaviors and the low scores of self-efficacy, health promotion planners should pay more attention to predisposing factors of self-care behaviors especially the self-efficacy in designing health promotion programs.

 

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  Background & Aim: The ultimate goal of self-care behavior is patients' empowerment. There are limited studies on perspectives of patients with Parkinson's disease on self-care. This study aimed to explore for the process of self-care in patients with Parkinson’s disease during 2011 to 2013 .

  Methods & Materials: This exploratory qualitative study was carried out using grounded theory method. Data were collected via semi-structured in-depth interviews and field notes. We interviewed with 12 patients with Parkinson 's disease and four family caregivers . Participants were selected from two neurology clinics. Interviews were conducted at participants' homes or nursing homes. Data were analyzed using the Corbin and Strauss (2008) approach . 

  Results: Concepts of study were identified using a micro and general analysis. The 'fear of becoming crippled' was identified as a main concern. Strategies used in response to context included 'independency', 'spiritual care', 'informed self-care' and ‘seeking treatment’. 'Striving for taking independent self-care' was the most important process. Demographic, familial and social factors had important roles in self-care processes of patients with Parkinson's disease .

  Conclusion: The process of self-care in patients with Parkinson’s disease depends on the context and severity of the signs and symptoms. Health care providers especially nurses can support patients with Parkinson's disease in achieving maintain independence in self-care. In addition, attention to self-care behaviors with focus on person as self-care agent can considerably increase control and management of life .

  

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Background & Aim: Increasing understanding of death anxiety among different cultures and patient populations is critical to provide quality patient care. Researchers who investigate death anxiety, are looking for a reliable and valid instrument compatible with culture in order to achieve this goal. The aim of the study was to evaluate the psychometric properties of the Templer’s Death Anxiety Scale-Extended (TDAS-E) among a sample of chemical veterans of Iran–Iraq warfare.

Methods & Materials: In this methodological study, 300 veterans completed the Persian version of the 51-item TDAS-E in 2015. The face, content and construct validity (convergent and discriminant validity) of the TDAS-E were assessed. Also, its reliability was measured using Cronbach’s alpha coefficient, construct reliability and intra correlation coefficient.

Results: Results of exploratory and confirmatory factor analyses extracted four stable distinct factors including fear of the hereafter, fear of facing death, fear of the shortness of life, fear of dying following an incident and mishap. The fitness of the four-factor model of the Templer’s death anxiety construct was approved based on standard indices (c²/df=2.832, GFI=.915, AGFI=.873, PCFI=.657, PNFI=.612, RMSEA=.078). Discriminant and convergent validity of all factors were acceptable. Also, scale reliability was confirmed using Cronbach’s alpha coefficient (0.88), construct reliability (higher than 0.70) and intra correlation coefficient (0.87).

Conclusion: The results of the current study revealed that the four-factor construct of TDAS-E had suitable validity and reliability among Iranian chemical warfare veterans. Given the proper psychometric properties, this scale can be used in future research to evaluate death anxiety in this population.

Background & Aim: Increasing understanding of death anxiety among different cultures and illness populations is critical to provide quality patient care. Researchers who investigate death anxiety, are looking for a reliable and valid instrument compatible with culture in order to achieve this goal. The aim of the study was to evaluate the psychometric properties of the Templer’s Death Anxiety Scale-Extended (TDAS-E) among a sample of chemical veterans of Iran–Iraq warfare.

Methods & Materials: In this methodological study, 300 veterans completed the Persian version of the 51-item TDAS-E in 2015. The face, content and construct validity (convergent and discriminant validity) of the TDAS-E were assessed. Also, its reliability was measured using Cronbach’s alpha coefficient, construct reliability and intra correlation coefficient.

Results: Results of exploratory and confirmatory factor analyses extracted four stable distinct factors including fear of the hereafter, fear of facing death, fear of the shortness of life, fear of dying following an incident and mishap. The fitness of the four-factor model of the Templer’s death anxiety construct was approved based on standard indices (c²/df=2.832, GFI=.915, AGFI=.873, PCFI=.657, PNFI=.612, RMSEA=.078). Discriminant and convergent validity of all factors were acceptable. Also, scale reliability was confirmed using Cronbach’s alpha coefficient (0.88), construct reliability (higher than 0.70) and intra correlation coefficient (0.87).

Conclusion: The results of the current study revealed that the four-factor construct of TDAS-E had suitable validity and reliability among Iranian chemical warfare veterans. Given the proper psychometric properties, this scale can be used in future research to evaluate death anxiety in this population.

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Background & Aim: Restless leg syndrome (RLS) is one of the common complications in patients under treatment with hemodialysis. Progressive muscle relaxation is a method which has been designed for reducing patients’ stress, pain and anxiety. The present study aimed to determine the effect of progressive muscle relaxation on the severity of RLS in hemodialysis patients.

Methods & Materials: In this quasi-experimental study (IRCT2015102824769N1), 74 hemodialysis patients were selected by convenience sampling method and divided into intervention and control groups based on records numbers. The intervention group was trained in progressive muscle relaxation technique in two half-hour sessions and they were asked to practice it twice a day for one month. RLS severity was measured using the standardized RLS questionnaire. Data were analyzed by descriptive and inferential statistical tests (independent and paired t-test, analysis of co-variance) using SPSS software version 23.

Results: There was no significant difference in the distribution of variables in the intervention and control group before intervention (P>0.05). Before the intervention, RLS severity score was 28.24±7.33 in the intervention group and 25.57±9.85 in the control group (P=0.189). After the intervention, the score for the intervention group was reduced to 10.67±5.66 (P>0.001) while there was no significant change in the control group after the intervention (26.16±9.69). Also, a significant difference was observed between the two groups in the mean score of RLS severity after removing the effect of RLS severity on pretest (P>0.0001).

Conclusion: The use of progressive muscle relaxation technique reduces RLS severity in patients under treatment with hemodialysis. Therefore, this technique is recommended to be used as one of the non-pharmacological methods to improve RLS in these patients.

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Background & Aim: Promoting hope in hemodialysis patients is very important. Various methods have been suggested in order to raise hope in patients with chronic diseases. The aim of this study was to investigate the effect of an illness perception-based intervention on hope in patients with hemodialysis.
Methods & Materials: This is a randomized clinical trial (IRCT2016103130609N1) on 120 hemodialysis patients admitted in the dialysis department of Bou Ali Sina hospital in Qazvin from December to February 2016. The samples were randomly assigned into control and intervention groups. Before the intervention, questionnaires including demographic information, the Herth hope scale and a summarized form of illness perception were completed. The intervention group received the illness perception-based intervention in three sessions of 30 minutes each, prior to hemodialysis. Four weeks later, the Herth hope scale and illness perception questionnaire were re-completed by the both groups. Data were analyzed by descriptive statistics, t-test and ANCOVA using the SPSS software version 23.
Results: Results showed no statistically significant differences in hope scores between the two groups (P=0.5589) but after the intervention, hope scores significantly increased in the experimental group (36.54±2.98) compared to the control group (33.88±3.76) (P<0.001).
Conclusion: The result of the present study indicated the illness perception-based intervention was effective in enhancing hope in the patients underwent hemodialysis. Therefore, this intervention is recommended for hemodialysis patients.
 

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Background & Aim: Breast cancer is one of the most prevalent cancers in women and is regarded as a chronic disease with various psychological complications including death anxiety. This study aimed to examine the effect of Benson’s relaxation technique on death anxiety among women with breast cancer.
Methods & Materials: In this randomized clinical trial, 100 patients with breast cancer referred to Velayat Hospital in Qazvin in 2017 were selected using the consecutive sampling and randomly assigned into groups of experimental and control. A questionnaire on demographic information and the Templer Death Anxiety Scale were used. Benson’s relaxation technique was taught to the patients in the experimental group. Afterward, they were asked to perform the technique for three months and were monthly followed up using checklists. The Templer Death Anxiety Scale was completed again by both groups. Data were analyzed via the SPSS software version 23 using descriptive and analytical statistics.
Results: There was no significant difference in demographic variables between the two groups (P>0.05). Before the intervention, no statistically significant difference was observed between the mean scores of death anxiety in the patients of the experimental group (46.4±10.3) and the control group (49.6±10.07) (P>0.05). However, after the intervention, a statistically significant difference was observed between the mean scores of death anxiety in the experimental group (44.5±10.2) and the control group (48.9±11.2) (P<0.05).
Conclusion: According to the results of the study, it can be concluded that Benson’s relaxation technique is effective in reducing death anxiety among patients with breast cancer.
Clinical trial registry: IRCT20170610034435N8
 

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Background & Aim: The Covid‐19 pandemic has posed numerous ethical challenges to nurses and has exacerbated moral distress in clinical settings. Hence, due to the important role of nurses in pandemics, this study was conducted to investigate the severity and frequency of moral distress among nurses working in clinical settings at Maragheh teaching hospitals during the outbreak of COVID-19.
Methods & Materials: This was a cross-sectional study conducted on 174 nurses working in surgical-medical, intensive care, pediatric and emergency wards of Maragheh hospitals in 2020-2021. Data were collected using a demographic form and the Corley’s Moral Distress Scale.
Results: The median (Interquartile Range (IQR) = Q3 − Q1) of the severity and frequency of moral distress experienced were 54 (44-59) and 52 (43-58), respectively. The median of moral distress experienced in the intensive care and emergency wards were 56 (51-59) and 46 (43-51), which was more severe than that of in other wards. The median of frequency and severity of moral distress in men were 48 (41-59) and in women 50 (43-59), respectively, which was significantly higher than that of in women (P<0.001). The severity and frequency of moral distress had a statistically significant relationship with age, and work experience (P>0.05) so that with increasing age and work experience, the severity and frequency of moral distress decreased.
Conclusion: Given the high frequency of moral distress among nurses during the COVID-19 pandemic in specific clinical settings, the use of management strategies in order to improve working conditions and create a positive setting can be helpful. It seems that holding courses on coping with moral distress in nurses in the context of the COVID-19 pandemic is an appropriate practical solution.