Background & Aim: Hysterectomy is the second most common major surgery among women of reproductive age. Studies have suggested that women do not usually receive adequate information regarding hysterectomy before the surgery. Depression is a common psychiatric condition diagnosed after hysterectomy. The aim of this study was to assess the impact of pre-hysterectomy counseling on depression among women.

  Methods & Materials : In this clinical trial, 100 women who had undergone hysterectomy for non-malignant conditionswere selected from two hospitals (women’s’ hospital and Imam Khomeini hospital) and completed the informed consent forms. Participants were randomly divided into two intervention and control groups. In the intervention group, we implemented the supportive counseling within two sessions. Depression was assessed 1-2 weeks before the surgery and two monthsafter the surgery. Data were gathered using the 30-item SAMA questionnaire (modified BECK questionnaire in Iran)for depression and a demographic questionnaire. The two groups were assessed using the Wilcoxon rank-sum test, Mann Whitney U test and paired-t test. Data were analyzed in the SPSS-14.0. The p-value less than 0.05 was considered significant forall tests.

  Results: Mann Whitney U test showed no significant difference between the control and intervention groups in the mean score of depression (p<0.001). In the intervention group, the mean score of depression was 44.46 ± 6.7 at baseline and 20.86 ± 5.9 after the intervention.

  Conclusion : Pre-hysterectomy counseling should be provided for women in order to reduce negative psychological consequences.

  Background & Aim: Oral health is one of the most important components of personal health. Understanding current status of oral health is necessary to provide future oral health interventions. The aim of this study was to determine factors influencing tooth brushing behavior based on the health belief model (HBM) among 5- and 6-grader students.

  Methods & Materials : : In this cross-sectional study, 370 primary school students were selected using the stratified cluster sampling method. Data were collected using a questionnaires based on the HBM. The obtained data were analyzed in the SPSS-20.

  Results: The results showed that 95.7% of the students brushed their teeth once or more daily. Mean and standard deviation of the brushing frequency in one week was 8.66±3.54. There was a significant correlation between the perceived barriers (P=0.00, r=-0.14) and self-efficacy (P=0.04, r=0.10) with the brushing behavior.

  Conclusion : According to the results, educating students and decreasing different barriers seems to be necessary to improve brushing behavior.

  Background & Aim: Children with cerebral palsy need permanent care and attention in various stages of growth and development. The parents experience problems in taking care of these children and making them independent. This study was conducted to explore these experiences.

  Methods & Materials : This qualitative study was conducted in 2011-2012 using content analysis. Purposeful sampling was used to recruit 19 parents of children with cerebral palsy referred to rehabilitation centers in Tehran. The data were gathered using in-depth and semi-structured interviews and were analyzed inductively.

  Results: Data analysis results revealed three original categories including "life with hardness" ، "being in ambiguity" ، and "need to be supported" ، and several subcategories including "physical strain" ، "psycho-emotional strain" ، financial burden" ، "restriction in social activities" "facing with anonymous" ، "lack of having an advisor" ، "need to get help from professionals and specialists" ، "need to have emotional- spiritual support" ، and "need to have help in caring the child".

  Conclusion : Parents in permanent care of children with cerebral palsy face with new and various situations consistently and experience difficulty and bewilderment because of insufficient family and social support. Further studies are needed to explore the support process of caregiver parents of these children.

  Background & Aim: Need assessment for promotion reproductive health is important subject and development a questionnaire is essential. Thus the aim of this study was development of questionnaire of intention to use of oral contraception in withdrawal users based on construct of Theory of Planned Behavior (TPB).

  Methods & Materials : In-depth interviews were conducted to elicit the salient beliefs relevant to oral contraception among withdrawal users. Then a cross-sectional study carried out in Tehran, Iran for validate of questionnaire. Participants recruited from attending five family planning clinics of public health services in the Eastern district of Tehran, Iran. Validity and reliability was evaluated using concurrent, content validity and Cronbach's alpha and test- retest respectively. Factor structure of the questionnaire was extracted by exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) conducted to assess how well the EFA extracted model fits observed data. The SPSS version 16 and Lisrel programs were used to analyze the data.

  Results: Reliability and validity were confirmed. The principal component analysis revealed a three-factor structure for the questionnaire including attitude, subjective norm and perceive behavior control that explained 50.4 percent of the total of variance.

  Conclusion : In general, the findings suggest that questionnaire of intention to use of oral contraception in withdrawal users based on Theory of Planned Behavior is a reliable and valid measure.

  Background & Aim : Childhood cancer discloses family, and mother in particular, to a number of challenges. It consumes a lot of time, energy, and money of parents to fulfill their caring responsibilities. In some cases and along with increase of caring pressure, mental health of parents deteriorates. The vesting consequences of such events may alter the process of children caring and their quality of life (QoL). The purpose of this study was to examine the relationship between mother’s general health status with the QoL of the child diagnosed with cancer.

  Methods & Materials : In this descriptive cross-sectional study, 124 mothers of children diagnosed with cancer and aged 6-14 years old, referred to Imam Reza and Amir Hospitals in Shiraz during a four month period (from early November to late February) were selected to the study. Data were gathered using the following instruments: 1) the questionnaire of factors related to QoL in children 2) mother's general health status form 3) TNO_AZL Children Quality of Life (TACQOL) and 4) Ped QL Cancer Module. Data were collected through interviewing with mothers and reviewing the medical records of the hospitals. Data were analyzed using the Kruskal–Wallis, Spearman correlation coefficient, Mann-whiteny test and logistic regression in the SPSS-19.

  Results: : A few number of mothers (7.3%) reported good general health status and a large number described their general health status as moderate (55.6%) and poor (37.1%). The mean of health related QoL score and the specific QoL score for children were 78.45±10.05 and 65.51±17.54, respectively. According to the multi-factorial logistic regression, demographic and social factors such as child’s age and treatment-related factors including the period of radiotherapy, along with the duration of disease were more correlated with health and specific QoL scores in children, compared to the mothers’ general health status score.

  Conclusion : Results from this study suggested that emotional support is as important as financial empowerment. The QoL in these patients and their families may improve by identifying the families who are at risk of mental problems.

  Background & Aim: Although breast self-examination (BSE) is no longer recommended for screening of breast cancer, its training and practicing is a gateway to health promotion and provides women with knowledge and attitudes that set the stage for clinical breast examination and mammography screening later in life. The aim of this study was to recognize predicting factors of the BSE based on the Health Belief Model (HBM) and the locus of control model among women aged 20-50 years old.

  Methods & Materials : Inthis cross-sectional study,400 women were selected through theconvenience sampling method from health centers. Data were collected using four questionnaires including the Champion’s Scale, health locus of control, and demographic and functional questionnaires. Data were analyzed in the SPSS using independent T-test, Chi-squared test, logistic and linear regression models.

  Results: The results showed that 10.9% of the participants reported performing BSE regularly. Perceived self-efficacy was the strongest positive predictor in the BSE performance (Exp (B) =1.863). Awareness had direct and indirect effects on the BSE. The locus of control did not predict the BSE (p=0.05).

  Conclusion : Improving self-efficacy, especially in young women, and increasing awareness about cancer among women is necessary to increase the rate of the BSE.

  Nearly a century has passed since the establishment of nursing education programs in Iran. The first nursing school was established in 1916 (1294 Solar Hijri) in Urmia and moved to Tabriz after a year due to the World War.

  Also, nursing research in Iran has a history of nearly half a century. Nursing research in Iran first began independently in 1970s (1350s SH) with starting admission in master of nursing by nursing schools. Before that, nurses usually participated in studies as an assistant. Most nursing research in this decade included descriptive research performed by master students as their dissertations which were mainly guided by non-nurse supervisors.

  In 1980s (1360s SH), nursing research became more analytical and nurses began to analyze the contributing factors in addition to their description and conduct epidemiological studies. The research findings were often presented in medical congresses, however few scientific congresses were held by nursing and midwifery schools in this decade which had significant role in current status of nursing research.

  Background & Aim: Governing organizational culture in hospitals can affect patients’ safety through establishment of behavioral norms among nurses. This study aimed to determine the relationship between nurses’ perception of organizational culture and their performance about patients’ safety .

  Methods & Materials: In this cross sectional, descriptive-correlation study, we used stratified sampling method to recruit 250 nurses working in general wards and emergency departments of general hospitals in Babol, 2013. Data were collected through questionnaires and were analyzed using the descriptive and inferential statistic tests including the Pearson test, ANOVA test and T-test in the SPSS . 

  Results: Nurses' perception of organizational culture was "fairly desirable" (54.5%). Performance of the nurses in the field of patients' safety was "desirable" (88%). The Pearson test showed that there was a positive and statistically significant correlation between nurses’ perception of organizational culture and their performance in the field of patients’ safety (P<0.01) .

  Conclusion: It seems that improving organizational culture in hospitals can enhance nurses’ performance in the field of patients' safety .

  Background & Aim: The ventilator associated pneumonia is a common problem in critical care units. It is associated with increased mortality, cost and length of stay. Nurses have great role in preventing the ventilator associated pneumonia. The aim of this study was to assess nurses' performance in prevention of ventilator associated pneumonia .

  Methods & Materials: In this descriptive study, 110 nurses working in selected hospitals affiliated to Tehran University of Medical Sciences were selected using convenience sampling method. A 32-item observational checklist was provided based on the ventilator associated pneumonia prevention guideline. The nurses' performance was observed three times. Data were analyzed using descriptive statistics in the SPSS-16 . 

  Results: This study showed that the mean score of the nurses' prevention was 46.8±5.79. Most of the nurses (66.4%) had poor performance and 36.6% had relatively good performance. There were no nurses with favorable performance in the prevention of ventilator associated pneumonia. The highest score was in contact precaution (72±9.67) and the lowest score was in mouth hygiene (18.78 ± 17.4) .

  Conclusion: The majority of nurses had poor performance in prevention of ventilator associated pneumonia. More attention should be paid for planning appropriate training programs for nurses and giving adequate facilities to improve health care quality .

  Background & Aim: The most common types of medical errors are medication errors. Medication errors can cause serious health problems and should be considered a threat to patients' safety. The aim of this study was to investigate the prevalence and types of medication errors and barriers to reporting errors by nurses in an educational hospital in Kermanshah University of Medical Sciences in 2012 .

  Methods & Materials: In this cross-sectional study, 96 nurses working in an educational hospital were randomly selected to the study. Review of medication errors and reporting them over the last three months were assessed using a valid and reliable questionnaire. Data were analyzed using the SPSS-20. 

  Results: The prevalence of medication errors was 79.2%. The most common errors included giving oral drugs by mistake (53.1%) and medication later or earlier than the stipulated time (41.7%), respectively. Reporting the medication errors was 14%. Among the barriers to reporting the errors, barriers related to administrative issues were more highlighted than the staff relating barriers.

  Conclusion: The results showed high prevalence of medication errors and low rates of error reporting. Holding periodic courses on safe medication and using management strategies to encourage nurses to report errors are recommended.

  Background & Aim: Limitation of fluid intake in parturient can affect uterine contractions. Several studies have been conducted on the effect of hydration in labor progress and reported different results. In the present study, we evaluated the effect of over IV hydration on duration of labor and outcome of pregnancy in parturient women .

  Methods & Materials: In this randomized clinical trial, 120 nulliparous women admitted to Ilam Mustafa Hospital were selected from February 2010 to December 2010. All participants had non-complicated singleton pregnancies and were randomly assigned in four groups. The first group received usual care while the second to fourth groups received lactated ringers at 60, 120 and 240 ml per hour (IV fluid groups), respectively throughout active labor phase. All women had unrestrictedly access to oral fluids. The analysis was done using the ANOVA and Chi-squared tests in the SPSS-16. The p-value less than 0.05 were considered to be statistically significant . 

  Results: Key variables known to affect labor outcomes were statistically similar in all groups. The mean duration of active phase of labor was lower in the intervention groups in comparison with the control group. All groups had significant differences in the duration of second stage of labor, Oxytocin augmentation, and prolonged labor. There was a trend toward a lower frequency of the Cesarean deliveries in the 240 ml group however it was not significant. There was no significant difference in the Apgar scores between groups .

  Conclusion: Over IV hydration reduced duration of labor. There were no reports of poor outcomes for mother and infants .

  Background & Aim: Several studies have shown that the self-care activity of patients with implantable cardioverter defibrillator is inadequate. This study was conducted to assess the effect of an educational program based on the Orem’s self-care model in self-care ability of the patients .

  Methods & Materials: This clinical trial was conducted among 66 patients with implantable cardioverter defibrillator. Four educational sessions were held based on the patient's needs and Orem’s self-care model. Data was collected using a self-report questionnaire at baseline and one month after the intervention. Data were analyzed using statistical tests (x², t-test, paired t-test) in the SPSS-18 . 

  Results: There were no significant differences in the self-care awareness, tendency to self-care, self-care skills, and self-care ability between the control and intervention groups. After the intervention, the self-care awareness score remained 22.06 ± 3.26 in the control group and increased (28.69 ± 1.51) in the intervention group (P<0.000). There was also significant difference in the tendency to self-care between the control (25 ± 3.31) and intervention (28.9 ± 1.33) groups (P<0.000). The self-care skills differed significantly between the control (14.9±3.06) and intervention (29.03±1.15) groups after the intervention (P<0.000). After the intervention, the self-care ability was also significantly different among the control (61.96±8.06) and intervention (86.63±2.93) groups (P<0.000) .

  Conclusion: The results of this study showed that implementing educational programs based on the Orem’s self-care model can improve self-care ability in patients with implantable cardioverter defibrillator. Applying this method is recommended in nursing interventions to promote health status of the patients .

  Background & Aim: Body image flexibility is defined as the capacity to experience the ongoing perceptions, sensations, feelings, thoughts, and beliefs associated with one's body fully and intentionally while pursuing chosen values. This study was aimed to translate Body Image flexibility Questionnaire (BI-AAQ ) into Persian language and assess the validity and reliability of the translated version as an instrument to measure body image resilience .

  Methods & Materials: In this cross-sectional study, 354 students (130 males and 224 females) studying in an academic year (2012-2013) at Tehran University of Medical Sciences were selected through convenience sampling method . Students filled out demographic questionnaires, "body image flexibility questionnaires", "acceptance and action questionnaire edition 2", and "depression, anxiety and stress scale". For data analysis, IBM SPSS 21 and IBM SPSS Amos 21 software were used . 

  Results: The test-retest coefficient was 0.72. The correlation of the scale with the weight consent, psychological flexibility, stress, depression and anxiety was -0.54, 0.33, 0.33, 0.45, and 0.37, respectively which represented the concurrent validity of the scale. Confirmatory factor analysis results also showed that single-factor model of body image flexibility questionnaire has good fitting the Iran' community. Internal consistency reliability was estimated with Cronbach ’s alpha (α=0.87) .

  Conclusion: Psychometric characteristics of the body image flexibility questionnaires showed that the questionnaire seems to be acceptable in Iranian society. It is a useful tool for research in the psychological and psychiatric clinics .

  Background & Aim: The nature of clinical practice has altered in recent years. It has been affected by different kinds of problem-solving models' so, the problem-solving skill is necessary in practice for nurse practitioners. Besides assertiveness is a critical element which persuades nurses and nursing students to establish good relationships and use their knowledge and professional skills effectively. The aim of this study was to assess the relationship between problem solving and assertiveness skills among undergraduate nursing students .

  Methods & Materials: This was a descriptive correlational study. The study was carried out in the School of Nursing and Midwifery at Iran University of Medical Sciences. The study population included all students enrolled in the four-year nursing program in 2009-2010. Data were collected using the Heppner and Petersen’s problem solving inventory and Rathus assertiveness schedule. Data were analyzed using the ANOVA, independent sample t-test and Pearson Correlation Coefficient tests in the SPSS . 

  Results: Three hundred and twenty two students participated in this study. The students' problem-solving skill (mean=89.5) and assertiveness (mean=12.1) were moderate. The study showed that last year students reported higher assertiveness skill than the freshmen (F=2.85 P≤0.037). The level of assertiveness was correlated with the level of problem-solving skill .

  Conclusion: Educational programs should provide opportunities for nursing students to enhance life skills such as problem solving and assertiveness skills. Nursing schools should improve students' skills in clinical approaches to be better care professional .

  A pilot or preliminary study is referred to a small-scale of a complete survey or a pretest for a particular research instrument such as a questionnaire or interview guide (1). Pilot studies could be conducted in qualitative, quantitative, and even mixed methods research (2).

  General application of pilot studies can be summarized in four areas: 1) to find problems and barriers related to participants' recruitment 2) being engaged in research as a qualitative researcher 3) assessing the acceptability of observation or interview protocol and 4) to determine epistemology and methodology of research. Three specific functions of pilot studies in qualitative research are assigned to three main qualitative methodologies including phenomenology, grounded theory, and ethnography. It allows exercising epoch within the phenomenological research, increasing theoretical sensitivity in grounded theory, and familiarity with fieldwork in ethnography (3-5).

  Background & Aim: Patients with end-stage renal disease undergoing hemodialysis are repeatedly exposed to stress and pain from approximately 300 punctures per year to their arteriovenous fistula . Patient comfort with the procedure is therefore of greatest importance for long-term compliance with the treatment and until a successful renal transplant. This study was conducted to determine the effect of rhythmic breathing on pain intensity when the needles are inserted into vascular access for hemodialysis .

  Methods & Materials: This was a quasi -experimental one-group time-series study. Thirty five patients in hemodialysis ward of Hamadan Besat hospital entered into the study via convenient sampling method. In this study, pain intensity during the insertion of hemodialysis vascular needles was measured in six sessions through two methods of routine intervention and rhythmic breathing. The data were collected using visual analog scale. Paired t-test was used to determine pain intensity mean difference between the two conditions . 

  Results: Overall, the results showed that the mean pain intensities were 5.45±1.15 and 2.19±0.92 in two conditions including routine intervention and rhythmic breathing , respectively. Paired t-test showed a significant difference between the routine intervention and rhythmic breathing (P<0.001) .

  Conclusion: These findings showed that rhythmic breathing was effective in reducing pain when the needles were inserted into the vascular access. Therefore, it is recommended to use rhythmic breathing as a simple and non-expensive method to reduce pain in patients before insertion of hemodialysis vascular needles .

  Background & Aim: Cancer is the most common childhood chronic medical illnesses that can affect quality of life of the children and their families. The aim of this study was to determine the effect of coping skills training on quality of life among parents of children with leukemia.

  Methods & Materials: This non-randomized clinical trial was conducted from March to June 2013. Ninety eight parents of children with leukemia who were referred to two selected hospitals affiliated to Tehran University of Medical Sciences were enrolled to study using convenience sampling method. The participants were allocated to two experimental (n=48) and control (n=50) groups. Data were collected through two questionnaires including demographic characteristics of the parents and children, and the Persian version of the Caregivers Quality Of Life index Cancer. Coping skills training including social communication skills was performed through small group discussion (5-8 members) in four 2-hours sessions for the experimental group. The questionnaires were completed four weeks after the intervention by the parents. Data were analyzed using the independent t-test, paired t-test, Fisher's exact test and Chi-squared test in the SPSS-16. 

  Results: The results showed significant increase in the overall quality of life after the intervention (P<0.001). The quality of life of parents in the experimental group was improved significantly in comparison with the control group (P=0.045). Mental/emotional burden (P<0.001) and lifestyle disruption (P<0.001) decreased significantly after the intervention.

  Conclusion: The coping skills training affected the quality of life among parents of children with leukemia . Effective educational interventions may help to increase the quality of life of parents who have children with Leukemia.

  Background & Aim: The Roy’s adaptation model is a helpful instrument to be used in treatment processes of patient s with chronic diseases. According to chronic nature of amputee veterans' diseases, it is expected that the implementation of care plan s based on this model can increase adaptation in the patients . The present study was performed to design and determine validity and reliability of a researcher-designed adaptation questionnaire based on the Roy’s adaptation model on war veterans with lower limb amputation .

  Methods & Materials: This study was conducted among war veterans referred to the veteran clinic of Orthotics and Prosthetics center using convenience sampling method during 2012-2014 . M ain concepts of adaptation defined based on the Roy’s adaptation model were used to provide items. The validity and reliability of the questionnaire was assessed using the content validity index (CVI), content validity ratio (CVR), face validity, internal consistency (Cronbach's alpha), and stability (test-retest reliability) tests.

  Results: Thirty five items were developed including 15 items on physiological area, 11 items on self-concept area, four items on dependence/ independence area, and five items on role playing area. The CVI was 0.95 . The Cronbach's alpha was 0.78. The correlation coefficient values ​​were more than 0.7 in each area .

  Conclusion: The psychometric analysis of the questionnaire showed proper validity and reliability for measuring adaptation on war veterans with lower limb amputation. The questionnaire is recommended to be used in nursing practice .

  Background & Aim: Coronary artery bypass graft is a critical intervention for patients with coronary artery disease. This surgery is associated with significant changes and unique experiences in lives of patients. This study was conducted to understand the experiences of patients with coronary artery bypass graft.

  Methods & Materials: This qualitative study was conducted using an interpretive phenomenological approach. Eleven patients were selected from outpatient cardiology clinics of Tehran Heart Center using purposive sampling method. Data were gathered through semi-structured in-depth interviews lasting 55-70 minutes. The van Manen six steps analysis was used to analyze the data . 

  Results: During the data analysis, the main themes of e xperiences of living with coronary artery bypass and rebirth were extracted. These themes contained living with healthy heart, feeling back to the young and attempts for health maintenance .

  Conclusion: According to the study, participants were inclined to maintain the new lifestyle, dietary changes and also adhere to medications prescription. Nurses can help patients with properly designed educational program based on experiences of the patients.

  Background & Aim: Women who experience anxiety during labor are more vulnerable to physical and mental illnesses. Emotional support by a knowledgeable individual can improve physical and even mental conditions. This study aimed to determine the effect of presence of a Doula in delivery unit on parturient women’s anxiety .

  Methods & Materials: This is an experimental study using a randomized interrupted time series with a control group. Using convenience sampling, 64 parturient women with research inclusion criteria were randomly assigned to the control or intervention groups. The parturient women in the intervention group benefited from presence of a Doula and her support. The control group received the usual care without presence of the Doula. Data were collected using the Spielberger state-trait anxiety inventory and a checklist. The results were analyzed using parametric and non-parametric statistical tests in the Stata-11 . 

  Results: The age, education, family income, location of residency, the trait and state anxiety did not have any differences between the two groups at the baseline. After the intervention, the state anxiety was reduced significantly in the intervention group compared with the control group at the time of leaving the labor room, delivery room and recovery room (P<0.001) .

  Conclusion: According to the present research findings, Doula can significantly reduce the anxiety level and its complications among parturient women during childbearing .