Background & Aim: Mothers often feel anxious about giving care to their premature babies. This maternal stress is associated with negative attitudes and behaviors towards babies. The aim of this study was to assess the effect of Kangaroo mother care on stress among mothers with premature babies .

  Methods & Materials: This quasi-experimental study was carried out on 46 pairs of mothers and their premature babies hospitalized in the ICUs of Shahid Sadooghi and Tamin Ejtemaee hospitals. The participants were selected using convenience sampling method and were assigned into two intervention and control groups. In the intervention group, the Kangaroo mother care was provided to the babies after breastfeeding for about 30 minutes once a day for four weeks. Maternal stress was measured using the Parental Stress Scale before and immediately after the intervention. Data were analyzed using the Chi-squared test, t-test, and Mann-Whitney test . 

  Results: The mean of stress score in mothers of the intervention and control groups were 102.0 ± 17.02 and 174.52 ± 18.25, respectively (P<0.001). The stress score was significantly different before and after the intervention among mothers of the intervention group (P<0.001) .

  Conclusion: The Kangaroo mother care decreased stress score among mothers who had premature babies. The Kangaroo mother care is strongly recommended to be used by mothers with premature babies .

  Background & Aim: Demographic transition and aging are global conditions result in increased risk of disability and chronic diseases such as diabetes. Considering stress as having mutual interaction with different aspects of health is vital in treatment of common disorders among older adults with diabetes. This study aimed to assess the relationship between the perceived stress with spiritual health among older adults with diabetes registered to the Association of Diabetes Prevention and Control in Babol .

  Methods & Materials: In this cross-sectional (descriptive- analytical) study, 194 older adults aged 60-75 years old were selected using convenience sampling from the Association of Diabetes Prevention and Control in Babol. Data were collected using the demographic form as well as the Perceived Stress Scale (PSS) and the Spiritual Well-being Questionnaire (SWB). The validity and reliability of the scales were confirmed previously. Data were analyzed using descriptive and inferential statistics including ANOVA, Chi-Squared tests, t-test and Pearson correlation coefficient in the SPSS-21 . 

  Results: The study findings showed that perceived stress was low in a substantial percentage of the elderly (74.2%) with the mean ± SD of 22.52±8.06. Also, the levels of spiritual health were medium to high among most participants (97.72 ± 11.51). Interestingly, there was a significant negative relationship between the perceived stress and spiritual health (r=-0.48, P<0.001) .

  Conclusion: This study elaborated the relationship between the perceived stress with spiritual health of elderly patients with diabetes. Considering the results, enhancing spiritual health as one of the health dimensions seems necessary .

  Background & Aim: Implantable Cardioverter Defibrillator is the most effective treatment for cardiac dysrhythmias. Having such life-saving device is the unique experience with important changes in the patient’ life. Understanding of these experiences can lead to success in treatment and follow- up.This study aimed to understand the experiences of patients with Implantable Cardioverter Defibrillator .

  Methods & Materials: A qualitative study using interpretative phenomenological approach was used. Thirteen participants were selected purposefully from heart clinics of Imam Khomeini hospital (Tehran). Each semi-structured interview was conducted in the period 30 to 45 minutes. Data analysis was performed using the six steps of van Manen . 

  Results: The main theme of ‘Start Living Again’ was extracted from patients with implantable defibrillator.This theme consist of ‘a sense of security’, ‘living with angel’, ‘attachment to the device’ and ‘attempt to maintain power’ .

  Conclusion: The participants with an Implantable Cardioverter Defibrillator have a life again with a sense of security and peace of mind. They try to keep this life-saving device.Therefore, health care providers, especially nurses can help this patients and their families by providing appropriate self care education .

  Background & Aim: Patients often build their perceptions about the quality of health services on the care provided for them in hospitals by nurses. The present study aimed to assess the relationship between the job satisfaction and burnout among nurses with patients' satisfaction in Shiraz hospitals in 2012 .

  Methods & Materials: In this cross-sectional study, participants were selected through a multi-stage sampling . A total of 280 nurses and 560 patients were recruited to the study. Data were collected using the Spector's job satisfaction and the Maslach Burnout questionnaire s. The structural equation modeling and the confirmatory factor analysis were used to analyze the data in the SPSS and AMOS . 

  Results: There were significant relationships between the nurses' job satisfaction and burnout with the patients' satisfaction. Also , there was a negative and significant relationship between the job satisfaction with burnout among nurses (P<0.001) .

  Conclusion: T he factors affecting job satisfaction and burnout among nurses should be considered in promoting health care provided by nurses .

  Background & Aim: Transparent and appropriate reporting of studies facilitates critical appraisal, application and combination of findings. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement, is a relatively new statement in order to improve the quality of reporting of observational studies. The present study aimed to assess the quality of reporting nursing and midwifery cohort studies according to the STROBE statement published in the Iranian electronic databases .

  Methods & Materials: In this cross-sectional study, we conducted a literature search in the SID, Magiran, Irandoc, Iranmedex databases and Google Scholar using the "cohort" keyword. It produced 1951 articles. After excluding duplicates and irrelevant articles, 241 papers were remained. We included: papers that were published after publishing of the STROBE statement, papers with cohort designs, and papers which their first author or corresponding author were nurse or midwife. Finally, we included 33 papers in our study. We evaluated the papers with the extended STROBE statement. Data were analyzed using the Kruskal Wallis, Mann Whitney and Spearman tests . 

  Results: About half (48.5%) of the papers had a prospective design others were historical cohort. The compliance with the STROBE statement was 56%. The title, abstract and introductions had generally good quality. The missing data, loss to follow-up and sensitivity analyses had poor quality. There were no associations between the papers' reporting quality with the year of publications, authors' specialty, design of the study, and the time of reviewing process .

  Conclusion: The quality of reporting in nursing and midwifery cohort studies was moderate. Reporting the essential elements of cohort studies according to the STROBE statement is recommended .

  Background & Aim: Breast cancer is the most common cancer diagnosed in women in both developed and developing countries. Long-term prognosis of breast cancer strongly depends on the stage of disease at diagnosis. More than three months after detecting breast symptoms by Iranian women, they go to visit a doctor. The understanding of life-threatening symptoms and the subsequent responses are differently affected by social interaction networks as well as cultural and social contexts. This study aimed to explore the role of social interactions on health-seeking behaviors among Iranian women with breast cancer symptoms .

  Methods & Materials: A qualitative study was conducted using purposive sampling method. Twenty Iranian w omen who attended the Cancer Institute in Imam Khomeini hospital at Tehran University of Medical Sciences and complained of symptoms of breast cancer were recruited to the study du ring 2012-2013. Data were collected through semi-structured and in-depth interviews. Interviews were transcribed and analyzed using conventional content analysis in the MAXqda . 

  Results: The results revealed three themes including: 1) effectiveness of social learning 2) seeking social support and 3) feedback with a supportive approach which included seven categories of informative social learning, reliable social learning, selective disclosure, seeking information, seeking emotional support , giving reassurance and social support for decision making .

  Conclusion: E ffective social learning and supportive interactions have influential role on health seeking behavior. Thus it is necessary to improve public awareness and correct clients' social beliefs about breast cancer to shorten the patients' delay .

  Background & Aim: With regard to the i ncreasing trends of information and complexities of health organizations , using of a dvanced tools and computers is necessary . Hospital staff is key members to develop health information systems, because they play not only a major role in the management of system, but also in the development, implementation and evaluation of the system. Since the evaluation of information systems is not possible without analyzing of the experiences and users ' views, thus the aim of this study was to explore nurses' experiences of the hospital information systems .

  Methods & Materials: In this qualitative study, we investigated the nurses' experiences of the application of hospital information systems for the rich and deep understanding of the phenomenon . The c onventional content analysis was used to collect and analyze the data . Face- to-face and semi- structured interviews were conducted with participants to achieve full saturated information. Saturation was achieved with 18 interviews . 

  Results: The emerging themes were gradual system evolution, , audit and responsibility, security, effectiveness and accessibility .

  Conclusion: Nurses' experiences were positive with the applying of the Health Information Systems. The negative experiences of the nurses were related with the application of the system and redundant work, not the system itself. Regarding to participants need, it is recommended that the system should be extended to other duties such as reporting so that more effective use of the system in order to improve the quality.

  Background & Aim: Medication errors are known as the most common preventable and life threatening medical errors. This study aimed to explore perceptions of nurses on medication errors .

  Methods & Materials: This was a qualitative study with content analysis approach. Seventeen nurses were selected purposefully from the intensive care units of Shohada hospital in khoramabad in 2012. Data were gathered using semi structural interviews with the nurses. Data were analyzed using the Lundman and Graneheim method. We used the Linclon and Gouba method to ensure a ccuracy and trustworthiness of the data . 

  Results: Four main categories and six subcategories were recognized including: 1) Management factors (inefficiency in recruitment of human power, poor physical condition and workload) 2) Inefficiency in professionalism (lack of commitment among nurses, insufficient knowledge and inefficiency in the inter professional relationship) 3) Failure in the process of drug prescription by physicians and 4) Failure in production and packaging drugs by drug companies .

  Conclusion: Training and recruiting professional and committed nurses, using electronic medical files, supervision on pharmacy companies to produce and package proper medication can reduce medication errors .

  Background & Aim: Reproductive behavior of a society can be studied in different ways. One of these ways is to check the birth intervals. The aim of the present study was to assess the childbirth along with factors influencing childbirth behavioral patterns in Ahwaz .

  Methods & Materials: In this study , factors affecting birth intervals of women aged 15-49 were investigated . To achieve this goal, given the nature of the birth intervals, the accelerated failure time model was applied. To estimate the parameters of this model, the R statistical software was used . 

  Results: Results indicated that women's educational level , husbands' ethnicity , place of residence , use of contraceptives , age at marriage and pregnancy status were factors significantly influencing first birth interval. Furthermore, women's ethnicity, contraceptive use, number of abortions or stillbirths, pregnancy status , duration of breast feeding and type of childbirth were the most important variables affecting the second birth interval. Also, husband's ethnicity, contraceptive use and duration of breast feeding had significant effects on the third birth interval in this study .

  Conclusion: Comparing the results of this study with those of previous studies shows a recent decline in pregnancy acceleration and an increase in average birth interval. In other words, changes in socio-economic and cultural statuses have caused longer birth intervals and fertility decreases .

  Background & Aim: Nurses’ m ental health is an important dimension of quality of life and health care delivery. Job instability can be threatening for mental health of nurses. This study was conducted to assess the relationship between minor psychiatric disorders (MPD) among nurses with their job stability .

  Methods & Materials: This was a cross-sectional-analytical study. A total of 771 nurses working in Bushehr and Fars provinces were recruited to the study through multi stage sampling. Mental health status was evaluated using the GHQ-12 questionnaire. The employment type -contractual, apprenticeship, permanent, and fixed term- were used as items to measure job stability. Data were analysed using latent class regression . 

  Results: About 27.48% of nurses suffered from MPDs. There was no significant relationship between the types of employment with MPD . There was a significant relationship between MPD with gender (P=0.049). Females were 20% more likely to have MPD .

  Conclusion: Prevalence of MPD among nurses was in the moderate level. High prevalence of MPD among female nurses shows necessity of providing appropriate strategies to control MPDs such as anxiety and stress among nurses .

  Background & Aim: H ospital emergency departments in Iran are prone to crisis for different reasons. Understanding nurses’ perspectives about these crises help in crisis management. The purpose of this study was to explain the nature, causes and consequences of crisis in emergency departments from nurses’ points of views .

  Methods & Materials: This was a qualitative study with content analysis approach. Data were collected using semi-structured interviews with 12 nurses working in emergency departments of general and trauma hospital. Participants were selected through purposive sampling method. Interviews lasted between 45 minutes to an hour. The data were recorded and transcribed. The accuracy and consistency of data were confirmed. Interviews were conducted until no new data were emerged. Data were analyzed using qualitative content analysis with conventional approach . 

  Results: Five themes were emerged through data analysis including: 1) unexpected imbalance 2) events 3) defect in service provider factors 4) positive consequences and 5) negative consequences .

  Conclusion: The results of this study revealed that every factor that can affect balance and daily tasks can make a crisis in emergency departments. Causes of the crisis can be divided into internal or external factors. Several measures should be planned to decrease the crisis in emergency departments from high rank decision making in the ministry of health and medical education to planning appropriate programs in hospitals .

  Background & Aim: Critical thinking is a necessary and important component of nursing profession. Since nurses are not limited to work under predetermined roles and need to meet various needs of patients, they should have critical thinking skills. This study aimed to determine the role of emotional intelligence and its components in critical thinking disposition .

  Methods & Materials: In this cross-sectional study, 118 female nurses working in educational hospitals of Qazvin were selected using quota sampling method. They completed the Trait Metal Mood Scale (TMMS) and the California Critical Thinking Disposition Inventory (CCTDI). Data were analyzed using descriptive statistics (frequency, mean, standards deviation and Pearson correlation coefficient) and inferential statistics (Multiple Regression) in the SPSS-16 . 

  Results: The results showed that there was a significant positive correlation between the total score of emotional intelligence with the total score of disposition toward critical thinking (r=0.385). There were also positive relationships between the total score of disposition toward critical thinking with the two subscales of emotional clarity (r=0.459) and emotional healing (r=0.220). There was no statistically significant relationship between the subscale of attention to emotion and total critical thinking score (r=0.117). The subscale of emotional clarity significantly predicted 21% of changes in critical thinking .

  Conclusion: Nurses who were more aware of their emotions and emotional transparency had higher critical thinking tendency. Empowering critical thinking can directly affect patients’ conditions. Given the major role of emotional intelligence in critical thinking, teaching nurses such skills could result in better performance and improving the quality of nursing care.

  Background & Aim: Exacerbation of the symptoms among patients with chronic obstructive pulmonary disease is a part of the disease's cycle . Despite having medical treatments, most patients experience severe degrees of dyspnea. Self-management programs can help relieving the symptoms. T his study aimed to assess the effect of a self-management program on dyspnea and fatigue severity in patients with chronic obstructive pulmonary disease (COPD) .

  Methods & Materials: In this randomized clinical trial, 50 patients with COPD referred to Apadana clinic in Ahvaz were recruited into the study. Patients were randomly allocated to control and intervention groups. The intervention group received a self-management program designed based on the 5A model the control group did not receive any intervention. Patients were assessed using the Fatigue Severity Scale and the Borg Dyspnea Scale at baseline and three month later. The Chi-squared test and t-test were used to analyze the data . 

  Results: There was no significant difference between the two groups in fatigue severity at baseline. At the end of the three months, the fatigue severity score differed significantly between the two groups (P=0.004). There was also significant reduction in the patients' dyspnea in the intervention group than the control group after 12 weeks (P<0.001) .

  Conclusion: Our program was effective in reducing the COPD symptoms among patients. This simple and non-expensive program can be applied as a beneficial intervention to decline major difficulties of the disease among patients with COPD .

  The results of several studies show the relationship between the ratio of nurses/patients with quality of care and patient outcomes (1-3). This means that less the ratio, more expected adverse outcomes for patients. These findings have led some institutions to establish mandated nurse-patient ratios (4). Establishing standard ratios could potentially improve patients' outcomes such as patients' safety (5, 6), decrease length of stay (3) and readmission rates (7), and improve recruitment and retention of nurses in the system and reduce their burnouts (8).

  According to Mohammad Aqajani, Deputy of the Iran Ministry of Health and Medical Education (MOHME), the country is facing a serious nursing shortage as about 80 thousand nurses serve 80 thousand beds in public hospitals, i.e. one nurse per hospital bed. However, the national standards suggest at least two nurses per bed. Now each year there are nine thousand graduates of nursing baccalaureate program thus, even if no nurse is retired or leave the system and all graduates could be recruited to work in the nursing field, still at least nine years will be needed to provide adequate nurses. In fact, a significant number of nurses leave their job due to retirement, early retirement, turnover and migration so achieving the standard of nursing staffing in a ten-year timeframe seems impossible. ...

  Caring is the most central concept in nursing. This concept distinguishes nursing from other health professions. However, according to some experts’ opinions, caring is not an only-nursing concept it is defined as the heart of all health professions. Caring is entered in the philosophy, vision and mission of several health organizations (1) and is introduced as the essence of nursing and the fourth complementary concepts of nursing Meta paradigm (2). Caring, as a central concept in nursing, has led to developing various caring theories. The most popular ones involve the cultural care theory of Leninger and the human care theory of Watson that were presented in the 1970s. In addition, the theory of Roach was developed in the 1980s. Another theory was presented by Boykin and Schoenhofer in the 1990s. These theories can be compared in some aspects including origin, domain, and definition of caring, description of nursing and other key components (3).

  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 .

  Background & Aim: Stroke is a major cause of disability. Developing new treatment approaches in order to improve and enhance post stroke recovery process is critical. The aim of this study was to determine the effect of mirror therapy on motion range of extremities of patients with stroke .

  Methods & Materials: This semi-experimental study was conducted among 50 patients with stroke hospitalized in Emam Reza and Qaem hospitals in Mashhad during 2012 to 2013. Patients were randomly allocated into two control (25 patients) and mirror therapy (25 patients) groups. In the mirror therapy group, twenty 30–minute daily sessions were implemented in where patients practiced motion range of upper and lower extremities of healthy side in front of mirror and observed the mirror image. Motion range of upper and lower extremities was assessed at baseline, during the sessions and in the last session of the intervention using the goniometer. Data were analyzed using the t-test and repeated measure ANOVA . 

  Results: There were no significant differences in terms of ability of motion range at baseline. The total motion range did not improved significantly in the intervention group in comparison with the control group after the intervention (P>0.05) however, in some joints, the motion was improved (P<0.05) .

  Conclusion: Mirror therapy, as a simple and inexpensive process can improve self-care of patients with stroke .

  Background & Aim: The &beta-Thalassemia major is a chronic disease that needs a regular blood transfusion. The blood transfusion is a complex process with high probability of human errors during the process which results in serious adverse events in patients. Nurses should deliver care based on the best available evidence or best practice. The aim of this study was to develop an evidence-based clinical guideline of blood transfusion in children with thalassemia .

  Methods & Materials: This study was conducted during 16 months from 2013 to 2014 based on three-step process of guideline adaptation including set up, adaptation and finalization. During these steps, topic and aims of the study were clearly identified. Then health questions were designed based on the PIPOH method. After conducting systematic searches, quality of the retrieved clinical guidelines was evaluated using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument and a committee consisting of experts and policy-makers in nursing field. After external review, expert panel meetings and consensus between members, the final version of the guideline was developed . 

  Results: The criteria of clinical practice regarding stages of blood transfusion were determined based on the evidence, cultural and health conditions and were presented in twelve sections.

  Conclusion: This clinical practice guideline developed based on evidence can guide blood transfusion process in clinical practice.

  Background & Aim: Quality of work life seems to have impact on employees' job satisfaction, job involvement, job performance, turnover, and organizational transformation. This study aimed to assess the relationship between job satisfaction with the components of quality of work life among midwives in mashhad .

  Methods & Materials: This was a correlational study conducted among 230 midwives in mashhad in 2014. Data were collected using a demographic questionnaire, Walton's quality of work life, and the Minnesota job satisfaction questionnaire. Validity of the questionnaires was confirmed by 10 experts. The reliability was confirmed by alpha Cronbach. Data were analyzed using the descriptive statistics, Pearson, Spearman and ANOVA tests in the SPSS-19 . 

  Results: The overall quality of work life and job satisfaction had significant positive correlations (P<0.001 r_p=0.525 ). The job satisfaction had correlation with fair and adequate payment (r_p=0.277 P <0.001), safe working conditions (r_p=0.274 P <0.001), proper opportunity promotion ( r_p=0.306 P <0.001), o verall space of life ( r_p=0.327 P <0.001), job lawfulness ( r_p=0.233 P <0.001), social dependence in the work life ( r_p=0.207 P <0.001), s ocial cohesion in the organization (r_p=0.352 P <0.001), and proper opportunities to develop human capabilities (r_p=0.259 P <0.001) .

  Conclusion: Higher quality of work life is correlated with the higher job satisfaction. Managers can plan and implement appropriate strategies to promote components of quality of work life of midwives to provide efficient health services .

  Background & Aim: Premenopausal syndrome affects daily activities of many women. This study aimed to compare the effects of Vitexagnus and Flaxseed on premenstrual symptoms in women referred to health centers of Tabriz from October 2013 to September 2014 .

  Methods & Materials: This randomized controlled trial was conducted among 159 women suffered from premenstrual syndrome (PMS). The PMS was measured using the premenstrual assessment form (PAF) . The participants were allocated into three groups (n=53 per group) using block randomization. The group I received 25 grams/d Flaxseed powder and placebo of the Vitexagnus group II received 3.2-4.8 mg/d Vitexagnus tablets and placebo of the Flaxseed and the control group received both placeboes. The PAF was completed at baseline and 1 and 2 month after the intervention. Data were analyzed using the general linear model . 

  Results: The PMS improved significantly in both intervention groups during the first and the second month after the intervention. In the Vitexagnus and Flaxseed groups, the mean total PMS score were significantly lower than that in the control group at the first months after the intervention (adjusted mean difference: -3.3 (95% CI: -4.0 to -2.1) -4.3 (-5.5 to -3.0), respectively). In the second month after the intervention, the mean total PMS score was -5.8 (-7.0 to -4.7) in the Vitexagnus group and -6.6 (-8.1 to -5.7) in the Flaxseed group. There was no significant difference between the Vitexagnus and Flaxseed groups in terms of the PMS score .

  Conclusion: According to the results of this study, Flaxseed and Vitexagnus are effective in improving PMS .