---

Background & Aim: Nursing care is an essential part of health care services. Missed nursing care is a new concept referring to any aspect of care, that is omitted or delayed. The present study aimed to assess missed nursing care and its related factors from the viewpoints of nurses working in the hospitals affiliated to Kerman University of Medical Sciences in 2017.
Methods & Materials: In this descriptive, cross-sectional study, 300 nurses participated. Two questionnaires on missed nursing care, and its related factors were used for data collection. Data were analyzed through the SPSS software version 20 using descriptive indices.
Results: The mean score of missed nursing care was 32.28±7.41, which was lower than the median (range) of the questionnaire. The highest mean score of missed nursing care and its related factor, respectively were “attending the interprofessional patient care conferences” and “the volume of activities related to patients’ admission and discharge”.
Conclusion: The level of missed nursing care was lower than the median in the present study, which can be lowered by proper management. In addition, by decreasing nurses’ workload, missed nursing care related factors can be reduced.
 

---

Background & Aim: Menopause has been recognized as a critical stage in women’s life. Menopausal symptoms and problems can affect women’s health and well-being. Health promoting behaviors may be useful in alleviating these symptoms. The purpose of this study was to determine the effect of couple counseling on severity of menopausal symptoms in women.
Methods & Materials: In a quasi-experimental study, 80 women with their husbands were selected by the convenience sampling method from health care centers in Zahedan in 2017, and were assigned to either experimental or control group. The data gathering tool included a demographic questionnaire and Menopuse Rating Scale questionnaire. Couple counseling for the intervention group was conducted in four 60-minute sessions. Data were collected before and 12 weeks after the intervention, and analyzed by independent and paired t-test, analysis of covariance and χ2 using the SPSS software version 21.
Results: There was no significant difference between the two groups in terms of demographic variables, but the mean of score changes for menopausal symptoms in the intervention group was -1.42±1.95 and in the control group was -0.10±1.10. The independent t-test showed a significant difference in the mean of score changes for menopausal symptoms in the two groups (P<0.0001).
Conclusion: Given that couple counseling has a positive effect on severity of menopausal symptoms in women, it is suggested that this counseling strategy be integrated into healthcare programs for menopausal women.
 

---

Background & Aim: Nowadays, home-based cardiac rehabilitation (HBCR) program is one of the major methods that can improve the quality of life of patients following coronary artery bypass graft surgery. The present study aimed to investigate the effect of a HBCR on the quality of life of patients following CABG.
Methods & Materials: In this clinical trial, 104 inpatients at Golestan and Imam Khomeini hospitals in Ahvaz in 2017, based on permuted-block randomization were assigned to an intervention or a control group. The intervention group received four training sessions for four days at the hospital and then six sessions of home-based cardiac rehabilitation (at 2-week intervals for three months). The Mac-New quality of life questionnaire was completed by the intervention and control groups before the surgery and three months after CABG surgery. Data were analyzed using the SPSS software version 22.
Results: The postoperative mean scores for quality of life subscales and for overall quality of life in the intervention group were greater compared to the control group (P<0.001). The obtained effect sizes were 1.17 for the emotional, 1.42 for the physical, and 1.91 for the social subscales and 1.67 for the overall quality of life. The Eta-squared value (0.408) indicated that the effect of the home-based cardiac rehabilitation program on the quality of life was significant (P<0.0001).
Conclusion: The study findings suggest that the home-based cardiac rehabilitation program has positive effects on the various subscales of quality of life. HBCR is recommended as a cost-effective care model for all patients attending heart surgery centers.
Clinical trial registry: IRCT20171114037468N1
 
 

---

Background & Aim: Efforts to improve self-care in patients with heart failure provide better treatment outcomes and longer life expectancy. The purpose of this study was to determine the effect of a caring program based on Pender model on health-promoting self-care behaviors in patients with heart failure.
Methods & Materials: In this single-blind randomized controlled trial, 48 patients with class II or III heart failure, referred to Golestan hospital in Tehran in 2017-2018, were recruited by the purposive sampling method and were randomly assigned to an intervention or a control group. For the intervention group, a caring program based on the Pender Health Promotion Model was conducted in six sessions. Data were collected by the Health Promoting Lifestyle Profile and the Self-Care Heart Failure Index, before and after the intervention. Descriptive and inferential statistical tests were used to analyze the data by the SPSS software version 16.
Results: The mean scores of the dimensions (except self-actualization) and the total score of health-promoting behaviors and self-care in the intervention group were higher than in the control group after the intervention (P<0.05). In addition, after the intervention, the mean scores of the dimensions and the total score of health-promoting behaviors and self-care significantly increased in the intervention group (P<0.05).
Conclusion: Implementing a caring program based on Pender model increases the self-care and health-promoting behaviors of patients with heart failure. Therefore, application of this caring program is recommended for this group of patients.
Clinical trial registry: IRCT20150801023446N17
 

---

Background & Aim: Health promoting behaviors have been recognized as an important strategy for maintaining and improving the independence, health and quality of life of people with chronic diseases. The aim of the present study was to compare the health promoting behaviors of patients with MS with those of healthy people.
Methods & Materials: This cross-sectional, comparative study was conducted on MS patients and healthy people in Guilan province in 2018. For this purpose, 120 MS patients (from the MS association of Guilan province and other health centers) and 120 healthy people were selected by the convenience sampling method. The Health-Promoting Lifestyle Profile (HPLP-II) was used to collect the data. The data were analyzed using the SPSS software version 22.
Results: The results showed that health promoting behaviors of MS patients were significantly lower than those of healthy people (t=-3.127, df=238, P<0.001). The results of the components analysis indicated that the mean ranks of self-actualization (U=4948.500, Z=-4.191, P<0.001), interpersonal relationships (U=12874.000, Z=-2.957, P<0.003), stress management (U=5787.000, Z=-2.644, P<0.008) and physical activity (U=5506.500, Z=-3.156, P<0.002) in MS patients were significantly lower than those in healthy people. However, there was no significant difference between MS patients and healthy people in the components of health responsibility and nutrition.
Conclusion: In general, it can be concluded that chronic conditions are associated with a decrease in health promoting behaviors in MS patients, and the patients should be educated in this area using appropriate nursing and psychological interventions.
 

---

Background & Aim: The experience of domestic violence has negative consequences on the mental health of pregnant women, and interventions must be designed to reduce these negative consequences. Therefore, the aim of this study was to determine the effect of supportive-educational intervention on psychological distress among pregnant women subjected to domestic violence.
Methods & Materials: This clinical trial was conducted on 100 pregnant women subjected to domestic violence, referred to comprehensive health centers of Zahedan for receiving prenatal care in 2018. Eligible women were selected by the convenience sampling method and randomly assigned into two groups of intervention and control. The intervention group received four supportive-educational individual sessions during two weeks. The control group received routine care during this period. Data were collected in two groups by the Kessler Psychological Distress Scale (K10) and Hurts, Insults, Threaten, Screams (HITS), before the intervention and four weeks after the intervention. The data were analyzed by statistical tests using the SPSS software version 21.
Results: The results showed that the mean score of psychological distress of pregnant women dropped from 30.9±4.58 to 22.18±3.81 (mean change score -8.72±3.93) in the intervention group and from 25.22±4.15 to 24.06±4.16 (mean change score -1.16±1.48) in the control group. Analysis of covariance demonstrated that there was a statistically significant difference in the mean score of psychological distress of pregnant women exposed to violence between the two groups after the supportive-educational intervention (P<0.001).
Conclusion: The results of this study showed that the supportive-educational intervention is effective in reducing psychological distress in pregnant women subjected to violence. Therefore, it is recommended to integrate supportive-educational interventions into prenatal care for pregnant women subjected to violence in order to improve fetal and maternal health.
 

---

Background & Aim: Brain injury is one of the most common traumas and the most important cause of death in traumatic events. Ventilated patients are susceptible to pressure ulcers caused by endotracheal tube fixation (ETF). The aim of the present study is to compare three methods of ETF (band, adhesive and holder) on the incidence of pressure ulcers in patients with head injury.
Methods & Materials: This randomized clinical trial was performed in a hospital in Mashhad in 2017. A total of 108 hospitalized patients with head trauma were included in the study by convenience sampling. The patients were randomly divided into three groups of ETF using holder, band and adhesive. In three groups, the incidence of pressure ulcers caused by fixation method was assessed at 6, 12, 18, and 24 hours after the intervention. The grade of ulcer was measured by pressure grading scale (EPUAP/NPUAP). The data were analyzed using the SPSS software version 16.
Results: The incidence of pressure ulcers at 6, 12, 18, and 24 hours after the intervention was significantly different in the three groups (P<0.05). At six and 12 hours after the intervention, the three groups had a grade one ulcer. However, after 18 hours, 10% in the adhesive group and band group and 24 hours after the intervention, 25% in the band group and 12.1% in the adhesive group had a grade 2 pressure ulcer, but this amount was 0% in the holder group.
Conclusion: Use of holder rather than adhesive and band for ETF in mechanically ventilated patients causes less pressure ulcers.
Clinical trial registry: IRCT20171015036800N1
 

---

Background & Aim: Diagnosis of cancer can cause emotional problems such as stress, anxiety, depression and incompatibility with the disease in the patient and his/her family, leading to adverse consequences in the improvement process and an increase in the complications of the disease. Considering the importance of this topic, the study was conducted to investigate the effect of Roy’s adaptation model-based care plan on the severity of depression, anxiety and stress in patients with colorectal cancer hospitalized in the treatment and educational centers of Urmia.
Methods & Materials: In this randomized clinical trial study, 36 patients with colorectal cancer (at the third or fourth stage of disease) hospitalized in the treatment and educational centers of Urmia were selected by a convenience sampling and were assigned to the intervention group or control group in 2016. Data collection tools were a form for assessing the Roy’s adaptation model and the depression, anxiety, and stress scale (DASS-21). The Roy’s adaptation model-based care plan was administered to the intervention group. Data analysis was performed using the SPSS software version 18 and t test and Chi-square test.
Results: The study results showed before the intervention, the mean scores of depression, anxiety and stress were 12.7±4.5, 13.9±4.8, 16.4±4.7 for the control group and were 15.7±4.5, 13.0±4.6, 12.6±4.2 for the intervention group, respectively. There was no statistically significant difference between the two groups (P<0.05). However, after the intervention, the mean scores of the studied variables increased in the control group (13.7±4.8, 13.93±4.9, 17.16±4.4) and decreased in the intervention group (10.46±3.1, 11.00±3.4, 13.8±5.2). There was a significant difference between the two groups (P<0.05).
Conclusion: Due to the severity of depression, anxiety, and stress among cancer patients, more cost-effective and non-pharmacological methods such as the Roy’s adaptation model, can be useful to control these complications and create a less stressful environment for these patients.
Clinical trial registry: IRCT20160220026662N5
 

---

Background & Aim: Improving clinical decision-making is one of the challenges of the pre-hospital emergency system. Therefore, the aim of this study was to determine the effect of pre-hospital trauma management training program on the capability of clinical decision- making in emergency medical technicians.
Methods & Materials: In a randomized controlled field trial study, 64 pre-hospital emergency technicians from Gonabad University of Medical Sciences, were randomly assigned to either intervention or control groups by the stratified sampling method in 2018. For the intervention group, a pre-hospital trauma management training program was administered based on existing domestic and global standards in a two-day crash course with a combination of learning techniques including lecture and simulation. The research instruments were a demographic questionnaire and a researcher-made questionnaire on clinical decision-making, completed before the course, immediately and one month after the completion of the course. Data were analyzed by the SPSS software version 19 using independent t-test, the repeated analysis of variance and Bonferroni's post-test.
Results: The mean changes in clinical decision-making scores before and immediately after the intervention (9.31 vs. 0.3), before and one month after the intervention (7.86 vs. 1.1) and immediately after the intervention and follow-up one month after the intervention (1.62 in. vs. 1.39) were significantly higher in the intervention group than in the control group (P<0.001).
Conclusion: The pre-hospital trauma management training program can improve clinical decision-making in pre-hospital emergency medical technicians. Therefore, this program can be integrated into the technicians’ training programs.
Clinical trial registry: IRCT20180802040677N1
 

---

Background & Aim: Postpartum depression disorder is a common psychosocial disorder with negative consequences for the mother and child. On the other hand, attention training technique can be more effective than other techniques for intervention in the cognitive-attention syndrome. Therefore, the present study was conducted to determine the effectiveness of attention training technique on the symptoms of depression, anxiety and metacognitive beliefs in patients with postpartum depression.
Methods & Materials: This study was conducted in a single-case experimental design using a multiple baseline design in eight sessions during one-, three- and six-month follow-ups on two patients, referred to the psychology and psychiatry unit of Tabriz Red Crescent in 2018. The Beck Depression Inventory, the Beck Anxiety Inventory and Metacognitive Beliefs Questionnaire were used to collect the data. Data analysis was performed using the Excel software as a graphical analysis and then based on the percentage of improvement, effect size and clinical significance.
Results: At the end of treatment, a significant reduction was observed in the symptoms of depression (61% remission), anxiety (48% remission) and metacognitive beliefs (83% remission) in patients with postpartum depression.
Conclusion: The results of this study showed that attention training technique can be effective in the treatment of patients with postpartum depression. However, further studies are needed in this area.
Clinical trial registry: IRCT20171227038096N1
 

---

Background & Aim: Creating and maintaining a safe environment is an important part of care in psychiatric wards. The results of previous studies indicated that some features of the physical environment facilitate the ward’s safety. The experiences of people who are most likely to be present in these environments can be the best source for identifying these features. Therefore, this study was conducted to explain patients’ and employees’ perceptions toward the features of a safe physical environment in psychiatric wards.
Methods & Materials: In this exploratory qualitative descriptive study, seven patients at discharge time and nineteen employees working in psychiatric wards were interviewed about their experiences in psychiatric wards and 84 hours of field observation was done. The data were analyzed using a qualitative content analysis approach according to the method proposed by Graneheim and Lundman.
Results: The results showed a safe physical environment in psychiatric wards meant “having an accident-free environment”. This theme was abstracted from two main categories included “Accidents prevention through design” and “having a natural life environment”, which, according to the experience of the staff, is required to balance the two. The subcategories of “having the design of accidents prevention” were “eliminating or modifying accident-causing objects”, “wards based on the characteristics of the patients” and “conditions for facilitating staff performance” and the subcategories of “having a natural life environment were “meaningful activities", “healthy and pleasant conditions” and “preserved privacy”.
Conclusion: According to the results of the study, it is necessary to create a physical environment free of accidents and at the same time to meet the daily needs of patients in order to prevent physical and psychological damage to patients and staff in psychiatric wards.
 

---

Background & Aim: The success of the surgical safety checklist in reducing surgical mortality and morbidity largely depends on the degree of compliance with the checklist and correct implementation of its components by the staff. The aim of this review is to determine the challenges of effective implementation of the surgical safety checklist and to provide solutions for its more effective implementation.
Methods & Materials: In the present systematic review, all the relevant qualitative papers published from 2010 to October 2018, were examined. A  literature search was done in databases SID, Iran Medex, Iran doc, Magiran, Science Direct, Medline/PubMed, Web of Science, Scopus, ProQuest, Google Scholar, Cochran Library with keywords patient safety, surgical procedures, operative, checklist, World Health Organization, implementation science, qualitative research and their equivalent terms in Persian. Inclusion criteria were articles written in English or Persian, qualitative studies and relevant to the objectives of the study. Exclusion criteria were review articles, posters, presentations, letters to editor and quantitative studies.
Results: The findings of the review of 14 qualitative studies showed that the most important challenges in effective implementation of the surgical safety checklist were unpredictable priorities, lack of collaboration and coordination of the surgical team members, mismatch between the checklist and hospital setting, lack of patient’s cooperation and lack of a planned approach towards implementing the checklist. The strategies to improve the implementation of the surgical safety checklist included checklist localization, improving the collaboration and coordination of all the team members, training and practicing, patient participation, and active organizational leadership.
Conclusion: The introduction of the surgical safety checklist to the health care setting is a permanent challenge and requires ongoing evaluations and its integration into the workflow in the hospital, active and effective leadership, explanation of why and how to use it by managers and receiving support from the organization. Continuous education, performance evaluation and the participation of all the surgical team members in the implementation of the checklist are key factors for effective implementation of the surgical safety checklist.
 

---

Background & Aim: Providing self-care education to patients and their family leads to improvement in the quality of life and increase in participation in self-care programs. The aim of this study was to compare the effect of education by peer and nurse on self-care in hemodialysis patients.
Methods & Materials: In this quasi-experimental study, 105 hemodialysis patients from three selected hospitals in three cities of Isfahan province (Zarinshahr, Falavarjan and Mobarakeh) were selected by the simple random sampling method from February 2016 to September 2016. Three centers were randomly assigned to three groups including education by peer, education by nurse and control. The individual face-to-face education was provided by the peer or the nurse to hemodialysis patients, and the control group only received routine education. Data gathering tool was the hemodialysis patients’ self-care questionnaire which was completed for three groups before and one month after education. The data were analyzed using the SPSS software version 18 through Chi-square test, paired t test, the analysis of variance and Tukey’s post-hoc test at the significance level of P<0.05.
Results: There were no significant differences between the three groups in age, duration of dialysis, gender, and level of education (P>0.05). The Tukey’s multiple comparisons tests showed that the effect of nurse intervention on self-care improvement was significantly more than peer intervention and the control group (P<0.001) and also the effect of peer intervention on self-care improvement was significantly more than the control group (P<0.001).
Conclusion: Education by a nurse is effective in the self-care behaviors of hemodialysis patients and will improve these behaviors. Also, using peer experiences has advantages for hemodialysis patients such as easy, low-cost and effective education, based on life experiences and lack of need for special equipment.
 

---

Background & Aim: White lie is one of the inevitable challenges that creates an ethical dilemma during the patient care process. White lie remains an abstract concept in caring process. The aim of this study was to analyze the concept of white lie in the caring process using a hybrid model.
Methods & Materials: A hybrid model of concept analysis including three phases was used in this study. In the theoretical phase, different databases including PubMed, CINAHL, Scopus, Science Direct, Google scholar, SID and Magiran were searched for finding relevant articles published in 1980-2018. The keywords were truth, white lie, care and deception (in Persian and English). In the fieldwork phase, semi-structured in depth interviews were conducted with nurses. In next step, by combining the two previous stages, the final analysis was performed.
Results: In the theoretical phase, the attributes of the concept were determined, including “harmlessness”, “without personal motivation” and “use in compulsion situations”. In the fieldwork phase, three main categories such as “the sweetness of the bitter truth”, “harmless sentences to prevent harm” and “temporary relief to balance the situation” were identified from the data analysis. By merging the concepts extracted from the theoretical and fieldwork phases, “white lie in the patient care process” was defined as “an ethical decision without personal motivation, which is chosen in unstable situations to prevent predictable harms to the patient in facing the bitter truth”.
Conclusion: Although a definition of white lie was developed based on the above three phases, the further development of this concept requires a deeper look at the Iranian-Islamic culture. Therefore, further research is recommended in other medical centers in the country.
 

---

Background & Aim: Substance use as a crisis and a long-term chronic disorder can lead to psychological burden and reduce the quality of life of family caregivers. The aim of this study was to determine the effect of the quality of life therapy intervention on the burden of the family caregivers of addicts.
Methods & Materials: This is a clinical trial. The research population included all the family caregivers of the recovering addicts, admitted to Baharan psychiatric hospital in Zahedan in 2018. The samples were 80 people who were randomly divided into either intervention or control group. Caregivers in the intervention group received eight sessions of group counseling based on the quality of life therapy and on the basis of the determined content, every other day. Before the intervention and eight weeks after the intervention, the data were collected using the Zarit burden questionnaire and were analyzed by statistical tests through the SPSS software version 21.
Results: Before the intervention, there was no significant difference in the mean score of burden between the two groups (P=0.25). After the intervention, the mean score of family caregiver burden in the intervention group (40.10±12.92) was significantly lower than in the control group (46.80±13.58) (P<0.01).
Conclusion: The quality of life therapy intervention in this study had a positive and significant effect on reducing the burden of family caregivers of addicts. Therefore, it is recommended that healthcare providers use this counseling approach along with addiction treatment programs to improve the psychological well-being of family caregivers.
Clinical trial registry: IRCT20160924029954N11
 

---

Background & Aim: Postoperative pain is one of the clinical challenges for nurses who care for patients. The objective of this review was to evaluate the effect of preoperative education on postoperative pain after elective surgery.
Methods & Materials: A literature search was done on PubMed, CINAHL, Cochrane Library, Web of Science, Scopus and EMBASE to find the articles published in English on clinical trials from January 2012 to June 2018.
Results: Out of 153 studies retrieved, 13 studies (2482 people) were reviewed. Generally, most studies indicated the effectiveness of preoperative education on postoperative pain relief (7 studies, n=1678). In other studies, there was no significant difference between education and the degree of pain reduction in the patient. Also, the results of some studies (n=204) showed that education with empathy could reduce anxiety in half of the cases.
Conclusion: Preoperative education as a complex intervention can reduce postoperative pain. Interactive education with empathy reduces patient’s anxiety and the need for postoperative analgesics. Therefore, training skilled nurses and the providers of such education is suggested for managing pain in patients.
 

---

Background & Aim: Iranian elderly population is increasing, and a high percentage of this population suffers from diabetes. Considering that the concept of active aging has not been developed in the context of chronic diseases that are common in aging (such as diabetes), the purpose of this study was to analyze the concept of active aging in diabetic elderly patients based on a hybrid model.
Methods & Materials: Three stages of hybrid model (theoretical, field work and final analysis) were used in this study. In the theoretical phase, 35 articles (published in 1990-2016) from scientific databases were analyzed. In the field work phase, 10 participants were interviewed and then a qualitative content analysis was performed. In the final phase, the findings of the two previous stages were merged and analyzed.
Results: The definition of active aging for the diabetic elderly is a comprehensive, dynamic, multidimensional and culturally dependent process that requires a sense of satisfaction, happiness, well-being, security, and physical and mental health, that is achieved through social participation, providence of appropriate health and employment services, awareness of diabetes, and financial, emotional, family, and governmental support that brings subjective and objective benefits to the international, national and individual levels (such as adaptation to illness, a sense of worth and self-esteem). In order to achieve this, paying attention to the whole life span from childhood to old age is needed.
Conclusion: The results of this study suggest that health, security, satisfaction, participation, access to health services, support and knowledge of diabetes play an important role in activating elderly people with diabetes in Iran.
 

---

Background & Aim: Patient monitoring in cardiac intensive care unit (CICU) is considered to be non-invasive and safe, but it can cause unintentional catastrophic consequences due to the alarm fatigue. The aim of the study was to determine the status of monitoring system alarms and nurses’ alarm fatigue.
Methods & Materials: This descriptive, cross-sectional study was carried out in cardiac intensive care units of a hospital in Fars province from January to March 2019. The alarm status of 24 monitoring devices was observed for 100 hours in 100 patients under the physiological monitoring. Patients under monitoring were included in the study using a continuous and convenience sampling. Also, 62 nurses working in five CICUs of this hospital completed the alarm fatigue questionnaire (through census). The data obtained from the observation and the questionnaires were analyzed by the SPSS software version 16 using descriptive statistics.
Results: The auditory alarms of monitoring devices were turned off and only visual alarms could be recorded. In the visual alarms recorded during 100 hours, 131 alarms (53.47%) were technical, followed by the false, nuisance, and ultimately real or actual alarms with rates of 40 (16.33%), 38 (15.51%) and 36 (14.69%), respectively. The mean (and standard deviation) score of alarm fatigue among nurses was 21.04 (7.52), and the alarm fatigue score for %50 of nurses was higher than the average score.
Conclusion: Turning off the auditory alarms can lead to serious risks to patients. Also, a high proportion of technical, nuisance, and false alarms can cause alarm fatigue in nurses. Adopting solutions in accordance with standard guidelines and checking physiological monitoring devices in hospitals are necessary in order to reduce false, nuisance, and technical alarms. Failure to pay attention to these issues leads to the alarm fatigue among nurses, which itself results in numerous consequences such as compromising the patients’ safety.
 

---

Background & Aim: Due to repeat emergency patients, the high quality obstetrics and gynecology triage is essential in the obstetrics and gynecology department. Given the importance of improving the healthcare quality, clarifying the aspects and features of the concept of obstetric triage quality would be helpful for determining criteria and standardization of obstetric triage quality. Therefore, the aim of the study was to explain the quality index of obstetric triage.
Methods & Materials: This qualitative study was conducted using a directed content analysis method on 15 participants. Participants included obstetric triage service providers and key specialists in obstetric triage. The data were collected through in-depth, semi-structured interviews. Data analysis was performed using the MAXQDA software version 10.
Results: At this stage of the study, conducted with in-depth, semi-structured interviews, 824 initial codes and 97 merged codes were extracted. The quality of obstetric triage was explained by three main themes, including process quality, structure quality and outcome. The concept of process quality included 35 codes in two sub-categories: actions and care, interactions and communications. Structure quality included 51 codes in five sub-categories: routine and process of triage, pattern and standard, equipment, physical space, and manpower. Outcome included eleven codes in five sub-categories: waiting time, satisfaction, physical implication, psychological implication, and cost.
Conclusion: The index of obstetric triage quality is influenced by the quality of the process (actions and care, communications), the quality of the structure (routine and process of triage, pattern and standard, equipment, physical space, manpower), and outcome (waiting time, satisfaction, physical implication, psychological implication and cost).
 

---

Background & Aim: Some women, throughout their life cycle, experience unintended pregnancy and had to decide on continuing or terminating it. Although the decision-making process always recurs, few studies have so far shed light on this complex, and context-based process. The aim of the present study was to explore Iranian women’s decision-making process to abort or continue an unintended pregnancy.
Methods & Materials: This was a qualitative study using grounded theory approach. Data were collected through unstructured, in-depth interviews with 29 participants in Tabriz from March 2016 to May 2017. The participants were selected through the purposeful sampling method and data collection were continued until reaching data saturation. Data analysis was carried out concurrently with the data collection, using the MAXQDA software version 10.
Results: Data analysis gave rise to four axial categories: “perceived threats”, “resistance mixed with indecision”, “values and supportive resources”, as well as “acceptance and confirmation of decision”. This means that the decision-making process among women with unintended pregnancy initially starts with a perceived threat as a main concern leading to their resistance towards accepting such a pregnancy, then exposure to threats arising from abortion can cause indecision and uncertainty in practicing abortion. In this respect, given the social support, women affected by religious values make efforts to choose the procedure with the least harm and threats and maximum acceptability and confirmability. “Confirmation of decision” is as well the outcome of the interactive process of decision-making.
Conclusion: What can differentiate the theory of decision-making on abortion or continuation of an unintended pregnancy from the general theories of decision-making is its sociocultural confirmability. Social acceptance of abortion and childbearing in line with moral evaluation of fetal development directs the confirmability process of decision-making about unintended pregnancy.