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Background & Aim: Nursing is a shift-working job at different hours of the day. Therefore, sleep disorders caused by disruption of sleep-wake cycle and circadian rhythm commonly occur in this group. The Benson’s relaxation technique is an easy, non-invasive, and non-pharmacological method that can affect the sleep quality in people. Therefore, this study was conducted to evaluate the effect of Benson's relaxation technique on sleep quality among shift-working nurses in hospitals.
Methods & Materials: In this quasi-experimental study, 80 nurses working in three hospitals in Rafsanjan in 2019, who had poor sleep quality score on the Pittsburgh Sleep Quality Questionnaire were selected by the convenience sampling method, and were assigned into either intervention- or control group, using stratified random sampling method. The intervention group was taught the Benson’s technique and they were asked to perform it before sleeping for one month. After one month, the Pittsburgh Sleep Quality Questionnaire was completed again by the both groups. The data were analyzed by independent t-test, paired t-test, Chi-square and fisher exact test using the SPSS software version 18.
Results: the mean and standard deviation of sleep quality score for the intervention group and control group before the intervention were 7.79±2.53 and 7.95±2.78 respectively and there was no significant difference between the two groups. One month after performing the technique, the mean and standard deviation of the sleep quality score for the intervention group were 5.58±2.32 and for the control group were 8.53±2.93, and the two groups were significantly different from each other (P<0.0001).
Conclusion: In this study, the Benson’s relaxation technique, which is a simple, low-cost, and non-invasive method with no side effects, improved the sleep quality of shift-working nurses. Therefore, nurses’ education and the implementation of this technique is recommended to improve their sleep quality.
Clinical trial registry: IRCT20180306038981N1
 

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Background & Aim: Considering the importance of accidents prevention especially in children under 5 years, the study was conducted to determine the predictor factors for household accidents in children under 5 years based on protection-motivation theory (PMT) in Bushehr.
Methods & Materials: In this descriptive study, 700 mothers with a child aged 6 months to 5 years, referred to health centers in Bushehr were selected by the convenience sampling method from March to August 2018. To collect the data, a valid and reliable self-structured questionnaire including demographic characteristics, questions on constructs of PMT and questions on the household accidents prevention behaviors was used. Data were analyzed by the SPSS software version 22.
Results: In this study, 86% of mothers (602) were housekeeper and 46% (326) had academic education. The most common accident prevention behavior was preventing access to drugs, chemicals and toxins (98%). Perceived self-efficacy (P<0.001, B=0.259) and perceived cost (P<0.001, B=-0.159) were significant predictors for household accident prevention behaviors in children under 5 years, and perceived self-efficacy was the most predictors construct. Based on the linear regression model, these two constructs along with a history of prior accident, predicted 15% (R²=0.150) of behavioral changes.
Conclusion: According to the results of the study, the PMT is a poor predictor for accident prevention behavior, and in educational programs, emphasis on promoting self-efficacy and providing assistance to reduce barriers and difficulties in creating safety in the home (decreasing perceived cost) are necessary for reducing household accidents in children under 5 years.
 

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Background & Aim: Menopause is a period in women’s lives with complications and consequences that can reduce the quality of life. The most common complications are vasomotor disorders which can affect sleep, life enjoyment, social activities and work. The usual treatment for these effects is hormone therapy but due to its side effects, most people tend to have complication-free treatments. One of these strategies is nutritional measures. The aim of this study was to determine the effect of group counseling about the nutritional measures of Iranian traditional medicine on vasomotor disorders in postmenopausal women.
Methods & Materials: This clinical trial study with multistage sampling was performed in 2018-2019 on 62 postmenopausal women referred to health center number 2 in Mashhad. Two health centers were selected as control or intervention group by Heads or Tails method in order to prevent the dissemination of the material. The intervention group received three sessions of the group counseling about the nutritional measures of Iranian traditional medicine. There was no intervention for the control group. The data collection tool was a questionnaire on the quality of life in menopause that was completed two months before and after the intervention. Data were analyzed on the SPSS software version 24 using independent t-test, Chi-square, Mann-Whitney, and Wilcoxon tests.
Results: There was no significant difference in the mean score of vasomotor between the two groups before the intervention (P>0.05) but after the intervention, the difference between the mean score of vasomotor before and after the intervention was -2.18±4.08 for the intervention group and 0.59±3.30 for the control group. A significant decrease in the vasomotor score was observed in the intervention group compared to the control group (P<0.001).
Conclusion: Group counseling about the nutritional measures of Iranian traditional medicine can help reduce vasomotor disorders.
Clinical trial registry: IRCT20180626040239N1
 

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Background & Aim: Maintaining and improving the health of the elderly through effective interventions requires the recognition of their lifestyle, including exercise using a valid and appropriate culture-specific tool. The aim of this study was to design and evaluate the psychometric properties of a tool for measuring exercise self-efficacy in the elderly.
Methods & Materials: A sequential exploratory mixed method study was performed in the form of a questionnaire with two qualitative and quantitative sections in 2019. The qualitative section consisted of item generation including three stages: theoretical stage (targeted search of existing literature), field work (semi-structured interviews with the elderly) and final analysis (integration of the results from the two previous stages). In the quantitative section, the psychometric properties of the questionnaire was evaluated using face, content and construct validity as well as the reliability through internal consistency and stability.
Results: Out of 37 initial items, four items were removed after calculating the item impact score.  Seven items were removed after assessing the content validity ratio and content validity index. Also, five items were omitted due to having a load factor less than 0.03. The result of exploratory factor analysis consisted of three factors “recognition”, “situational compatibility” and “self-control” which all together could explain 90.180% of the variance. The Cronbach’s alpha and the Intraclass correlation coefficient were found to be 0.957 and 0.949 respectively.
Conclusion: The data analysis approved that the designed tool can be used for measuring exercise self-efficacy among the elderly due to having acceptable reliability and validity, simplicity and a short completion time.
 

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Background & Aim: Patient participation is an important component of the patient-centered care approach and part of patients’ rights, with positive outcomes for the health care system. The aim of this study was to explore the nurses' experiences of patient participation in nursing care and its related factors.
Methods & Materials: This qualitative study was carried out with the participation of 18 nurses working in educational hospitals of Tabriz in 2019. The purposeful sampling through semi-structured interviews and focus group sessions was used to collect the data. Data analysis was performed using conventional content analysis. To achieve the accuracy of the data, the Lincoln and Guba criteria were used.
Results: Analysis of the data resulted in four main categories "giving information, decision-making, collaboration and respect". The patient’s participation from the nurses’ perspectives was: an interactive process of decision-making and collaboration between the nurse and the patient with the exchange of information, respect, and permission from the patient. The results also included the prerequisites, domains, outcomes, barriers, and solutions for patient participation in nursing care.
Conclusion: Patient participation today is considered the legal right of the patient and also the gold standard of international health care systems. So nurses, health system policy makers, patients and academic centers can use these results to improve patient participation in the care.
 

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Background & Aim: Caring for children with chronic illness is associated with the care burden of families and affects their self-efficacy. In addition, family-centered care can have positive outcomes. The aim of this study was to determine the relationship of the perception of family-centered care, burden of care and self-efficacy in the mothers of children with chronic illness.
Methods & Materials: This descriptive-analytical study was conducted in 2019 on 220 mothers of children with chronic illness, admitted to pediatric hospitals in Tehran and were selected using the convenience sampling method. Data were collected using the Perception of Family-Centered Care-Parent, Perceived Maternal Parenting Self-Efficacy, and the Impact-on-Family Scale. Data were analyzed by SPSS software version18 using descriptive and inferential statistics such as Pearson correlation and regression tests at the significance level of 0.05.
Results: Results showed that perception of family-centered care is directly associated with self-efficacy and inversely associated with the burden of care (respectively P<0.001 and P=0.022), so that for each 1-unit increase in the score of perception of family-centered care, self-efficacy of mothers increased by 0.25 and the burden of care decreased by 0.23. No significant association was found between self-efficacy and the burden of care (P=0.962).
Conclusion: Given that family-centered care can lead to an increase in self-efficacy and a reduction in the burden of care, nurses can improve mothers’ self-efficacy and reduce their burden of care by improving family-centered care.
 

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Background & Aim: Menstrual health is an important aspect of adolescent health. Most girls do not have proper information about menstrual health, and incorrect information from unreliable sources makes problems for them. Aim of this study was to compare small group-based education with maternal participation and routine education on adolescent girls’ menstrual health behaviors.
Methods & Materials: This randomized clinical trial study was performed on 60 high school students with regular menstruation in the groups of intervention and control. Among high schools in Mashhad in 2018, two schools were assigned to one of two groups by lottery. Menstrual health education was provided to the intervention group in four sessions as the groups of 3-4 people. For mothers in this group, two 2-hour sessions with the same content were held and the students in control group received routine education. Data were collected by a questionnaire on menstrual health behaviors, before the intervention, after the end of the first and second menstrual cycle. Data were analyzed by Mann-Whitney, Chi square and independent samples t-test using the SPSS software version 16.
Results: before the intervention, there was a statistically significant difference in the menstrual health behaviors score (P=0.199). After the intervention, mean score of menstrual health behaviors (the end of the first and second menstrual cycles) significantly increased (P<0.001) for the two groups. Also, mean score of menstrual health behaviors for the intervention group was significantly higher than that of for the control group (P<0.001).
Conclusion: The small group-based education with the participation of mothers in comparison to routine education was more effective in promoting menstrual health behaviors in adolescent girls. This method is recommended to health planners for education of health issues, including menstrual health.
Clinical trial registry: IRCT20180904040952N2
 

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Background & Aim: The experience of approaching death is one of the undeniable facts of aging that can cause fear and anxiety in the elderly. Given that spirituality as a solid base can be a powerful factor in controlling tense situations, this study was conducted to examine the effect of spiritual group therapy on death anxiety in the elderly.
Methods & Materials: This quasi-experimental study was conducted on 50 elderly people attending the elderly daily center in Aliabad Katoul (Golestan Province) in 2018. Sampling was done using the convenience method and participants were randomly assigned into either experimental- or control group. The experimental group received spiritual group therapy in 8 sessions within eight weeks. The data were collected using a demographic characteristics questionnaire and the Templer death anxiety scale. Using the SPSS software version 16, data were analyzed through independent t-test, paired t-test and covariance test at a significance level of less than 0.05.
Results: The rate of death anxiety before the intervention in the experimental- and control group were 7.36±3.67 and 7.32±1.65 respectively, which did not show a statistically significant difference (P=0.961). After the intervention, the average score of death anxiety for the experimental group was 5.24±3.28 and for the control group was 7.84±1.92 which showed a statistically significant difference (P<0.001).
Conclusion: According to the results, it is recommended to provide the necessary conditions to the elderly to participate in spiritual activities, which can be effective in improving the psychological state of the elderly.
Clinical trial registry: IRCT20181207041877N1
 

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Background & Aim: Gestational diabetes mellitus is the most common medical disorder during pregnancy that has many negative psychosomatic effects on the pregnant women and their fetus. According to existing studies, the role of counseling and husband’s support in gestational diabetes has been less studied, so the present study aimed to determine the effect of couples' supportive counseling on self-care behavior in women with insulin-treated gestational diabetes.
Methods & Materials: In this randomized clinical trial, 64 pregnant women (26-30 weeks of gestation) with gestational diabetes referred to the diabetes clinic of Umm al-Banin Hospital in Mashhad in 2018-2019 were divided into the intervention or control groups using the 4-way blocking method. For the women and their husbands in the intervention group, couples' supportive counseling was conducted by the researcher in the form of three one-hour sessions with one week interval. A diabetes self-care questionnaire was completed in two stages, before and four weeks after the intervention for both groups, and data were analyzed by independent t-test and paired t test using the SPSS software version 16.
Results: There were no statistically significant differences between the two groups in pre-intervention self-care scores (P>0.05). After the intervention, the difference between the mean of self-care scores before and after the intervention in the intervention group was 12.09±7.56 and in the control group was 0.00±3.60, which a significant increase was observed in the self-care score for the intervention group compared to the control group (P<0.001).
Conclusion: Couples' supportive counseling helps to promote self-care behavior in patients with gestational diabetes and can be used as an effective method to reduce the adverse consequences of gestational diabetes.
Clinical trial registry: IRCT20181002041202N1
 

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Background & Aim: Hysterectomy is one of the most common surgeries in women, which causes many physical and psychological complications including anxiety. The aim of this study was to compare the effect of diaphragmatic breathing and pursed lip breathing on anxiety in women undergoing hysterectomy.
Methods & Materials: In this double-blind randomized controlled clinical trial, 126 patients referred to Taleghani hospital of Arak during 2017-2019 were selected by convenience sampling, and then assigned into three groups of diaphragmatic breathing, pursed lip breathing and control using the random number table. Anxiety was measured the evening before the operation (before the intervention), one hour before entering the operating room (after the intervention) and two hours after the operation, using the Spielberger Anxiety Questionnaire. Data were analyzed using descriptive and analytic statistics using the SPSS software version 16.
Results: The mean and standard deviation of anxiety scores for the diaphragmatic breathing, pursed lip breathing, and control groups were 55.33±10.49, 55.4±9.84, and 55.07±11.31 respectively, and there was no significant difference between the groups (P=0.983). One hour before going to the operating room (after the intervention), the mean and standard deviation of the anxiety score was 41.98±8.5, 42.43±7.88, and 52.86±11.5, respectively, and after the operation, the scores decreased to 37.79±8.13, 38.07±8.33 and 50.62±11.35 respectively. There was a significant difference between the three groups (P<0.0001). There was no statistically significant difference in the anxiety scores between the diaphragmatic breathing group and the pursed-lip breathing group after the intervention (P=0.999).
Conclusion: The results of this study showed the diaphragmatic breathing and pursed-lip breathing techniques are effective in reducing hysterectomy anxiety in women. Therefore, using this non-pharmacological approach is recommended to reduce anxiety before and after hysterectomy surgery.
Clinical trial registry: IRCT20180103038211N4
 

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Background & Aim: Tokophobia was introduced as a psychiatric disorder for the first time in 2000. The purpose of this study is to answer four questions: What is tokophobia and how does it occur? What is the global prevalence of tokophobia? What are the symptoms of tokophobia? and what are the strategies for the control and treatment of tokophobia?
Methods & Materials: This systematic review was conducted by searching articles in English and Persian published between January 2000 and January 2018 on international databases; PubMed, Scopus, Web of Science, Google Scholar, Science Direct, and domestic databases; Magiran and SID, along with a manual search in resources.
Results: After reviewing 151 articles, finally 16 were included in the study. The results indicate that tokophobia is a severe and pathological fear of childbirth. In the categorization of psychiatric disorders, it is classified as a specific phobia based on the Diagnostic and Statistical Manual of Mental Disorders, 4^th edition (DSM-IV). The etiology of tokophobia is multifactorial, and its prevalence in pregnant women was reported around 14 percent among 18 countries. The signs and symptoms of the disorder are insomnia, crying, restlessness, depression, anxiety and severe worry about childbirth. Psychological strategies, cognitive behavior therapy and medication have been proposed to reduce the fear of childbirth in women in different studies.
Conclusion: As a guide, these results can assist the healthcare team members to recognize and screen at-risk women as well as to perform nursing interventions and psychotherapy in the prenatal and delivery stages.
 

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Background & Aim: Physical activity is a health behavior that helps one's mental and general health, improves the health of women during preconception period and reduces pregnancy and birth complications. The aim of this study was to predict physical activity based on the BASNEF model constructs during preconception period among women referred to Uremia health centers.
Methods & Materials: This cross-sectional study was conducted on 230 women during preconception period, who were selected using the multistage sampling method in 2018. The data collection tool was a researcher-made questionnaire containing sociodemographic information, the BASNEF model constructs, and a short form of the international physical activity questionnaire. Data were analyzed using logistic and linear regression and t-test through the SPSS software version 16.
Results: The results showed that 61.3% of women had low levels of physical activity. Knowledge (β=0.2, P<0.003), attitude (β=0.15, P<0.017), and enabling factors (β=0.18, P<0.004) significantly explained their intention to do physical activity. Also, among the predictive variables, knowledge (P<0.001) significantly explained physical activity.
Conclusion: Low rate of women's physical activity during preconception period calls for designing an intervention based on BASNEF model in order to influence knowledge, attitude and enabling factors.
 

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Background & Aim: Some studies across different disciplines have investigated students’ learning styles (LS) separately. However, few studies have investigated the LS of students of various educational disciplines in Medical Sciences. We aimed to determine the LS of students of Semnan University of Medical Sciences.
Methods & Materials: In this descriptive-cross-sectional study, 228 students of Semnan University of Medical Sciences were selected by cluster sampling in 2017. Data collection tool was the latest version of Kolb's learning style inventory. Finally, the data were analyzed by descriptive and analytical (Chi square) tests using the SPSS software version 18.
Results: In this study, 54.8% of students were female and 89.5% were single. 63.2% had the average scores higher than 16 and 52.2% were at second semester. The LS of students were assimilation (40.4%), divergent (21.9%), accommodation (19.3%), and convergent (18.4%). There was a significant relationship between the type of LS with the field of study (P=0.014) and average score (P=0.006), but there were no correlations between the type of LS with gender, age, marital status and academic semesters (P>0.05).
Conclusion: Considering that the assimilation LS was predominant within the students and given the fact that medical profession is a communicative, people-centered, and practical work, the faculty needs to emphasize the LS of students, and use various teaching strategies to strengthen and enhance the capabilities which are necessary for this group in educational and clinical settings.
 

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Background & Aim: Pregnancy and childbirth is one of the most important events in the life of every woman that can be a memorable experience with positive consequences for the mother and the baby, under support of others, especially the spouse. Numerous interventions to promote men's participation have been conducted during this period. Therefore, this study was conducted with the aim of a systematic review of men's participation in prenatal care.
Methods & Materials: This study is a systematic review of published articles on strategies to promote male participation, during pregnancy, childbirth and after childbirth (from 2000 to 2019), based on PRISMA guidelines, and the search was conducted by two scholars on the valid databases. Experimental and quasi-experimental studies, published on strategies for increasing male participation during perinatal period, published in national and international journals, were included in the study. Qualitative assessment of the articles was done using the Jadad and CONSORT checklist and the data extraction was based on the researcher's checklist.
Results: In this systematic review, 4808 articles were identified. After reviewing the titles, and considering the inclusion and exclusion criteria, 15 articles were included in the study. The promotion strategies were categorized into four groups: female-centered, couple-centered, community-centered, and facility-centered.
Conclusion: According to the results of the study, in order to promote the participation of men in perinatal care, it should be planned on four areas of female-centered, couple-centered, community-centered and facility-centered.
 

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Background & Aim: Addiction as a crisis and a chronic long-term disorder can lead to mental health symptoms in the users and their family members, the most common of which are stress, anxiety and depression. The aim of the study was to determine the effect of a quality of life intervention on the psychological reactions in family caregivers of addicts.
Methods & Materials: This study is a clinical trial. The research population included the family caregivers of addicts admitted to Baharan psychiatric hospital in 2018. The sample consisted of 80 subjects who were randomly divided into intervention and control groups. The caregivers in the intervention group received eight sessions of group counseling based on quality of life therapy and based on specified content, every other day. Eight weeks after the intervention, the data were collected using the DASS-21, and were analyzed by the SPSS software version 21 using paired t test, independent t test, Chi-square and Covariance.
Results: After the quality of life intervention, the mean scores of stress, anxiety and depression in family caregivers in the intervention group (11.50±4.36, 11.05±3.49, 10.57±4.67) were significantly lower than those of in the control group (14.67±4.93, 14.02±4.33, 13.40±4.77) (P<0.01). There were no significant differences in these variables between the two groups before the intervention.
Conclusion: Counseling based on quality of life therapy in this study had a positive and significant effect on reducing the severity of psychological reactions in family caregivers of addicts. Therefore, health care providers are recommended to use this counseling approach along with addiction treatment programs to increase the welfare and psychological well-being of family caregivers.
Clinical trial registry: IRCT20160924029954N11
 
 

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Background & Aim: Optimal weight gain during pregnancy, as an important indicator of maternal and fetal health, is affected by many adjustable variables. The present study was conducted to evaluate the gestational age-specific weight gain based on the indices of the American Institute of Medicine and to determine its related factors.
Methods & Materials: In this descriptive study, 250 pregnant women referred to the health centers of Torbat Heydarieh were assessed in 2018. The gestational age-specific weight gain was calculated for each woman, and based on the amount of deviation from the IOM indices, the subjects were divided into three groups including weight gain less than optimal, optimal and over than optimal. Data collection tools were demographic questionnaire and Multidimensional Body Relationship Questionnaire. Data were analyzed by chi-square, ANOVA, Kruskal-Wallis tests and ordinal regression using the SPSS software version 16.
Results: In this study, 22% of the subjects gained weight less than optimal, 46.4% gained weight normally and 31.6% had excessive weight gain. Weight gain in most women with normal and low body mass index was in a normal range (55.4%) and in most overweight and obese women was higher than an optimal range (43.2% and 35.7%, respectively). Weight gain was related to age, education, parity, abortion history, feelings of women and their partners toward pregnancy and wanting the pregnancy from the viewpoint of the partner (P<0.05). After entering the significant variables into the ordinal regression model, only nulliparity was able to predict pregnancy weight gain status (P=0.017).
Conclusion: Optimal weight gain in most pregnant women of this study may reflect the proper nutrition and effectiveness of prenatal care in this city. Identifying factors related to weight gain out-of-range increases the effectiveness of interventions on weight gain.
 

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Background & Aim: Proper recording of the nursing report indicates the nurse’s optimal clinical performance and compliance with the standards. Nanda Nursing Diagnosis is one of the most important and widely used international standard terms for recording nursing care. The aim of this study was to determine the degree of compliance and frequency of nursing diagnoses registered in the pediatric oncology department with the statements of nursing diagnoses of the Nanda classification system.
Methods & Materials: In this descriptive study, the nursing reports recorded in the files of children hospitalized in the pediatric oncology wards of two hospitals affiliated to Shahid Beheshti University of Medical Sciences in the first quarter of 2016, were reviewed. Sampling was done by the census method for 3 consecutive months. Overall, 86 files and 3701 nursing reports were reviewed. Nurses' documentation was analyzed through the manifest content analysis. The obtained expressions were adapted to the nursing diagnoses of the Nanda classification system and the degree of adaptation and frequency of nursing diagnoses were determined.
Results: The overall compliance between the diagnoses extracted from the nursing reports and the Nanda nursing diagnoses was 14.7%. The most frequent nursing diagnoses were diagnoses related to safety/protection classification with a frequency of 47.95%, followed by diagnoses related to nutrition classification with a frequency of 24.42% and finally a frequency of 12.8% for nursing diagnoses related to comfort classification.
Conclusion: The findings of the present study indicated the low levels of compliance with the Nanda nursing diagnoses and nursing process in the nursing reports. Therefore, practical training is suggested to increase nurses' knowledge and motivation to apply Nanda nursing diagnoses.
 

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Background & Aim: The healthy nutrition education is one of the most important priorities in all life periods, especially in childhood. The teaching method is also considered one of the important factors for the effectiveness of education. Therefore, the aim of this study was to compare the effect of lecture and role-playing methods on awareness of healthy nutrition in school-age children.
Methods & Materials: This quasi-experimental study was conducted on 60 primary school students in Gonabad city in 2017. Participants were selected by multistage random sampling and allocated into two groups of role-playing and lecture. Students' awareness was measured by a self-structured questionnaire before, immediately and one month after education. Data were analyzed using the SPSS software version 16 by descriptive and inferential statistics. A P-value less than 0.05 was considered significant.
Results: The mean score of awareness for the role-playing group before, immediately and one month after the intervention respectively was 10.77±2.55, 14.1±55.15 and 14.50±1.10 and for the lecture group respectively was 11.07±1.85, 13.72±1.43 and 11.47±2.84 (the score range: 0-16). There was a significant difference in the mean score of awareness before, immediately and one month after the intervention between the two groups (P<0.001), and in the role-playing group, the increase in awareness score was more than in the lecture group.
Conclusion: Considering the greater effect of role-playing method than lecture on healthy nutrition education in school-age children, it is suggested that more attractive, dynamic and effective methods such as role-playing, in accordance with educational behavioral goals, be used in school nutrition education programs. In addition to enhancing educational efficiency, this will make the effects of education and learning more sustainable for students.
 

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Background & Aim: Self-control is the capacity to organize cognitive and emotional responses in order to provide continuous and adaptive behavior with ideal standards for long-term goals. Due to the high levels of care burden of patients with chronic disease, this study aims to explain the concept of self-control in the family caregivers of patients with chronic disease based on the family-centered empowerment model.
Methods & Materials: Data were collected through in-depth, semi-structured interviews with 26 participants (19 caregivers, four nurses and three patients with chronic disease) from June 2016 to August 2017 in southwestern of Iran. Data were analyzed using the directed content analysis approach. The documents recording, accurate description of details, member checking, peer checking, and maximum variation of participants, were considered for ensuring the trustworthiness of the data.
Results: “Transcendental self-control” of family caregiver was explained by four conceptual categories: “caregiver insight", "value prioritization in care", "acceptance of care responsibilities" and "committed care". By predicting the potential risks of playing the care role and deeply understanding the conditions of care while paying attention to the value prioritization outcome-centered and virtue-based care, the family caregiver accepts the care burden through positive thinking and expediency and modestly offers "committed care" while having competent care experiences.
Conclusion: The explanation of self-control concept based on family-centered empowerment model in the real field creates a clear understanding of this concept and leads to "commitment care" by family caregivers of patients with chronic diseases and in turn provides a basis for reducing workload in the clinical setting.
 

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Background & Aim: Self-care plays an important role in the management of care for patients with chronic renal failure. In order to provide effective education, it is necessary to identify problems, concerns and challenges in this group of patients. The aim of this study was to explore the challenges of self-care in the patients undergoing hemodialysis.
Methods & Materials: This study is part of a research project on adherence to treatment regimen in hemodialysis patients referred to hospitals affiliated to Tehran University of Medical Sciences in 2019. Patients with the highest and lowest mean (SD) scores of self-care were selected by the purposeful sampling method and finally, 22 in-depth semi-structured interviews were performed with 18 interviewees. All data were recorded, transcribed and analyzed using the conventional content analysis approach proposed by Graneheim and Lundman.
Results: Findings from the data analysis included four categories: "the mismatch between the view of patient and the view of nurse", "missing loop training", "culture: a double sword ", and "dual role of religious beliefs".
Conclusion: The results of the present study showed that patients undergoing hemodialysis faced many challenges in self-care. They had difficulty in understanding the meaning of self-care and its implications. There is a need to plan for educating these patients and also changing their religious and cultural beliefs.