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Background & Aim: One of the assisted reproductive technologies is the use of donated oocyte. Although, the data about medical aspects of this process is available, knowledge of the psychological aspect related to this therapy is limited. Each individual's psychological aspects can be assessed by the self-concept and the self-discrepancy. Therefore, the present study aimed to assess the self-concept and self-discrepancy among women receiving and donating oocyte.

Methods & Materials: In this descriptive-analytical investigation, carried out in 2015, given the limited research population, 53 women referred to Royan infertility institute, were investigated in each of the donor and recipient groups using the available sampling method. The data were collected by three questionnaires including demographic questions, Rogers’s self-concept scale and self discrepancy scale (ideal-self discrepancy and ought-self discrepancy). The data were analyzed through the descriptive statistics, Chi-square and t-test using SPSS v.16.

Results: Results showed that the self-concept and self-discrepancy scores were poor in both the donor group and the recipient group. Scores of the recipient women (the questionnaire was reverse scored) were more than scores of the donor women. There was no significant difference between the two groups in the mean scores of self-concept (P=0.53). There was a significant difference between the two groups in the ought-self discrepancy score (P=0.02) but no significant difference was found between the two groups in the ideal-self discrepancy score (P=0.15).

Conclusion: According to the results, it should be noted that in the process of oocyte donation, only physical assessment is not enough but individuals’ psychological needs are necessary to be taken into account. So, the authorities should consider measures to assess the psychological aspects of women receiving and donating oocyte.

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Background & Aim: The challenges that patients face after intestinal ostomy surgery can lead to impaired adjustment and self-efficacy. There is evidence suggesting these variables have reciprocal effects on each other. Therefore, the present study aimed to determine the correlation between adjustment and self-efficacy in patients with intestinal ostomy.

Methods & Materials: This descriptive correlational study was conducted on 76 patients with intestinal ostomy hospitalized in hospitals affiliated to Mashhad University of Medical Sciences using convenience sampling method in 2015. Research instruments were comprised of the demographic and disease information questionnaire, the Stoma Self-efficacy Scale, and the Ostomy Adjustment Inventory. The SPSS software v.19 using descriptive and inferential statistics was used to analyze the data.

Results: The results of Pearson correlation test showed a significant and positive linear correlation between the mean score of self-efficacy and the dimensions of adjustment: acceptance (P<0.001, r=0.518), anxious preoccupation (P<0.001, r=0.438), social engagement (p<0.001, r=0.488), and anger (P<0.001, r=0.384). Moreover, multiple regression analysis indicated that the dimensions of social engagement and acceptance have a significant and positive linear correlation with self-efficacy in patients with intestinal ostomy.

Conclusion: The results revealed that the dimensions of social engagement and acceptance of ostomy were the most important factors in relation to self-efficacy. Therefore, in order to care for patients with intestinal ostomy especially in the early months after surgery, it was recommended to help patients adjust themselves to the physical appearance of ostomy and maintain their social engagement, by designing and implementing appropriate educational and supportive interventions.

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Background & Aim: Diabetes is a chronic disease that needs lifelong special self-care behaviors. Adolescents with type 1 diabetes need self-care education for the control of diabetes and the prevention of its complications. Therefore, this study aimed to determine the impact of self-care education on the control of diabetes complications, medications and HbA1C in adolescents with type 1 diabetes.

Methods & Materials: This study is a non-randomized clinical trial (IRCT2015051322258N1) carried out on seventy four adolescents aged 12-18 years old with type 1 diabetes referred to the Iran diabetes association. They were selected using convenience sampling method and allocated into two groups (intervention: 34 people, control: 40 people). An educational intervention was performed in five sessions for the intervention group. After education, the patients were trained and followed up using mobile services for three months. The instruments consisted of a demographic characteristics form and a section of the self-care behaviors scale evaluating medications and the control of complications. Data were analyzed by the SPSS software v.18.

Results: Before the education, no significant difference was observed in the mean scores of medications and control of complications and level of HbA1C between the two groups of intervention and control (P>0.05). After the education, there was a significant difference between two groups in the mean scores of medications and control of complications and level of HbA1C (P<0.05).

Conclusion: Self-care education and the follow up after educational sessions can lead to the reduction in diabetes complications and HbA1C level among adolescents with type 1 diabetes.

Background & Aim: Diabetes is a chronic disease that needs lifelong special self-care behaviors. Adolescents with type 1 diabetes need self-care education for the control of diabetes and the prevention of its complications. Therefore, this study aimed to determine the impact of self-care education on the control of diabetes complications, medications and HbA1C in adolescents with type 1 diabetes.

Methods & Materials: This study is a non-randomized clinical trial (IRCT2015051322258N1) carried out on seventy four adolescents aged 12-18 years old with type 1 diabetes referred to the Iran diabetes association. They were selected using convenience sampling method and allocated into two groups (intervention: 34 people, control: 40 people). An educational intervention was performed in five sessions for the intervention group. After education, the patients were trained and followed up using mobile services for three months. The instruments consisted of a demographic characteristics form and a section of the self-care behaviors scale evaluating medications and the control of complications. Data were analyzed by the SPSS software v.18.

Results: Before the education, no significant difference was observed in the mean scores of medications and control of complications and level of HbA1C between the two groups of intervention and control (P>0.05). After the education, there was a significant difference between two groups in the mean scores of medications and control of complications and level of HbA1C (P<0.05).

Conclusion: Self-care education and the follow up after educational sessions can lead to the reduction in diabetes complications and HbA1C level among adolescents with type 1 diabetes.

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The essence of nursing is protecting the public and nursing profession believes that receiving high quality and safe services, is the community’s right. During the past decades nursing has been considered as a significant profession with characteristics such as autonomy, professional commitment, expertise and responsiveness (1). The body of contemporary nursing is consisted of knowledge and skills, value system, academic education and professional socialization. Autonomy has been defined as nurse’s capacity for determining their action through independent choosing in all the fields of nursing practice and self-regulatory in nursing practice is necessary for achieving professional freedom of action (2).
Professional self-regulatory is the decision-making power for determining the inclusion criteria for the members to enter the profession and start their activity in that profession. It will determine who, with what specialties and how much knowledge and skills have the inclusion criteria for the profession (3). During the mid-19^th century, combination of knowledge and skills, emphasis on commitment to duty against seeking personal interests and also independence from external interferences in professional matters (autonomy) were mentioned as the most important features of self-regulated professions. From the early 20^th century, the motivations for professionalization got in line with professional self-regulatory (2). According to the Donabedian Model, a “social contract” exists between the society and the profession and under this contract the society will accept profession’s independence in exchange for their services and will give independence to that profession so that they could manage their own matters. In return for this privilege, the profession would act responsively to maintain the public interests (4).
Professional self-regulation would be granted to a profession as a privilege when the public would be able to receive the best possible services after that professions’ self-regulation (4). In fact, professional self-regulatory would guarantee the quality of services (2,5,6). During the past two decades, World Health Organization (WHO), to educate and employ competent and skilled nursing workforce, has recommended the governments to strengthen their professional self-regulatory frameworks. International Council of Nurses (ICN) in cooperation with the WHO has published a statement of their perspective of professional self-regulatory. This statement has mentioned that safe and high quality care, creating a monitoring system for licensing, professional policy making and applying the professional laws and rules could be reached by creating and improving the infrastructures of professional self-regulatory systems. ICN stated that professional self-regulatory is a method for applying discipline, stability and control over the profession and its performance (7, 8). National and international studies have shown that would improve educational and clinical standards which in turn would increase the power of the profession in managing its own matters.
Since professional self-regulatory would lead to the activity of qualified and competent individuals in a profession, it would increase people’s trust in professional services providers as capable and honest individuals and would provide the public interests (1). In professional self-regulatory, by firing professionally unqualified and uncommitted to the ethical codes individuals from the profession, the interests of the profession would be provided (4).
In the main, there are two ways a profession can be regulated: by the profession itself (professional self-regulatory) or directly by government. If the government would take the responsibility of managing the profession, the members of the profession would be forced to accept the laws and rules of the profession; while the approved laws by the self-regulated profession are flexible and would be accepted voluntarily (9).
Self-regulatory professions have two separate bodies for their activities: 1- the monitoring body and 2- the supporting body. The monitoring body maintains the interests of the profession through creating the inclusion criteria for the profession, licensing, certifying and disciplinary actions; while the supporting body would perform toward promoting the economic and professional benefits of the profession’s members. The goal of the supporting body is to develop the profession to assist the members and advance the profession; but the monitoring body will develop the profession to support the public interests. Most of the times, the public interests are not in conflict with the profession’s interest, but in case of such conflicts, professional self-regulatory should act toward achieving the public interest (10).
The condition of professional self-regulatory in Iranian nursing
Iranian nursing has had significant advancements during the recent years which development of academic education, formation of Iranian Nursing Organization (INO), establishment of Scientific Association of Iranian Nursing, establishment of research centers and publishing numerous research-scientific journals in different fields of nursing are some of them (11). However, the profession of nursing in Iran still has many shortcomings. Evaluating the laws of the Nursing Organization of the Islamic Republic of Iran, which is the greatest non-governmental nursing organization in Iran, although the goals of the organization are in line with the self-regulatory goals of the profession, but in most of the self-regulation requirements, no independent role has been defined for the organization, in a way that, in the definition of 6 duties out of 8 defined duties for the INO cooperation with or helping other organizations has been used and only in the third duty, “trying for improvement of the quality, skills and knowledge of nursing graduates” and the seventh duty, “determining standards for issuing, extending or cancelling membership cards”, the legislator has appointed an independent role for the organization. Maybe for this reason, and many other reasons that are not in the scope of this article, the INO has not considered professional self-regulation performances sufficiently. Other nursing associations in Iran, due to lack of regulatory mechanism and also the low number of members from the nursing profession, could not have an effective role in professional self-regulatory. In Iran, regulating the rules and managing the matters of nursing have always been a responsibility of the government (6,12). On the other hand, during the recent years, we have witnessed the establishment of the nursing deputy in the Ministry of Health and Medical Education (MOHME) which indicates the efforts for governmental management of this profession.
The authorities’ approach toward the nursing profession during the recent years for encountering various challenges is one of the examples of governmental management and lack of professional self-regulatory. For example, the nursing shortage could be mentioned which is a global problem. To resolve this problem, the MOHME has increased the capacity of training nursing students and the number of nursing schools. These measures have led to educating students at schools with no infrastructures and no competent educational board which is in conflict with the quality of services (public interests). In return, the next measure to compensate for the shortage in nursing workforce is educating practical nurses by the MOHME. Most of the experts have suggested this solution for the problem of shortage in nursing workforce, but it has been perceived as compulsory by the members of the profession and they disagree with it (13).
Considering that finding an appropriate self-regulatory mechanism for the profession requires the involvement of all the beneficiaries, especially the members of the profession, it is recommended that all of the active organizations in the field of nursing would start determining the characteristics and features of an appropriate self-regulatory organization for the nursing profession of Iran through conversations and then would make their best efforts for its establishment.
 

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Background & Aim: Besides medical treatment, self-care education is necessary for patients with heart failure. The aim of this study is to compare the effect of telenursing and education without follow-up in the caregivers of heart failure patients on the self-care behavior and clinical status of heart failure patients.

Methods & Materials: This clinical trial (IRCT2016080829184N2) was performed on 66 heart failure patients referred to the clinic of Taleghani hospital in Abadan in 2015-2016. The patients were randomly divided into three groups: control, intervention-1 and intervention-2 groups. Control group did not receive any intervention. Patients and caregivers in the intervention-1 group received verbal education, and caregivers in the intervention-2 group received continuous phone follow-up plus verbal education. Self-care behavior, fatigue severity and exercise tolerance were assessed in the patients by the self-care behavior questionnaire, fatigue severity scale and six minutes walking test at baseline and the end of 3 months. Descriptive statistics, chi-square, paired t-test, ANOVA, ANCOVA and Scheffe post hoc test were used to analyze the data using the SPSS software v.18.

Results: At baseline, three groups were consistent in terms of demographic variables and three variables. At the post-test, there was a significant difference between the intervention-2 group with the control group and intervention-1 group in self-care behavior (P<0.001) and the patients’ fatigue score mean (P<0.004). But, no significant difference was observed between three groups in the patients’ exercise tolerance score mean.

Conclusion: Telenursing for the caregivers of heart failure patients can lead to the improvement of self-care behavior and decrease in fatigue among the patients.

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Background & Aim: Patients’ assessment is fundamental to nursing practice and the more precise assessment nurses can perform, the better outcomes patients can achieve. Better practice requires suitable knowledge, skills and attitude regarding the importance of physical assessment. This study aimed to determine correlation between knowledge-skill and the importance of physical assessment in nurses employed in hospitals.

Methods & Materials: In this descriptive correlational study, 300 nurses employed in the medical, surgical, ICU and CCU wards of hospitals affiliated to Kerman University of medical sciences, were chosen conveniently in 2016. The data collecting instrument included demographic data, knowledge-skill and the importance of physical assessment items. Data were analyzed by the SPSS software version 19 using correlation coefficient test, linear regression and ANOVA.

Results: The mean score of knowledge-skill was 3.14(±0.74) and the median (mode) score of importance was 4(0.52). There was a significant and positive correlation between knowledge-skill and the importance of physical assessment. The nurses had higher knowledge-skill scores for those skills that they had considered more important. The most effective variable on the correlation between knowledge-skill and importance was education.

Conclusion: Nurses’ self-assessment of their skills in performing physical assessment was at a low level but they considered all skills important. Effective educational programs can fulfill the nurses’ needs for physical assessment skills.

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Background & Aim: The delay in childbearing is associated with a reduction in the total fertility rate and increase in the risk of pregnancy at an older age. Social learning theory has mostly been used to clarify the interaction between personal and environmental factors and behavior. In order to understand the factors underlying delayed childbearing, the present study aimed to predict the factors affecting the delay in first childbearing among young married women using the Bandura’s social learning theory.
Methods & Materials: This cross-sectional correlational study was conducted on 284 married women referred to the health centers and OB/GYN clinics of teaching hospitals in Mashhad in 2015-2016. The data collecting tool was comprised of five questionnaires regarding to personal and social factors. Data were analyzed by descriptive statistics, Pearson and Spearman correlation co-efficient, linear regression and multivariate regression using the SPSS software version 16.
Results: The mean age of participants was 27.99±4.2, and the mean interval between marriage and the first child was 3.22±1.96, which was 1.25 years more than that of ideal spacing between marriage and childbirth. Multiple linear regressions showed negative and positive fertility motivations, perceived maternal self-efficacy, martial relationship, the number of sisters and childbearing-related religious beliefs had a significant effect on the interval between marriage and first childbirth (P<0.01).
Conclusion: The individual and environmental factors predicting delay in the first reproductive behavior were identified using the Bandura's social learning theory. The both factors should be considered in designing intervention programs for increasing fertility rate.
 

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Background & Aim: Diabetes is the most common metabolic disease that needs self-management. The aim of this study was to compare the effects of loss- and gain-framed messages on knowledge, self-efficacy and self-management in diabetic patients.
Methods & Materials: In this randomized clinical trial (IRCT2016122931653N1), 112 patients with type 2 diabetes referred to the 17th Shahrivar Diabetes clinic in Borazjan in 2017, were divided into three groups including loss-framed message, gain-framed message, and control. The data were collected by questionnaires in three steps; before, one week and three months after intervention. Chi-square test, one way analysis of variance and repeated measures analysis of variance were used to analyze the data on the SPSS software version 22.
Results: Before the intervention, mean scores for knowledge, self-efficacy and self-management in loss-framed messages group and gain-framed messages group were lower than control. One week and three months after the intervention, mean scores for knowledge, self-efficacy and self-management in both the loss-framed messages and gain-framed messages groups showed a significant increase compared to the control group (P<0.001). One week after the education, self-management score in the gain-framed messages group was 102.26±11.20, in the loss-framed messages group was 111.53±13.73 and in the control was 88.75±11.41. Three months after the education, self-management score in the mentioned groups were 105.58±11.80, 108.72±15.39 and 88.49±13.51, respectively.
Conclusion: The results of this study showed that designing and implementing educational programs based on loss-framed messages and especially gain-framed messages can improve knowledge, self-efficacy and self-management behavior in diabetic patients.
 
 

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Background & Aim: Waterpipe smoking during pregnancy is a health problem, and interventions must be designed for its cessation. The present study was conducted to examine the effect of motivational interviewing (MI) on self-efficacy to quit hookah smoking in pregnant women.
Methods & Materials: The randomized clinical trial was conducted on 140 pregnant women who smoked hookah and lived in the marginal settlements in Zahedan in 2017. The convenience samples were randomly assigned to intervention and control groups. Data were collected using demographic characteristics and self-efficacy to quit hookah smoking questionnaires. Participants in the intervention received four group sessions of MI, while those in the control only received usual recommendations for quitting hookah smoking. The post-test was performed eight weeks after the completion of the intervention. Independent t-test, paired t-test, Chi-square, and Analysis of Covariance (ANCOVA) were used for data analysis through the SPSS software version 21.
Results: The demographic characteristics and gestational age of women were comparable between two groups, but the duration of hookah consumption in the intervention was more than the control (P=0.008). While the mean score of self-efficacy of two groups in pre-test was alike, in the post-test the score of self-efficacy in the intervention (60.85±7.25) was higher than the control (22.77±3.79) (P<0.001).
Conclusion: Given that MI approach has a positive effect on self-efficacy to quit hookah smoking, it is suggested that this counseling strategy is integrated into health care programs for pregnant women smoking hookah.
Clinical trial registry: IRCT201609240299954N5
 

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Background & Aim: Insufficient health literacy is a major barrier to self-care in patients with heart failure. The purpose of this study was to determine relationship between health literacy and self-care behaviors in patients with heart failure.
Methods & Materials: In this correlational study, 100 patients with heart failure who were referred to teaching hospitals in Qom were selected through the convenience sampling method in 2017. The data collection tools were the heart failure-specific health literacy scale, the self-care of heart failure index (SCHFI) and the hospital anxiety and depression scale (HADS). Data were analyzed using descriptive statistics, the Pearson’s correlation coefficient and multiple liner regression analysis on the SPSS software version 16.
Results: More than half of the patients had a moderate level of self-care. The highest and lowest health literacy scores were respectively related to critical health literacy (10.47±2.56) and functional health literacy (9.14±3.74). The result of multiple regression analysis showed that only functional health literacy was a better predictor of self-care behaviors in patients with heart failure (β=0.30, P=0.014).
Conclusion: The findings showed that functional health literacy was an important predictor of self-care behaviors among patients with heart failure. It seems necessary to design effective interventions in order to improve patients’ skills for analyzing functional information and decision making in self-care.
 

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Background & Aim: Stoma in children causes physiological and psychological changes and reduces self-esteem and quality of life. The aim of study is to determine the effectiveness of self-care skills training on self-esteem and quality of life in 8-12 year old children with stoma.
Methods & Materials: This study is a non-randomized clinical trial with pretest and posttest design, performed in selected hospitals (Mofid, Hazrat Ali Asghar and Medical Center) in Tehran in 2016-17. A total of 36 children aged 12-8 years with stoma, were selected using the convenience sampling method and divided into two groups of intervention (n=18) and control (n=18). Self-care skills training was performed in six sessions of 45 minutes for the intervention group. The control group received routine care. The Cooper Smith questionnaire and the Kindle quality of life questionnaire were used in this study. Data were analyzed by descriptive and inferential statistics using the SPSS software version 16.
Results: The repeated measures analysis of variance showed a significant difference in the quality of life score means over time (P<0.005) and between the two groups of intervention and control (P<0.015). Also, there was a significant difference in the self-esteem score means over time (P=0.004) and between the intervention and control groups (P=0.004).
Conclusion: Self-care skills training for 8-12 year-old children with stoma, has increased their self-esteem and quality of life. Therefore, nurses can use self-care skills training for similar patients.
Clinical trial registry: IRCT20160802029166N2
 

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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
 

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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.
 

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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: 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: 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: 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.
 

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Background & Aim: Sleep disturbances in type II diabetes patients due to insulin resistance is a risk factor for the exacerbation of the disease. Therefore, assessment of the factors affecting the improvement of sleep in diabetic patients is a necessity for health care providers. The aim of this study was to investigate the relationship between sleep quality and self-management in type 2 diabetes patients.
Methods & Materials: This is a descriptive, cross-sectional study. A total number of 170 patients with type 2 diabetes referred to the medical centers affiliated to Qazvin University of Medical Sciences were included using the convenience sampling method in 2018-2019. Data were collected by the Richards-Campbell Sleep Questionnaire (RCSQ) and the Diabetes Self-management Questionnaire (DSMQ). Data were analyzed by the SPSS software version 21 using the descriptive/analytical statistics.
Results: The results showed that the mean score of sleep quality was 49.89±25.90 (range: 0-100) and mean score of self-management was 31.82±6.80 (range: 0-48). The results from the Pearson correlation analysis showed a significant relationship between sleep quality and self-management (P<0.05). Also, the stepwise linear regression model showed that the use of health care systems and physical activity and other variables such as marital status and weight of patients had a significant effect on their sleep quality (P<0.05).
Conclusion: The results of the study showed that an increase in the patients’ self-care status, use of health care systems, increased daily physical activity and having an ideal weight can be predictors in improving patients' sleep quality. Therefore, providing infrastructure programs such as continuing education and providing appropriate care programs for diabetics to improve self-management activities, as well as increasing daily physical activity, increasing the use of health systems, and weight control can improve the sleep quality of this group of patients who account for a significant proportion of chronic diseases in communities.
 

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Background & Aim: Patients with heart failure experience some outcomes such as poor self-management, poor adherence to treatment and low quality of life. The aim of the current study was to evaluate the effect of self-management based discharge planning on treatment adherence in patients with heart failure.
Methods & Materials: In this quasi-experimental research, 80 patients with heart failure hospitalized in teaching hospitals in Zahedan in 2019-2020, were selected by convenience sampling and were randomly allocated into either intervention or control groups. The self-management-based discharge plan consisted of four educational sessions in hospital for the intervention group. In order to follow up, the first call was made 2-3 days after discharge. Then, the patients or their family caregivers were contacted weekly in the first month and twice a month in the second and third month. Data were collected by the treatment adherence questionnaire and were analyzed using independent sample t-test, Fisher exact test, Chi-square and repeated measures ANOVA by the SPSS software version 16.
Results: The two-way repeated measures analysis of variance showed a significant difference in the mean scores of treatment adherence over time (P<0.001) and in the intervention and control groups (P<0.001).
Conclusion: According to the findings, it is recommended that self-management-based discharge plan be employed in an integrated manner for patients with heart failure in medical wards.