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  Background & Aim: Lack of knowledge about acute myocardial infarction and its treatment result in feeling anxious among the patients. Implementing appropriate educational methods can decrease anxiety in patients with acute myocardial infarction. This study was conducted to compare effects of two educational methods (face-to-face and electronic educational methods) on anxiety among patients with acute myocardial infarction .

  Methods & Materials: This was an experimental study in which 105 patients hospitalized with acute myocardial infarction in the "CCUs" of three educational hospitals were selected based on eligibility criteria and were allocated into three groups including face-to-face educational group, electronic education group, and control group using block randomized allocation. Data were collected using demographic check-list and the Spielberger state-trait anxiety inventory questionnaire. The level of anxiety was measured before and immediately after the interventions in all three groups. Data were analyzed in the SPSS-16.

  Results: Both educational methods reduced anxiety significantly in patients with acute myocardial infarction. There were no significant difference between the two educational method groups in the anxiety level (P=0.94) .

  Conclusion: Both face-to-face and electronic educational methods reduced anxiety in patients with acute myocardial infarction. It is recommended that nurses use one of these educational methods to reduce anxiety among the patients .

  

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  Background & Aim: The HIV infection is a serious health problem with major effects on various aspects of life. It is essential to understand the lived experiences of patients living with HIV/AIDS. The present study was conducted to investigate affected patients' lived experiences .

  Methods & Materials: This qualitative study was carried out using an interpretative, phenomenological approach. Nineteen patients with HIV/AIDS were selected using purposive sampling method. Field notes, in-depth and semi-structured interviews were used to collect data. The interviews were transcribed verbatim and were analyzed using the hermeneutic approach developed by Diekelmann (1989) . 

  Results: From 19 participants, 57.9% were males. Mean age was 39 years 42.1% were single 47.4% had CD4 counts less than 200 cells/mm3. The main emerged themes were as follows: 1) death way 2) halo of worries 3) hope to cure. Based on the final step of the Diekelmann approach, "being in state of hope and fear" was emerged as a constitutive pattern in patients living with HIV/AIDS .

  Conclusion: Patients with HIV/AIDS experienced fears, doubts, worries, hopes and many emotional challenges in different aspects of their lives. Caregivers should understand and comprehend the emotional states of the patients. Health care providers should design effective interventions to help individuals to cope with HIV/AIDS .

  

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

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

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

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

  

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

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

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

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

  

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  Background & Aim: Psychological and social factors such as attachment styles may influence chronic diseases through self-care behaviors. This study was conducted to determine the relationship between attachment styles and self-care behaviors in patients with heart failure .

  Methods & Materials: In this correlational study, 180 patients with heart failure hospitalized in CCUs and Post CCUs of educational hospitals in Zahedan in 2014 were selected through convenience sampling. Data collection tools included the Experiences in Close Relationships-Revised (ECR-R) questionnaire and Self-Care of Heart Failure Index (SCHFIV6.2). Data were analyzed in the SPSS-20 using the descriptive statistics, independent T-Test, Pearson's correlation and regression analysis . 

  Results: The mean and standard deviation of self-care behaviors score of the group with secure attachment style (62.89 ± 12.66) was significantly higher than the group with insecure attachment style (40.43 ± 16.11) (P<0.05). Also, the regression model showed that the score of anxiety, attachment avoidance and age were as predictors of the self care scores in patients .

  Conclusion: Regarding the relationship between attachment styles and self-care behaviors and the low level of self-care in patients with insecure attachment style, psychological interventions should be considered through long-term treatment of chronic heart failure .

  

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  Background & Aim: Virtual education can be delivered via different routes. The purpose of this study was to investigate the effectiveness of interactive and non-interactive virtual educations about brain death and organ transplantation on knowledge and satisfaction of education among intensive care nurses .

  Methods & Materials: This quasi-experimental study was conducted on intensive care nurses of hospitals affiliated to Tehran University of Medical Sciences in 2014 . Participants were selected through a convenient sampling method and were assigned into two groups with 32 participants in each. The first group participated in an interactive electronic education while the second group received a non-interactive education about brain death and organ transplantation . Knowledge of both groups was measured before and after the education. The satisfaction of participants with the course was measured using a questionnaire. The scores were compared within and between groups using the paired and independent t-test, respectively . 

  Results: The knowledge of both groups increased significantly after the intervention (P<0.001) however, there was no significant difference between the mean scores of the two groups after the education (P<0.05). The s atisfaction with the course was significantly higher in the interactive education group (P=0.04) .

  Conclusion: B oth interactive and non-interactive electronic educations increased the knowledge of nurses. The nurses were more satisfied with the interactive education. Further studies are recommended .

  

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Background & Aim: Maternal request for caesarean section due to fear of normal vaginal delivery (NVD) is one of the main reasons for the high rate of caesarean section. This study aimed to compare the fear of NVD and type of delivery between two groups of pregnant women attended childbirth preparation classes (CPC) and women received routine prenatal care (RPC).

Methods & Materials: In this prospective cohort study, 202 Primigravid women attended healthcare centers for prenatal care services in the East of Guilan were selected using convenient sampling in 2013-2014. Fear of NVD was assessed using a childbirth attitude questionnaire at two stages (before attending CPC or receiving RPC, then at the third trimester of pregnancy). Both groups were followed up to the delivery time. Data were analyzed using inferential and descriptive statistics (Chi square, paired t-test, ANOVA, t-test) through SPSS v.16. P<0.05 was considered as significant.

Results: There was no significant difference (P=0.23) in the mean score of fear of NVD between two groups before attending CPC (35.59±8.78) and receiving RPC (37.08±9.08). The comparison of the mean score of fear of NVD between two groups at the third trimester of pregnancy showed a significant reduction (P<0.001) in the first group (32.30±8.31) than in the second group (37.29±9.55). A significant difference was also observed between two groups in the rate of NVD (P=0.002).

Conclusion: Results confirm the importance of CPC in decreasing fear of NVD and increasing the rate of NVD in primigravid women attended these classes. Therefore, women’s attendance at CPC is recommended to be encouraged.

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Background & Aim: Pap smear test is an effective screening method for early detection of cervical cancer. This study aimed to determine the effect of education based on the health belief model on women’s belief and practice regarding Pap smear test.

Methods & Materials: In this quasi experimental study, 100 married women under coverage of Bushehr health centers participated in the study in 2014-2015. The data collection instrument was a questionnaire consisted of demographic information, the questions concerning knowledge and the HBM constructs regarding Pap smear. The training program was performed in two group sessions. Three months after the intervention, women’s practice about Pap smear test was evaluated in both groups. After data collection, data were analyzed by descriptive statistics, repeated measure analysis of variance, independent t-test and Chi square on SPSS software v.20.

Results: Before the study, both groups had not any significant differences in all variables and constructs. After the intervention, the mean scores of knowledge (P<0.001), perceived seriousness (P=0.015) and perceived barriers (P<0.001) were significantly different between two groups. Three months after the intervention, 42 (85.7%) in the intervention group and 4 (8.2%) in the control group had performed Pap smear test (P<0.001).

Conclusion: Designing and implementing educational program based on health belief model can promote women’s awareness and reduce their perceived barriers and as well as enhance their practice regarding Pap smear test.

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Background & Aim: Unhealthy snacks consumption has an important role in childhood obesity. The aim of this study was to evaluate the effect of an educational intervention for mothers on the consumption of healthy snacks in children aged 1-5 years using social cognitive theory.

Methods & Materials: This quasi-experimental study was (IRCT2013062912456N2) conducted on 126 mothers who had children 1-5 years old in 2013. The mothers were selected from Hamadan health centers and divided into two groups of intervention and control. The intervention consisted of four sessions, a booklet, a short video, and 6 written messages. The constructs of SCT and food consumption frequency were assessed at baseline, 10 days after the last session and 2-months after the intervention. The data were analyzed by Chi-square test, independent t-test, repeated measures and covariance analysis using SPSS software version 16.

Results: At baseline, the two groups were similar in the demographic characteristics, the constructs of SCT, and unhealthy snacks consumption frequency (P>0.05). Considering that the interaction effects of group and time in the repeated measurement analysis of variance were significant, the means of two groups were compared at each stage using independent t test and significant differences between the two groups were observed at two stages after the intervention.

Conclusion: This intervention had a positive effect on the consumption of healthy snacks. Therefore, SCT and the implemented procedure could be used to develop interventions to modify snack consumption patterns in children.

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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: 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: 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: Depression is common among cardiac patients, especially patients with heart failure and leads to a poor prognosis. This study aimed to assess the effect of exercise on depressive symptoms in patients with heart failure, attending the Cardiac Rehabilitation Center.
Methods & Materials: In this clinical trial, 60 patients with NYHA class II and III heart failure who referred to the Cardiac Rehabilitation Center of Shafa Hospital affiliated to Kerman University of Medical Sciences in 2015 were randomly assigned into two groups of 30 patients. Subjects in the intervention group participated in a supervised 8-week exercise program, 3 days per week, while those in the control group only received standard routine care. Data were collected before and after the intervention by the demographic form and the Personal Health Questionnaire Depression Scale (PHQ-8). Data analysis was done by Chi-Square, Wilcoxon, Mann-Whitney U and Nonparametric ANCOVA tests using the SPSS version 21 and R software.
Results: The two groups were homogeneous in terms of depression score before the intervention. The median and interquartile range of the score of depression were 10 (5.25) in the control group and 8.5 (9.25) in the intervention group which showed a significant difference (P=0.042). By adjusting the variables of the duration of the disease and the pre-test scores of depression symptoms by non-parametric covariance test, the difference between the two groups was also significant.
Conclusion: Exercise can reduce depressive symptoms in patients with heart failure.
Clinical trial registry: IRCT201605107844N10
 

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Background & Aim: Falling is a serious problem in the elderly population, with many physical, psychological, social and economic consequences. The fear of falling has been considered an activity limiting condition, which can lead to a reduction in the quality of life of the elderly people. The study aimed to determine effect of fall care behaviors training on fear of falling among the elderly people referred to health centers.
Methods & Materials: This double-blind randomized clinical trial was carried out on 110 elderly people referred to health centers in Ardabil in 2017. Participants were selected by the multi-stage random sampling and divided into intervention and control groups by random allocation. The data collection tools were consisted of demographic questionnaire, Mini-Mental State Examination: MMSE, Abbreviated Mental Test Score: AMTS and Fall efficacy scale international: FES-I. Data were analyzed using statistical tests on the SPSS software version 22.
Results: The mean and standard deviation of fear of falling in the intervention and control groups before the intervention were 33.91±12.03 and 31.22±14.76, respectively (P=0.29). Three months after the intervention, the mean and standard deviation of fear of falling were 22.32±4.45 and 30.85±15.03 (P<0.001). Also, ANCOVA was used for controlling pre-test scores and level of education compared to the post-test scores in the two groups (P<0.001).
Conclusion: The results showed that education on fall care behaviors reduces the fear of falling in the elderly people. Therefore, this education is suggested to be considered in the self-care program for elderly people.
Clinical trial registry: IRCT20180205038618N1
 

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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: 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.
 

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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.
 

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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: 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: 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.