Forough Ansarinik, Masoomeh Mahdavifar, Saeed Hosseini Teshnizi, Aref Faghih,
Volume 31, Issue 3 (9-2025)
Abstract
Background & Aim: Asthma is a prevalent respiratory disease, and encouraging health behaviors is a crucial preventive strategy for managing the condition. This study aimed to assess the impact of self-care education delivered retrospectively on health-promoting behaviors in patients with asthma.
Methods & Materials: This two-group randomized clinical trial with a pre-test-post-test design was conducted on 100 asthma patients visiting Shahid Mofatteh Clinic in Yasuj in 1402. Participants were selected through convenience sampling and randomly assigned to either the intervention or control group. The intervention group received three individual training sessions, one per week lasting 60 to 90 minutes each, delivered retrospectively. The control group did not receive any training. Data was collected using questionnaires on personal and disease information, as well as health-promoting lifestyle. Data analysis was conducted using descriptive and inferential statistical methods in SPSS version 26.
Results: Prior to the intervention, the mean health behavior scores in the experimental group were 124.52±16.05, and in the control group were 121.82±16.61, showing no statistical significance (P=0.411). However, following the intervention, the scores increased to 135.60±10.57 in the experimental group and 123.26±8.92 in the control group, with a statistically significant difference (P<0.001) indicating a significant improvement in the experimental group.
Conclusion: Self-care education delivered in a retrospective manner is recommended as a simple, practical, and cost-effective educational approach for individuals with asthma to enhance health behaviors.
Clinical trial registry: IRCT20230529058325N1
Fatemeh Dehghani, Zohreh Khavari, Bahareh Fallah, Zahra Rezaei-Haftadori, Maasoumeh Barkhordari-Sharifabad,
Volume 31, Issue 4 (1-2026)
Abstract
Background & Aim: With the growing elderly population and increased survival rates, it is crucial to focus on the palliative care skills and knowledge of nursing students. This study aimed to assess the effect of palliative care education on the knowledge, attitude, and perceived self-efficacy of nursing students.
Methods & Materials: This quasi-experimental study took place in 2025 with 32 nursing intern students from the Meybod/Yazd Nursing School. Participants' knowledge, attitude, and perceived self-efficacy were evaluated before and after a palliative care education intervention using a questionnaire. Perceived self-efficacy was also measured one-month post-intervention. The intervention consisted of six four-hour sessions of a palliative care education program. Data analysis was conducted using SPSS version 21 and descriptive and inferential statistical methods (paired t-test and analysis of variance with repeated measures).
Results: Prior to the intervention, the mean scores for knowledge, attitude, and self-efficacy in palliative care were 26.90±3.76, 81.87±9.42, and 28.50±8.10, respectively. Following the intervention, the mean scores for knowledge (33.40±2.84), attitude (84.68±10.29), and self-efficacy (29.75±5.72) increased. One month later, the mean self-efficacy score rose to 32.37±6.52. The results indicated that only the increase in knowledge scores before and after the intervention was statistically significant (P<0.001).
Conclusion: The findings suggest that palliative care education positively impacts the knowledge level of nursing students. Therefore, implementing educational programs in this area during the educational period can be beneficial.
Atefeh Estabraghi, Tabandeh Sadeghi, Seyedhamid Seyedbagheri, Reyhaneh Hassanshahi,
Volume 31, Issue 4 (1-2026)
Abstract
Background & Aim: Various pharmacological and non-pharmacological methods are utilized to manage pain and improve physiological indicators in patients with COVID-19. Reflexology is a non-pharmacological complementary method that is often used. The current study sought to investigate the impact of foot reflexology on pain and physiological indicators in patients with COVID-19.
Methods & Materials: This quasi-experimental study was conducted on 70 patients with COVID-19 hospitalized in Ali Ibn Abi-Talib (AS) Hospital in Rafsanjan in 2022 AH. Participants were randomly assigned to the intervention and control groups using a coin toss. In the intervention group, foot reflexology was performed on lung-related points for 10 minutes daily for 5 consecutive days. The control group received simple foot massage without pressure on lung-related points. Before and after the intervention, the pain score and physiological indicators (arterial blood oxygen saturation, systolic and diastolic blood pressure, temperature were examined and recorded. The data were analyzed using independent t-tests, paired t-tests, and chi-square tests in SPSS version 20 software.
Results: Following the intervention in the intervention group, the mean changes in pain score were 6.31, diastolic blood pressure was 7.82, and arterial blood oxygen saturation was 9.02. There was a statistically significant difference between the intervention and control groups (P<0.05). However, systolic blood pressure and temperature did not show a significant difference between the two groups (P>0.05).
Conclusion: Foot reflexology was effective in improving pain and some physiological indicators in patients with COVID-19. Therefore, this non-invasive intervention is recommended for these patients.
Avishan Gholamiyan, Somayeh Gheysari, Zinat Mohebbi,
Volume 31, Issue 4 (1-2026)
Abstract
Background & Aim: Clinical competence is crucial for enhancing the quality of patient care and increasing patient satisfaction with nurses. Critical thinking is a key factor that influences the clinical competence of nurses. Therefore, this study aimed to explore the relationship between critical thinking and clinical competence among nurses working in intensive care units.
Methods & Materials: This descriptive-correlational study involved 240 nurses working in intensive care units at hospitals affiliated with Shiraz University of Medical Sciences in 2021. Participants were selected using stratified random sampling. Data collection included demographic questionnaires, the California Critical Thinking Form B, and assessments of nurses' clinical competence. Data analysis was conducted using descriptive statistics and the Spearman correlation coefficient in SPSS software version 23.
Results: The mean total score of nurses' clinical competence was 143.53 with a standard deviation of 26.62, indicating an average level of clinical competence based on the instrument's scoring. The total score for nurses' critical thinking was 17.51 with a standard deviation of 13.41, showing a relatively high level of critical thinking among the nurses in the study. A positive and significant correlation was found between the total score of clinical competence and critical thinking (r=0.147, P=0.023).
Conclusion: The results suggest that nurses with stronger critical thinking skills also demonstrate higher levels of clinical competence. Therefore, incorporating strategies to enhance critical thinking in nursing education programs can enhance students' clinical competence, better preparing them for effective clinical judgment and decision-making in complex care scenarios.
Zohrehsadat Mirmoghtadaie, Morteza Heidari, Seyedeh Zahra Nahardani, Akram Heidari,
Volume 31, Issue 4 (1-2026)
Abstract
Background & Aim: In light of the holistic approach to health, it has become increasingly important to utilize spiritual capacities to meet patients' needs. Spiritual care education for nursing students is therefore essential. This study aimed to address the lack of educational content in this area within the Iranian medical education system by developing a spiritual care educational package for nursing students and evaluating its impact on students' spiritual care scores.
Methods & Materials: This study, conducted in 1401, followed the Rothwell model and involved 60 final-year nursing students from Tehran, Shahid Beheshti, and Iran Universities of Medical Sciences. Participants were selected through simple random sampling in proportion to the number of final-year nursing students at each university. The educational package was provided to students as a text file for self-study, discussion with clinical instructors, and application in internship settings. Students' spiritual care scores pre- and post-training were compared using descriptive and inferential statistics in SPSS version 26.
Results: The average spiritual care score of the participating students increased from 1.94 to 4.21, indicating a significant positive effect of the training package (P<0.05). However, variables such as age, gender, university of study, and interest in the field did not have a significant effect on the increase in score (P>0.05).
Conclusion: The results of the present study suggest that the training package was effective in improving students' spiritual care scores. Therefore, it is recommended that nurses and other health disciplines receive training in spiritual care through various m
Mansoore Karimi, Fatemeh Kameli, Mohammad Reza Mansoorian, Hossein Ajamzibad,
Volume 31, Issue 4 (1-2026)
Abstract
Background & Aim: The quality of communication between parents and adolescents can have profound effect on adolescents’ attitudes towards them and the formation of their emotional and social relationships. This study aimed to determine the effect of parent-child relationship training for parents on adolescents’ attitudes towards them.
Methods & Materials: This quasi-experimental study with a pre-test-post-test design and a control group was conducted on students aged 16 to 18 and their parents in 2023. In this study, 56 parents of students with poor parent-child relationships were placed in the intervention and control groups (28 people in each group) along with the relevant student. Parents in the intervention group received training on improving parent-child relationships, while the control group did not receive training. After 21 days, the quality of the parent-child relationship and adolescents’ attitudes towards parents were assessed. Data analysis was performed using SPSS version 27 software using independent t-test, paired t-test, Mann-Whitney, Fisher and Chi-square tests.
Results: The two groups were homogeneous in terms of demographic characteristics (P>0.05). The results showed that after the intervention, the quality of the parent-child relationship and adolescents' attitudes towards parents in the intervention group significantly improved compared to before the intervention and compared to the control group (P<0.001).
Conclusion: Training in parent-child communication skills has a positive effect on improving parental relationships and adolescents' attitudes. These findings emphasize the importance of including parenting training in family education programs.
Ali Hosseinzadeh, Abolfazl Rahimi, Robabe Khalili, Ali Tayebi, Mohamad Nikpouraghdam,
Volume 31, Issue 4 (1-2026)
Abstract
Background & Aim: End-stage renal failure requires careful and effective planning in the hemodialysis process to improve patients' quality of life and reduce complications. Therefore, this study aimed to investigate the impact of using cold dialysis solution on sleep quality and blood pressure changes during hemodialysis in patients with end-stage renal failure.
Methods & Materials: This blinded randomized clinical trial included 82 patients undergoing hemodialysis in Baqiyatallah and Milad hospitals in Tehran in 2023. Patients were randomly assigned to either the intervention group (41 individuals) or the control group (41 individuals). The intervention group received hemodialysis with cold dialysis solution (35°C), while the control group received standard dialysis solution (37°C) for 4 weeks. Data was collected using a demographic and disease characteristics form, Richard Campbell Sleep Quality Questionnaire (RCSQ), and a mercury sphygmomanometer. Data analysis was conducted using SPSS version 26 software, utilizing Mann-Whitney, independent t-test, chi-square, and paired t-test.
Results: The mean sleep quality score in the cold hemodialysis group (35°) after dialysis was significantly higher than the standard group (37°) (P=0.004). No significant difference was observed between the two groups before dialysis (P=0.759). There was no significant difference between the mean systolic and diastolic blood pressure scores before dialysis in the two groups. However, after dialysis, the reduction in blood pressure (systolic and diastolic) in the cold hemodialysis group was significantly less than in the standard group (P<0.001).
Conclusion: The results of this clinical trial showed that the use of cold dialysis solution during hemodialysis significantly improved the sleep quality of patients with end-stage renal failure and reduced blood pressure changes during treatment. These findings can be used to improve the treatment process and enhance the quality of life of these patients.
Clinical trial registry: IRCT20230521058244N1
Arezoo Rozbahani, Salam Vatandost, Bijan Nouri, Parvin Mahmoodi,
Volume 31, Issue 4 (1-2026)
Abstract
Background & Aim: The health of nurses’ work environments can influence their clinical competence and accordingly the quality of care they provide. Therefore, this study aimed to determine the relationship between a healthy work environment and clinical competence among nurses working in intensive care units of the teaching hospitals affiliated with Kurdistan University of Medical Sciences in 2023.
Methods & Materials: This cross‑sectional study was conducted using a census method on 245 nurses working in the intensive care units of Kosar, Tohid, and Besat teaching hospitals in Sanandaj during the winter of 2023. Data were collected using a demographic and occupational information form, as well as the Healthy Work Environment and Clinical Competence questionnaires. Data analysis was performed using STATA software version 12, using independent t‑test, one‑way analysis of variance (ANOVA), and Kruskal-Wallis statistical tests.
Results: In the present study, 198 nurses (81.1%) reported their work environment health as low, 43 nurses (17.6%) as favorable, and only 3 nurses (1.3%) as very favorable. Nurses reported their clinical competence as good (86.5±2.72). No statistically significant relationship was found between a healthy work environment and overall clinical competence or its dimensions (P>0.05).
Conclusion: The lack of a significant relationship between a healthy work environment and nurses’ clinical competence in this study does not diminish the importance of providing a healthy work environment for nurses. The findings indicated that the level of work environment health was not desirable, whereas nurses’ clinical competence was good. Considering the importance of a healthy work environment, implementing measures to improve work environment health is essential.
Zohre Maryami, Shahla Faal Siahkal, Razieh Peighambardoost,
Volume 32, Issue 1 (4-2026)
Abstract
Background & Aim: Fertility is one of the most important phenomena determining population changes and fluctuations. Therefore, considering the population decline in the world, including in Iran, this study aimed to determine the effect of e-learning on childbearing tendency in childless and single-child women.
Methods & Materials: In this experimental study, two-stage random sampling was performed on 128 childbearing-age women without children or with only one child (64 in the intervention group and 64 in the control group) from four health centers in Marand County in 2023–2024. The intervention group received e-learning in four sessions (one session per week) remotely via the Eitaa messenger. The control group received routine care. Childbearing tendency before and after the intervention was evaluated in both groups using Mann-Whitney and Wilcoxon statistical tests in SPSS version 24.
Results: The median scores of childbearing tendency in the intervention group before the intervention were 59.0 (range: 52.5-64.5) and one month after e-learning were 68.5 (range: 62.0-73.0). In the control group, the median scores were 64.0 (range: 58.0-69.0) before and 64.5 (range: 58.0-69.0) after the intervention. Statistical tests showed a significant improvement in childbearing tendency after the training (P<0.001).
Conclusion: The improvement in childbearing tendency resulting from e-learning can help enhance women's inclination toward childbearing.
Clinical trial registry: IRCT20190826044621N2
Shirmohammad Davoodvand, Reza Masoudi, Reyhaneh Eskandarian, Soleiman Kheiri, Somaye Zamanifard,
Volume 32, Issue 1 (4-2026)
Abstract
Background & Aim: Anxiety and sleep disorders have adverse effects on the well-being of patients with acute coronary syndrome. This study aimed to determine the effect of self-management based on Social Cognitive Theory on anxiety and sleep quality in patients with acute coronary syndrome.
Methods & Materials: This clinical trial was conducted in 2024 on 72 patients with acute coronary syndrome hospitalized in the cardiac intensive care units of Hajar Hospital, Shahrekord. Participants were enrolled sequentially and conveniently and were randomly assigned to two groups of 36 (intervention and control). They completed the Beck Anxiety Inventory and the Pittsburgh Sleep Quality Index. The intervention group received virtual education in six 30-minute sessions. The control group received routine care. Data were collected before, immediately after, and 8 weeks after the intervention. Data analysis was performed using chi-square and Mann-Whitney tests in SPSS version 20.
Results: Before the intervention, there was no significant difference in anxiety scores or sleep quality between the two groups (P>0.05). After the intervention, sleep quality showed a significant difference compared to before the intervention (P<0.05). However, anxiety levels did not show a significant difference after the intervention compared to before (P>0.05).
Conclusion: Considering the effect of the intervention based on Social Cognitive Theory on sleep quality in patients with acute coronary syndrome, this intervention is recommended in addition to conventional care for these patients. Further studies are needed to reduce their anxiety levels.
Clinical trial registry: IRCT20240626062258N1
Mohammad Ganji, Elham Navab, Maryam Esmaeili, Shima Haghani, Mahboubeh Shali,
Volume 32, Issue 1 (4-2026)
Abstract
Background & Aim: Determining the amount of risk that threatens patients can lead to making correct treatment decisions. This study aimed to determine the diagnostic accuracy of early warning scores in prehospital care for diagnosing traumatic brain injury and the need for intensive care unit admission.
Methods & Materials: This descriptive-analytical study was conducted in 2024 among patients referred to the emergency department of selected hospitals affiliated with Tehran University of Medical Sciences. Using convenience sampling, 250 trauma patients were enrolled in the study. Data collection was carried out utilizing a demographic questionnaire and various scoring systems, including the National Early Warning Score 2 (NEWS2), Modified Early Warning Score (MEWS), Triage Early Warning Score (TEWS), and Modified Emergency Medical Score (MREMS). SPSS version 16 software and sensitivity, specificity, area under the curve, and confidence interval tests were used to analyze the data.
Results: The mean age of the patients was 40.90±15.78 years. According to the findings, 217 patients (86.8%) had a diagnosis of traumatic brain injury and 70 patients (28%) required intensive care unit admission. The National Early Warning Score 2 showed the highest diagnostic accuracy with sensitivity (82.2%), specificity (81.1%), and area under the curve (0.88).
Conclusion: The higher diagnostic accuracy of the National Early Warning Score 2 makes it a valuable tool for identifying patients who have sustained traumatic brain injury and require intensive care unit admission.
Raoofeh Karimi, Zahra Rooddehghan, Amirhossein Khajezadeh, Nikou Sardarpour, Mahsa Abbaszadeh, Mohammad Javad Ahmadzadeh Zeidi,
Volume 32, Issue 1 (4-2026)
Abstract
Background & Aim: Intolerance of uncertainty is an emerging psychological construct that may influence health-related behaviors, particularly treatment adherence. The present study aimed to determine the association between intolerance of uncertainty and treatment adherence in patients with diabetes.
Methods & Materials: This cross-sectional descriptive-correlational study was conducted in 2024 on 103 patients with diabetes referred to Imam Khomeini Hospital in Tehran. Samples were selected using a convenience sampling method. Data were collected using a demographic and clinical characteristics form, the Morisky Medication Adherence Scale, and the Intolerance of Uncertainty Scale developed by Freeston et al. Data were analyzed using descriptive (mean, standard deviation, and frequency) and inferential statistics (independent t-test, Pearson correlation coefficient, and one-way ANOVA) in SPSS version 16.
Results: Intolerance of uncertainty showed a significant positive correlation with age (r=0.27, P=0.006) and a significant negative correlation with diabetes duration (r=-0.27, P=0.006). Single participants had significantly higher levels of intolerance of uncertainty compared to married participants (P=0.005). Furthermore, treatment adherence demonstrated a significant positive relationship with age (r=0.34, P<0.001) and was higher among women (P=0.021) and single individuals (P=0.032). Among the participants, 50 individuals (48.5%) had high intolerance of uncertainty, and 44 individuals (42.7%) had low treatment adherence. A significant positive correlation was observed between intolerance of uncertainty and treatment adherence (r=0.65, P<0.001).
Conclusion: The findings of the present study indicate that diabetic patients who experience higher levels of intolerance of uncertainty are more likely to adopt treatment adherence as a coping strategy when faced with uncertain circumstances and unpredictable outcomes of their disease. This behavior serves as a means to reduce psychological distress and regain a sense of control. These findings underscore the importance of addressing psychological dimensions, particularly intolerance of uncertainty, by nurses and other healthcare team members. However, due to the cross-sectional nature of this study and other limitations, the interpretation of the results should be approached with caution.
Naeimeh Sarkhani, Hooman Shahsavari, Nasrin Nikpeyma,
Volume 32, Issue 1 (4-2026)
Abstract
Background & Aim: Newly graduated nurses play a vital role in fulfilling hospital workforce requirements; however, their transition into teaching hospitals is accompanied by numerous challenges. Thus, this study aimed to explore the challenges faced by newly graduated nurses when selecting teaching hospitals for healthcare service provision.
Methods & Materials: This descriptive qualitative study was conducted in 2023 with the participation of 36 undergraduate nursing students from Tehran University of Medical Sciences, who were recruited through purposive sampling. Data were collected via semi-structured individual interviews. The data were analyzed manually using framework analysis, and the trustworthiness of the data was established based on Guba and Lincoln’s criteria.
Results: Data analysis led to the extraction of 11 subcategories and 5 main categories. The identified categories included: challenges related to nursing services (e.g., heavy workload); human relations challenges (e.g., lack of choice in preferred wards); financial challenges (e.g., salary and benefit delays); accessibility challenges (e.g., long commuting distance); and challenges related to the low priority of hospital employment (e.g., due to the intention to continue education).
Conclusion: The findings revealed that newly graduated nurses face a range of challenges throughout the process of selecting teaching hospitals. These results underscore the need for health policymakers and hospital managers to focus on improving working conditions, enhancing financial and human support, facilitating easier access, and offering motivational incentives. Utilizing these findings can contribute to the development of effective strategies for attracting and retaining newly graduated nurses in teaching hospitals.
Roghayeh Shavandi, Parastoo Oujian, Hosein Zahednezhad, Maliheh Nasiri,
Volume 32, Issue 1 (4-2026)
Abstract
Background & Aim: Achieving autonomy remains a significant challenge within the nursing profession. Nurses must possess moral courage to attain professional autonomy, which should consequently enhance their job self‑efficacy. This study aimed to investigate the relationship between professional autonomy, moral courage, and job self‑efficacy among nursing managers.
Methods & Materials: This descriptive‑correlational study was conducted on 200 nursing managers, including senior nursing managers in organizational positions, middle managers serving as supervisors, and operational managers working as head nurses across eleven teaching hospitals affiliated with Shahid Beheshti University of Medical Sciences in 2024. Data were collected using a demographic and professional characteristics form, Jung's Professional Autonomy Questionnaire, Sadoughi‑Asl's Nurses' Moral Courage Questionnaire, and Riggs' Self‑Efficacy Scale. Data analysis was performed using SPSS version 21 and LISREL version 8, employing Pearson's correlation coefficients and path analysis.
Results: The mean scores were as follows: professional autonomy was 26.92±6.6 (moderate level), moral courage was 422.11±39.52 (high level), and job self‑efficacy was 114.98±11.38 (high level). Professional autonomy demonstrated a direct and significant positive correlation with moral courage (r=0.187, P=0.008), and moral courage showed a significant positive correlation with job self‑efficacy (r=0.41, P<0.001). The structural model analysis revealed that all path coefficients were significant (P<0.001), except for the path from professional autonomy to job self‑efficacy (P=0.635).
Conclusion: The findings of this study suggest that enhancing professional autonomy can improve the moral courage and job self‑efficacy of nursing managers. This important finding can serve as a foundation for designing effective programs and interventions in this field.
Nahid Maleki, Mohaddeseh Bakhshi, Khadigeh Mirzaei, Malihe Rezvanifard,
Volume 32, Issue 1 (4-2026)
Abstract
Background & Aim: Breastfeeding is a health promotion priority due to its short‑term and long‑term health implications for both mothers and infants. However, breastfeeding rates have consistently declined worldwide. Therefore, the protection, promotion, and support of breastfeeding are considered public health priorities. This study aimed to explore the educational needs of breastfeeding mothers to inform the management and optimization of educational‑consultative services.
Methods & Materials: This qualitative content analysis study was conducted between 2019 and 2021 in five health centers and four hospitals affiliated with Mashhad University of Medical Sciences. A total of 25 breastfeeding mothers, 2 family members, and 9 health personnel were selected through purposive sampling and participated in semi‑structured in‑depth interviews. Sampling continued until data saturation was achieved. Data were analyzed using the Elo and Kingas approach with the assistance of MAXQDA 2010 software. Trustworthiness was established based on Guba and Lincoln's criteria.
Results: The category of "educational‑consultative services" emerged from the analysis, which comprised two main subcategories: "management and optimization of education" and "comprehensive consultative services". These two subcategories reflected the perceived educational and consultative needs of mothers, encompassing five sub‑subcategories: "the need for education at the appropriate time and place", "the need for combined educational approaches", "the need for breastfeeding counseling", "the need for psychological counseling during breastfeeding", and "the need for sexual counseling during breastfeeding".
Conclusion: Mothers require educational‑consultative services to sustain breastfeeding. Addressing these needs in the planning and management of educational‑consultative services can contribute to the optimization of breastfeeding care.
