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Background & Aim: Cesarean section (CS) rate was 56% in 2012 in Iran, which was considerably higher than the WHO recommended rate (10-15%). Thus, the Normal Delivery Promotion (NDP) program as a part of Iran’s Health Transformation Plan (HTP) was implemented in 2014 to reduce unnecessary cesarean deliveries and promote maternal and neonatal health. The aim of the study was to evaluate the effect of the NDP plan on the CS rates.
Methods & Materials: This quasi-experimental and longitudinal study analyzed the immediate and long- term effects of the NDP program on the CS trend in Iran using an interrupted time series analysis. Monthly CS rates in the hospitals of the country were extracted from April 2013 to September 2018.
Results: Overall CS rate in Iran decreased by 6% immediately after the implementation of the NDP program and then remained at the same level. The NDP program reduced the CS rate in teaching (9.5%), non-teaching (11.7%), private (18.1%), and charity (27.1%) hospitals. But the CS rate increased in social security (7%) and other hospitals (15.7%). The CS rate would have reached 58.5% by September 2018 if the NDP program had not been implemented.
Conclusion: The NDP program was somewhat effective in reducing the CS rate in Iran. Promoting this program by formulating a strategic plan and comprehensive action plans addressing various underlying causes of CS at meta (ministry of health), macro (universities of medical sciences), meso (hospitals) and micro (obstetricians, midwives, and mothers) levels and considering effective solutions in the areas of governance and leadership, financing, human resources, equipment, information and service delivery is critical to achieve the determined national goals.
 

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Background & Aim: Accreditation of hospitals plays an important role in promoting the quality, safety and effectiveness of medical services, and increasing the efficiency of hospitals. The effectiveness of the accreditation system depends on the quality of the accreditation standards, the comprehensiveness of the accreditation method, and the quantity and quality of the accreditation appraiser. There is a need for appropriate metrics to review and evaluate the implementation of the charter of patients’ rights in the accreditation of hospitals. The aim of this study was to explain the challenges of patients’ rights in the Iranian hospitals accreditation system.
Methods & Materials: This qualitative study was conducted using a conventional content analysis approach with the participation of 13 key informants. In parallel with the interviews, with the aim of assessing the comprehensiveness, the coverage of the patients’ rights components was assessed by accreditation metrics in four sessions. Data analysis was conducted using the Graneheim and Lundman method.
Results: The challenges of the accreditation system were explained by two categories "Content deficiencies of hospitals accreditation standards", "Managerial challenges of accreditation system".
Conclusion: Accreditation has an effective and serious role in the improvement of hospital services and can be a good monitor for observing the rights of service recipients and the charter of patients’ rights. This study provides useful information on the content deficiencies of the country's accreditation standards in terms of service recipients’ rights and its implementation challenges that can be used by policy makers.

 

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Background & Aim: The main care need of patients with myocardial infarction (MI) is continuous care, presenting an important challenge in the field of nursing care. Therefore, This study aimed to evaluate the effect of nurse-led home-based cardiac rehabilitation on adherence to therapeutic regimens in patients with MI.
Methods & Materials: In this randomized clinical trial study, 80 eligible patients were selected through convenience sampling from selected hospitals affiliated with Tehran University of Medical Sciences in 2020-2021. Subsequently, they were randomly allocated to either the intervention or control groups. The control group received routine education upon hospital discharge, whereas the intervention group participated in a nurse-led cardiac rehabilitation program conducted both in-person at home and online, comprising four 90-minute sessions once a week, and were monitored for two months. Participants completed socio-demographic and treatment compliance questionnaires before and three months after the intervention. The collected data was analyzed using descriptive and inferential statistics with SPSS software version 20.
Results: Both groups were homogeneous in most demographic variables (P>0.05). The mean and standard deviation of treatment adherence scores before the intervention in the intervention and control groups were 70.82±7.91 and 67.94±11.20, respectively (P=0.015). After the intervention, these values changed to 75.10±6.13 and 68.77±10.12, respectively, with a statistically significant difference observed between the two groups (P<0.001).
Conclusion: The results revealed that nurse-led home-based cardiac rehabilitation was effective in enhancing treatment adherence. Therefore, it is suggested that cardiac rehabilitation care be consistently extended to the home setting.
Clinical trial registry: IRCT20201006048953N

 

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Background & Aim: Self-efficacy disruption poses a significant challenge for patients with a stoma, affecting their ability to engage in community life and carry out daily activities. Utilizing remote training methods for patients presents an opportunity to maximize the use of these resources. This study aims to determine the effect of a telenursing-based training program on the self-efficacy of patients with a stoma.
Methods & Materials: This quasi-experimental study involved a convenient sample of 80 patients with a stoma in Zahedan in 2023, who were randomly assigned to two groups: intervention and control, each comprising 40 participants. The intervention group received the telenursing-based program application. Self-efficacy was assessed using the self-efficacy of stoma patients questionnaire before the intervention, as well as one and three months after the intervention. Data were analyzed using Chi-square test and a two-way repeated measures analysis of variance through SPSS software version 26.
Results: The intervention group exhibited a mean (SD) age of 42.84±12.98 years, while the control group had a mean (SD) age of 46.26±11.89 years (P=0.320). The self-efficacy total scores in the intervention group showed values of 69.75±8.05 before the intervention, 77.28±7.57 at one month, and 92.72±6.43 at three months post-intervention, suggesting a significant effect of the telenursing-based training on self-efficacy levels (P<0.001).
Conclusion: The results of the present study show the effect of the telenursing training program on improving self-efficacy levels in patients with stoma. Therefore, it is recommended to implement such programs to support this patient population.

 

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Background & Aim: Hypotension is a common complication associated with plasmapheresis. Elevating the legs and using elastic stockings are nursing interventions aimed at preventing hypotension. The objective of this study was to compare the effects of elastic stockings and leg elevation on the prevention of hypotension during plasmapheresis.
Methods & Materials: This randomized crossover clinical trial was conducted on 35 patients undergoing plasmapheresis at Beheshti Hospital in Hamadan from 2020 to 2021. Patients were selected based on convenience sampling and then allocated to four different methods in four sessions using random permuted block designs: elastic stockings (A), leg elevation (B), a combination of elastic stockings and leg elevation (C), and a control group (D). Blood pressure was monitored before, during (every half hour), and half an hour after the completion of plasmapheresis. Data analysis was performed using SPSS version 24, applying repeated measures ANOVA with a significance level of 0.05.
Results: During plasmapheresis, systolic blood pressure decreased over time in all four methods (P<0.001). Blood pressure measurements in intervention methods A, B, and C were higher than in the control group (P<0.001). Among the intervention methods, blood pressure in method C was higher than in methods A and B, while method B was higher than method A (P<0.001).
Conclusion: The use of elastic stockings in combination with leg elevation is more effective in preventing hypotension. Therefore, it is recommended as an easy and cost-effective method for preventing hypotension in patients undergoing plasmapheresis and for nursing staff to implement.
Clinical trial registry: IRCT20191020045166N1