---

Background & Aim: Postpartum depression disorder is a common psychosocial disorder with negative consequences for the mother and child. On the other hand, attention training technique can be more effective than other techniques for intervention in the cognitive-attention syndrome. Therefore, the present study was conducted to determine the effectiveness of attention training technique on the symptoms of depression, anxiety and metacognitive beliefs in patients with postpartum depression.
Methods & Materials: This study was conducted in a single-case experimental design using a multiple baseline design in eight sessions during one-, three- and six-month follow-ups on two patients, referred to the psychology and psychiatry unit of Tabriz Red Crescent in 2018. The Beck Depression Inventory, the Beck Anxiety Inventory and Metacognitive Beliefs Questionnaire were used to collect the data. Data analysis was performed using the Excel software as a graphical analysis and then based on the percentage of improvement, effect size and clinical significance.
Results: At the end of treatment, a significant reduction was observed in the symptoms of depression (61% remission), anxiety (48% remission) and metacognitive beliefs (83% remission) in patients with postpartum depression.
Conclusion: The results of this study showed that attention training technique can be effective in the treatment of patients with postpartum depression. However, further studies are needed in this area.
Clinical trial registry: IRCT20171227038096N1
 

---

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

---

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

---

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.
 

---

Background & Aim: The important aspects of maternal postpartum adjustment are readiness in caring for the family, newly-added member and self as well as return to pre-pregnancy functional status. The aim of the study was to determine the predictors of postpartum maternal functioning.
Methods & Materials: This cross-sectional study was conducted on 422 newly delivered mothers attended the healthcare centers of Bonab in 2016 using the cluster random sampling method. Data were collected through a socio-demographic characteristics form, the Edinburgh postpartum depression scale, and the functional status questionnaire. The multivariate linear regression model on the SPSS software version 21 was used to determine the predictors of functional status.
Results: Mean (SD) of the functional status total score was 2.3 (0.24). The maximum and the minimum scores were in the subdomains “infant care” [3.64 (0.32)], and “social activities and society” [1.43 (0.41)], respectively. There was a significant inverse correlation between postpartum depression and total score of functional status, self-care and social activities and society subscales. According to the general linear model, postpartum depression, spouse’s age and job, economic status, mother’s education level and the number of pregnancy were the predictors of mothers’ functional status during postpartum period.
Conclusion: Postpartum depression and some socio-demographic characteristics are among the variables influencing maternal functional status. Therefore, the early diagnosis and treatment of postpartum depression and consideration of the mothers’ socio-demographic characteristics, can improve maternal functional status and result in better maternal postpartum adjustment.
 

---

Background & Aim: Self-care education is one of the effective ways to improve the quality of life and health in patients with heart failure. The purpose of this study was to determine the effect of applying the specific situation theory on the quality of life in patients with heart failure.
Methods & Materials: In a clinical trial study, 80 patients with class 2 or 3 heart failure, referred to 12 Farvardin hospital in Kahnooj in 2018 were included. Data collection tool included a three-part questionnaire: demographic variables, Left Ventricular Dysfunction Scale to assess patients' quality of life, and Self-care Heart Failure Index. The questionnaires were completed at the first visit and three months after follow-up. Data was analyzed using independent and paired t-test, ANOVA, Pearson correlation through the SPSS software version 20.
Results: Before the intervention, there was no significant difference in the scores of quality of life and self-care between the two groups. After the intervention, the mean score of quality of life and self-care dimensions increased (P<0.001). Regarding self-care after the intervention, the highest score was related to self-care confidence with mean and standard deviation of 21.43 and 3.30 respectively, and the lowest score was related to self-care management with mean and standard deviation of 17.45 and 5.5 (P<0.001).
Conclusion: Paying attention to the dimensions of self-care based on a specific situation theory can lead to a better understanding of these patients’ problems and appropriate planning, and in turn improvement of the quality of life. Since in this study, most of the participants were illiterate, using visual teaching aids, adjusting the schedule according to the patient's conditions and readiness, and if necessary, family involvement can have positive results. It appears necessary to consider the underlying factors in the implementation of self-care programs, especially in people with lower levels of education and income.
Clinical trial registry: IRCT20141109019862N6
 

---

Background & Aim: Clinical decision-making is an essential part of the nursing profession. The nursing profession is based on ethical principles. Due to their commitment to patients, morally courageous nurses ignore occupational risks threatening their own lives.  The aim of this study was to investigate the relationship between moral courage of nurses and their participation in clinical decision-making.
Methods & Materials: This descriptive, cross-sectional study was conducted in 2019. The study population was nurses working in the CCU and ICU of Shahid Rajaie Cardiovascular Medical and Research Center. The sample size was 195 people. The data was collected using the Sekerka’s Moral Courage Scale, and the Participation in Decision Activities Questionnaire (PDAQ). Data was analyzed using descriptive statistics, independent t-test and Pearson correlation coefficient through the SPSS software version 19.
Results: The mean scores of moral courage and PDAQ in nurses were 90.38 ± 11.48 and 117.24±39.42, respectively. A positive correlation was found between moral courage and participation in clinical decision-makings (r=0.397, P<0.001).
Conclusion: The results showed that moral courage has pride of place in the nursing profession that can encourage nurses to actively participate in clinical decision making. Therefore, professional ethics courses are suggested to be organized to improve decision-making and clinical ethical performance of nursing students and nurses.
 

---

Background & Aim: Caring for children with congenital heart disease is very challenging for their parents, and the mothers of these children have a low quality of life. The aim of this study was to evaluate the effect of discharge planning on quality of life among mothers of children with congenital heart disease undergoing surgery.
Methods & Materials: In this quasi-experimental study, 72 mothers of children with congenital heart disease referred to Shahid Rajaie Cardiovascular center in Tehran in 2019 were included in the study using the continuous sampling method and non-randomly allocated to experimental or control groups (36 in each group). Data collection tool included demographic questions and the SF-36 questionnaire, which was completed before and two months after the intervention. The intervention was performed in six thirty-minute training sessions at the time of admission, during hospitalization and discharge. The training follow-up continued for two months after discharge. Data was analyzed by the SPSS software version 20 using Chi-Square test, independent t-test and Fisher's exact test.
Results: The mean score of quality of life before the intervention was 58.93±19.35 in the experimental group and 64.93±16.78 in the control group, and there was no significant difference between groups (P=0.165). Two months after the intervention, the mean score of quality of life was 73.44±17.81 in the experimental group and 73.67±16.49 in the control group, and there was no statistically significant difference between groups (P=0.956).
Conclusion: The discharge planning did not improve the mothers’ quality of life. It is suggested that in addition to educating about proper care of the child, psychological support be provided for mothers while implementing discharge planning.
Clinical trial registry: IRCT20180501039489N3
 

---

Background & Aim: Pain during vascular access is an integral part of the life of hemodialysis patients. The aim of this study was to determine the effect of topical ginger on pain following needle insertion into the arteriovenous fistula in hemodialysis patients.
Methods & Materials: In this clinical trial, 100 hemodialysis patients were selected from two hospitals in Shahroud in 2019 and were randomly assigned to intervention or control groups. For the intervention group, ginger ointment was used 20 minutes before needle insertion into the arteriovenous fistula. The control group only received routine care. Patients' pain after needle insertion was assessed using the Numerical Pain Rating Scale. Data was analyzed using the SPSS software version 18 and Chi-square, Fisher, and independent t-tests.
Results: There was a statistically significant difference in the mean and standard deviation of pain scores between the control (8.46±1.26) and intervention (5.08±1.29) groups (P<0.001). While most people in the intervention group experienced moderate pain, most people in the control group had severe pain.
Conclusion: According to the results of the study, the use of topical ginger, which is cheap with almost no side effects, can reduce the severity of pain following needle insertion into the arteriovenous fistula in hemodialysis patients, and its use in hemodialysis wards is recommended.
Clinical trial registry: IRCT20190825044608N1
 

---

Background & Aim: Performing daily activities is a major element of quality of life in heart failure patients. The Duke Activity Status Index (DASI) is a tool to measure factional capacity. We aimed to examine the psychometric properties of the DASI in patients with heart failure.
Methods & Materials: In this methodological study using convenience sampling, we included 120 patients with heart failure referred to the heart clinic of Afshar hospital, Yazd in 2018.  We first translated the original DASI to Farsi using forward and backward translation method. Then, we evaluated its face validity, content validity, criterion-related validity, construct validity (Exploratory Factor Analysis), and reliability (internal consistency).
Results: In quantitative content validity, the content validity index and content validity ratio were confirmed. The criterion-related validity was confirmed using the Spearman correlation coefficient between the New York Heart Association functional classification scores and the DASI score (r=-0.77, P<0.001) with a significant correlation. To assess construct validity, exploratory factor analysis revealed two factors, explaining 52.61% of the total variance. Factor 1 included items with high MET values and factor 2 included those with low MET values. The reliability of the DASI was determined using the Cronbach’s alpha coefficient that was 0.81.
Conclusion: The DASI is of good validity and reliability and due to its appropriate psychometric properties, this tool can be used to evaluate the functional status of patients with heart failure.

 

---

Background & Aim: COVID-19 is one of the crises that seriously threatens the individuals’ mental health, especially pregnant women. On the other hand, the COVID-19 quarantine can affect the occurrence of domestic violence in pregnant women. The aim of the current study was to investigate the prevalence of domestic violence in pregnancy and the factors affecting it during the COVID-19 pandemic.
Methods & Materials: This was a descriptive-correlational study conducted on 308 primiparous mothers referred to health centers in Isfahan in 2021. The participants were selected using the multi-stage sampling method. Data was collected using a demographic characteristics form and the domestic violence questionnaire. Data analysis was done through the SPSS software version 22 using the Spearman's correlation coefficient, Mann-Whitney and Kruskal-Wallis tests.
Results: A total of 59 mothers (19.2%) experienced domestic violence during their pregnancy (a score of 60 and above from the domestic violence questionnaire). The most prevalent type of violence (including perceived) was psychological violence with 74.4% (229 people), followed by economic, sexual, and physical violence with 35.1% (108 people), 17.2% (53 people), and 14.9% (46 people) respectively. A significant relationship was found between domestic violence during pregnancy and the number of siblings, birth order, the educational level of mother and her husband, and husband’s occupation (P<0.05).
Conclusion: The COVID-19 pandemic has made pregnant women more vulnerable to domestic violence. There are many individual and cultural factors contributing to domestic violence. Some factors were identified as the predictors of violent behavior such as the educational level of woman and her husband, and occupation. Identifying these factors and screening of domestic violence during pregnancy can prevent the occurrence of violent behavior by the spouse and the negative consequences of domestic violence on the mother and her fetus.

 

---

Background & Aim: Pain and inflammation caused by needle insertion into the fistula is a common problem in hemodialysis patients. The aim of this study was to evaluate the effect of topical application of Rosemary essential oil on inflammation and pain severity caused by needle insertion into arteriovenous fistula in patients undergoing chronic hemodialysis.
Methods & Materials: In this clinical trial, 60 hemodialysis patients from the hemodialysis ward of Golestan hospital and Imam Khomeini hospital in Ahvaz were randomly assigned to two groups using block randomization. The intervention group received rosemary essential oil, while the control group received distilled water applied to the needle insertion site 5 minutes before each hemodialysis session. Pain severity was assessed using the VAS scale and inflammation severity was determined using the Phlebitis checklist at baseline and during six sessions. Data were analyzed using t-test, chi-square test and repeated measures analysis of variance (ANOVA) on SPSS software version 22.
Results: The results showed that the mean score for pain increased in the control group from 5.13±1.74  to 5.93±1.67, while it decreased in the intervention group from 5.83±1.53 to 3.77±1.43 (P=0.003). Additionally, the mean score for inflammation increased during the sessions in the control group, ranging from 1.27±1.20 to 2.07±1.08. However, in the intervention group, the mean score for inflammation decreased from 2.57±1.92 to 1.33±1.44. Nevertheless, this difference was found to be statistically insignificant (P=0.267).
Conclusion: The findings of the present study showed that the topical application of rosemary essential oil had a significant effect on reducing pain resulting from needling. However, its effect on reducing the severity of arteriovenous fistula inflammation in patients undergoing hemodialysis was not statistically significant. Based on these results, it is recommended to provide training to nursing staff and hemodialysis patients regarding the use of rosemary essential oil as a means to alleviate pain experienced during the procedure. Further research is required to investigate its potential for reducing the severity of fistula inflammation.
Clinical trial registry: IRCT2019102804526N1

 

---

Background & Aim: Establishing effective communication and forming a strong attachment with a newborn baby are crucial tasks during the postpartum period. The bond between mother and baby has a profound impact on the child's well-being, as well as the mother's health. The aim of the present study was to investigate the effect of auriculotherapy on the mother-infant attachment.
Methods & Materials: This randomized controlled clinical trial was conducted between March 2021 and September 2022 on a sample of 106 pregnant women who referred to the maternity ward of Shahid Sadoughi Hospital in Isfahan for normal vaginal delivery. The participants were randomly assigned to either the intervention group, which received auriculotherapy in addition to routine care, or the control group, which received only routine care. Auriculotherapy involved the stimulation of specific acupuncture points including oxytocin, uterus, Shen Men, thalamic, lung 1, and lung 2. Data collection was carried out using a checklist of demographic characteristics and the Maternal Postnatal Attachment Scale. Statistical analysis was performed using SPSS software version 26, employing independent t-test, paired t-test, exact Fisher's test, and chi-square test. A significance level of P<0.05 was considered statistically significant.
Results: The results showed that there was no statistically significant differences observed in demographic variables between the intervention and control groups (P>0.05). However, the mean score of attachment after delivery in the auriculotherapy group was significantly higher compared to the control group (P=0.004).
Conclusion: Based on the findings of this study, it has been determined that auriculotherapy exhibits the potential to enhance maternal attachment to the baby. Given its ease of use and non-invasive nature, it is strongly recommended to consider incorporating auriculotherapy as an intervention to improve mother-baby attachment during the postpartum period.
Clinical trial registry: IRCT20091219002889N12

 

---

Background & Aim: In women experiencing intimate partner violence, resilience can serve as a protective factor against the worsening of psychological problems. Acceptance and Commitment Therapy has emerged as a potential means to enhance resilience in these individuals. The aim of this study is to determine the effect of Acceptance and Commitment Therapy on the resilience of women experiencing spousal abuse.
Methods & Materials: This is a quasi-experimental study. A total of 80 women experiencing spousal abuse were selected through quota sampling from the women referring to the health houses affiliated to the Mashhad ol-Kube health center in Arak, Iran between 2020 and 2021. The participants were then divided into intervention and control groups using the block randomization method. The intervention group received the Acceptance and Commitment Therapy in eight sessions, lasting 90 minutes each, once a week. The data collection tools included a questionnaire on personal and health characteristics, the Revised Conflict Tactics Scale, and the Connor‐Davidson Resilience Scale. The Resilience Scale was completed by both groups one week and five weeks after the intervention. The data were analyzed through the SPSS software version 23 using descriptive statistics, independent t-test, Chi-square test, Fisher’s exact test, and two-way repeated measures ANOVA. A significance level of P<0.05 was used to determine statistical significance.
Results: The mean and standard deviation of the resilience score for the intervention group increased from 59.21±13.29 before the intervention to 64.31±11.27 and 72.34±10.49 in the post-test and follow-up periods. For the control group, these figures were 52.47±17.2, 51.94±14.72, and 52.47±15.3, respectively. Based on the results of the two-way repeated measures ANOVA, there was a statistically significant difference in the mean score of resilience between the intervention and control groups at the three time points examined (P<0.001).
Conclusion: The implementation of Acceptance and Commitment Therapy can significantly improve the resilience of women experiencing spousal abuse. This intervention holds great potential for being incorporated into mental health improvement programs specifically designed for women who have experienced spousal abuse.

 

---

Background & Aim: The availability of information regarding people's experiences of returning to work after heart surgery, taking into account the socio-cultural context of Iranian society, is limited. The aim of this study is to discover the process of returning to work after heart surgery.
Methods & Materials: A qualitative study using the grounded theory approach was conducted between 2021 and 2022. Through purposive and theoretical sampling, 21 participants who had undergone heart surgery and were in the process of returning to work were selected. They were chosen from the cardiac surgery ward of Amiralmomenin Hospital in Kordkuy, as well as among patients seeking treatment from cardiac surgeons in Golestan province. Data were collected through conducting semi-structured interviews and taking field notes. Data analysis was conducted using the method proposed by Corbin and Strauss in 2015.
Results: "Feeling of doubt about return-to-work", "perceived psycho-social support", "personal and occupational factors", "unfavorable consequences of heart surgery" and "limited support from governmental/non-governmental institutions" were determined as contextual factors influencing the process of return-to-work. Moreover, "effort to adjust the job", "situation evaluation" and "self-management" were introduced as strategies, while "adaptability to the job" were identified as the consequence of returning to work. Finally, the core variable of the study was determined to be "the thoughtful effort to match the job".
Conclusion: Based on the results, it was determined that several individual and environmental factors influence the process of return-to-work for people who have undergone heart surgery. To facilitate a successful return to work, it is crucial to provide psycho-social support from both the family and work environment. It is recommended that policy makers in the health and social affairs sectors take active steps to empower people during the post-recovery period. Additionally, fostering collaboration between the Ministries of Labor and Health, as well as insurance organizations, can greatly facilitate the return to work of individuals after heart surgery.

 

---

Background & Aim: Patients undergoing hemodialysis commonly experience discomfort due to the insertion of needles into their arteriovenous fistula. The aim of the study was to compare the effect of EMLA ointment and lidocaine spray, along with the use of rhythmic breathing on the intensity of pain caused by the insertion of needles in the arteriovenous fistula among hemodialysis patients.
Methods & Materials: This study was a randomized clinical trial conducted on a total of 80 patients who were referred to Imam Khomeini and Golestan hospitals in Ahvaz in 2022. The numerical pain measurement scale was used as the data collection tool. The participants were selected using the convenience sampling method and then randomly allocated into two groups. In the EMLA ointment group (n=39), a total of 2 grams of EMLA ointment was applied to the target area 60 minutes before the hemodialysis procedure. In the lidocaine spray group with rhythmic breathing (n=41), 2 puffs of lidocaine spray were administered along with rhythmic breathing 5 minutes prior to needle insertion. The pain intensity was then measured and recorded. The collected data was analyzed using descriptive and inferential statistics in SPSS version 20, with a significance level set at 0.05.
Results: The group receiving EMLA ointment and the group receiving lidocaine spray, with rhythmic breathing had mean pain scores of 1.95±1.09 and 2.12±1.10, respectively. Although the mean pain score in the EMLA ointment group was lower than that in the lidocaine spray group with rhythmic breathing, the difference was not statistically significant (P=0.479).
Conclusion: The findings of this study indicate that both EMLA ointment and lidocaine spray, along with the use of rhythmic breathing, have comparable efficacy in reducing pain among hemodialysis patients. Therefore, considering the patient's condition, the utilization of either of these methods is recommended.
Clinical trial registry: IRCT20220512054826N1

 

---

Background & Aim: The utilization of emotional expression methods, including narrative counseling and written emotional expression, has been shown to be efficacious in mitigating the intensity of diverse psychological issues such as depression and acute stress, particularly following traumatic events. Additionally, emergency cesarean section is commonly acknowledged as a traumatic event that may lead to psychological challenges for the mother. The purpose of this research was to compare the effectiveness of emotional expression through writing and narration in reducing post-traumatic stress and postpartum depression among women undergoing emergency cesarean section.
Methods & Materials: This quasi-experimental study was conducted in Zahedan, involving a total of 120 women who underwent emergency cesarean section and were admitted to Ali Ibn Abi Talib (AS) hospital during the period of 2021-2022. The participants were selected using convenience sampling and were randomly divided into three groups: written emotional expression, narration and control, with each group consisting of 40 participants. The intervention consisted of one face-to-face session and two non-face-to-face sessions. Data collection involved the use of the Edinburgh Depression Questionnaire and PTSD assessments, administered before and six weeks after the intervention across all three groups. The data were analyzed using SPSS version 24, employing descriptive and inferential tests such as ANOVA and Tukey's post hoc analysis.
Results: The results showed a significant decrease in the average scores of post-traumatic stress and postpartum depression in the written emotional expression and narration groups, compared to the control group, after the intervention (P<0.05). However, before the intervention, there were no significant differences observed among the three groups (P>0.05). Furthermore, a higher mean difference was observed in both post-traumatic stress and postpartum depression scores before and after the intervention in the written emotional expression group, compared to the narration group, indicating a greater effect of written emotional expression (P<0.001).
Conclusion: Based on the research findings, highlighting the positive effect of both narration and written emotional expression, it is recommended to incorporate these techniques as supplementary components within comprehensive educational and care programs for women experiencing traumatic childbirth.

 

---

Background & Aim: Knee osteoarthritis as a common chronic illness leading to disability, imposes numerous challenges on individuals in terms of daily living and self-care. Therefore, the implementation of tele-rehabilitation nursing interventions that foster patients' internal health locus of control and enhance the development of self-care behaviors may be useful. This study aimed to determine the effect of tele-nursing rehabilitation on the health locus of control in patients with knee osteoarthritis.
Methods & Materials: In this randomized clinical trial study, a total of 34 patients with knee osteoarthritis referred to the rehabilitation clinics affiliated with Shiraz University of Medical Sciences in 2022 were enrolled. The intervention group participated in an 8-session tele-rehabilitation nursing program, while the control group received standard routine care. The Multidimensional Health Locus of Control scale was administered to both groups on three separate occasions. The data were subjected to descriptive and inferential statistical analyses using SPSS software version 26.
Results: According to the results from a two-way repeated measures analysis of variance (ANOVA), a statistically significant difference was observed solely in the trend of changes in the mean score of internal belief between the two groups and over the study time period (P<0.001). Specifically, the scores of the intervention group exhibited a significant increase over time, surpassing those of the control group.
Conclusion: The implementation of tele-rehabilitation nursing care, which emphasizes patient responsibility for their internal health locus of control can improve self-care. Therefore, it is recommended that nurses employ this approach in managing additional chronic conditions.
Clinical trial registry: IRCT20220216054038N1

 

---

Background & Aim: Given the importance of the emergency department in providing prompt and high-quality services, the emphasis on lean management has increased to minimize non-value-added and wasteful activities within a process. The aim of the study was to determine the process of patient flow and identify opportunities for its improvement using the Six Sigma method as one of the most important subsystems of lean management, in the emergency department of the selected teaching hospital in Kerman.
Methods & Materials: The current research is a sequential mixed-method study conducted in 2022 within the cardiovascular and neurological emergency department in Kerman. The Six Sigma method, specifically the DMAIC approach consisting of four steps, was employed in conjunction with spaghetti charts to implement lean management principles. The research population included 180 patients referred to the cardiovascular and neurological emergency department. The data were collected using researcher-developed forms, and Excel software version 2013 was used to analyze the data.
Results: By examining the processes and using the spaghetti chart, the main problems contributing to prolonged patient admission time in the cardiology and neurology emergency department were identified. The implementation of a strategy involving the presence of admission staff during triage for level 1 to 3 patients will eliminate the additional distance and time required for patient admission.
Conclusion: The use of lean thinking principles in the emergency department with the implementation of Lean Six Sigma and Spaghetti Chart by streamlining the service process, will result in improving patient flow, providing timely quality services, reducing service delivery time, and ultimately increasing patient satisfaction.

 

---

Background & Aim: Patients with heart failure often experience inadequate self-care and diminished quality of life, leading to significant constraints in their daily personal and social activities. This study aims to evaluate the effect of individually designed energy conservation training on enhancing self-care capabilities and improving the quality of life for patients with heart failure.
Methods & Materials: This randomized clinical trial was conducted from June 2022 to May 2023 and involved 60 heart failure patients in the CCU and cardiology ward, as well as cardiovascular clinic at Shahid Madani and Shohadai Ashayer Hospital in Khorramabad, Lorestan. Based on established inclusion criteria, participants were randomly assigned to either the intervention group (n=30) or the control group (n=30). The intervention group received individually designed training in four sessions, each lasting 30 minutes, spaced over three weeks (total duration of nine weeks). In contrast, the control group received standard nursing education upon discharge. Participants completed the European Heart Failure Self-Care Behavior Scale and the Minnesota Living with Heart Failure Questionnaire both prior to the intervention and at the tenth week post-intervention. Data were analyzed using SPSS software version 24, employing the Mann-Whitney U test, Wilcoxon test, independent t-test, and chi-square tests.
Results: After the intervention, the intervention group demonstrated a statistically significant decrease in mean scores for self-care and quality of life compared to the control group (P<0.001). These findings indicate an enhancement in self-care practices and an improvement in the quality of life.
Conclusion: Individually designed energy conservation training effectively improves self-care and quality of life in patients with heart failure. Therefore, using this complication-free, non-pharmacological approach can be beneficial for this patient population.
Clinical trial registry: IRCT20220612055150N1