Background & Aim: Pregnancy experience can be a kind of crisis in women&aposs lives. Different forms of anxiety can make problems in pregnant women. This study aimed to determine the effect of attachment education on anxiety and attachment behaviors of first-time mothers.

Methods & Materials: In this clinical trial, 84 primigravida women were selected from two hospitals in Shirazi using convenience sampling. The participants were randomly allocated to the test and control groups. Data were collected using a personal data form, the Anxiety Inventory Spielberger, and the maternal infant attachment tab view. The intervention group received four two-hour sessions during one month training course on attachment behavior. Maternal attachment behaviors were shaped Weekly on the forms. The control group received usual care of pregnancy. At the first day after the delivery, the researchers observed mothers attachment behavior during breastfeeding in all groups using Avant sheet without informing the mothers. Data were analyzed using statistical tests such as Chi-square, T-test, and paired t-test.

Results: The mean of the anxiety score was no significantly different before the intervention between the groups (P=0.59). The average anxiety scores was statistically significant after the intervention in the two groups (P=0.003). Also, average scores on the attachment of mothers with the breastfeeding infants was statistically different (P<0.001) in the intervention group.

Conclusion: Attachment behavior training reduces anxiety and increases maternal attachment.

Background & Aim: Infants are very sensitive and special attention is needed to take care of their physical and mental health. Some studies showed that massage by parents can improve infants&apos sleep quality. The aim of this study was to compare the effect of massage with sunflower oil or sesame oil on infants&apos crying and sleep times.

Methods & Materials: This triple-blinded clinical trial was conducted on 120 infants who were 10-15 days old, full-term, single, exclusively breastfed and with no history of hospitalization. The infants were assigned randomly into three groups of sunflower oil massage, sesame oil massage and massage with no oils. Mothers administered 15 minutes of massage to their infants twice per day (morning and afternoon) for 28 days. Times of crying and sleep were measured by a parents&apos information form at baseline, and at the end of the first, second, third, and fourth weeks of the study. Data were analyzed using the repeated measures ANOVA.

Result: Within four weeks of following, decreasing pattern of infants crying time was not significant (P=0.18) however, the mean of crying time between the three groups was significant (P=0.007). The interaction effect of crying time and groups was not significant (P=0.18). Increasing pattern of infant sleep time was statistically significant in the fourth weeks of the following (P<0.001) however, the mean of sleep time between three groups was not significant (P<0.56). The interaction effect of sleeping time and groups was not significant (P<0.10).

Conclusion: Since there were not statistical significant differences between the infants&apos crying and sleep times between the three groups, and despite the fact that increasing pattern of infants sleep time is a normal pattern, it is not possible to have a proper conclusion.

Background & Aim: Hypothermia is a main side effect during surgery in which blood pressure, heart rate, intra cranial pressure, oxygen consumption, pain and discomfort increase. The rate of cesarean section in Iran is three times more than global standard. This study aimed to investigate effect of pre-warmed intravenous fluid therapy on prevention of shivering after general anesthesia in cesarean section.

Methods & Materials: A total of 62 women undergoing general anesthesia for elective cesarean section were randomly allocated into two intervention and control groups. In the intervention group, patients received pre-warmed serum (37°C) and in the control group, patients received serum at room temperature (25.5°C). The postoperative shivering and some homodynamic parameters of the participants were assessed in recovery room.

Results: The mean of body temperature in the intervention and control groups were 35.9°C±0.48 and 35.42°C±0.6, respectively (P<0.05). The incidence of post operative shivering in the intervention and control groups were 13% and 35%, respectively (P<0.05).

Conclusion: Infusion of pre-warmed serum (37°C) would prevent postoperative shivering and could improve nursing care for women underwent general anesthesia in cesarean section.

Background & Aim: This study aimed to assess the relationships between iron and copper levels in maternal and cord serums together and with pregnancy outcomes.

Methods & Materials: An Analytical cross-sectional study was conducted among 370 pregnant women in labor and their neonates in Maryam, Akbarabadi and Imam hospitals in Tehran, Iran. Copper concentrations were measured using the standard atomic absorption spectrophotometer method and Iron concentrations were measured by a kit through RA 1000 method. Data were collected using a questionnaire and were analyzed using Spearman correlation, Chi- square and Logistic regression tests.

Results: The mean copper concentrations in the maternal and cord bloods at delivery were 114.52±37.4, 22.4±11.6 (μg/dl), respectively. The Iron levels were 119.2±64, 164.3±65.3 (μg/dl), respectively. Of all the mothers, 54.3% had copper deficiency, 1.1% Iron deficiency and of all the newborns, 44.7% had copper deficiency and 3.5% Iron deficiency. The Spearman Correlation analysis showed significant positive correlations between concentrations of each element in maternal serum with cord serum and also between maternal iron with maternal copper, and maternal iron with cord copper. The Chi-square analysis showed that there was a significant relationship between maternal copper deficiency and gestational hypertension (P<0.001). There were no significant relationships between these trace element levels at delivery with premature rupture of membranes and preterm labor. Logistic regression analysis showed a significant negative relationship between maternal copper levels and gestational hypertension (odds: 0.98, 95%CI: 0.97-0.99).

Conclusion: Maternal copper deficiency was rather high in the participants of the study (54.3%), and was related to incidence of gestational hypertension. These findings illustrated importance of trace elements during pregnancy. Providing suitable dietary recommendations and giving supplements during pregnancy can help to decrease maternal and fetal mortality and morbidity.

Background & Aim: Postoperative nausea is a common problem after general anesthesia, especially in ambulatory surgery. In ocular surgeries including strabismus surgery, intraocular pressure increase may lead to eye damage. Drug therapy has various side effects. The purpose of this study was to evaluate acupressure on nausea in patients undergoing strabismus surgery.

Methods & Materials: In this double-blinded clinical trial, 60 patients undergoing strabismus surgery were allocated into intervention and control groups. In the intervention group, a sea-band was placed on the P6 point of patients&apos wrists 30 minutes before induction of anesthesia. In the control group, the sea-band was placed in the opposite position of the patients&apos wrists. Data were collected during six hours after surgery in the recovery room. Data were analyzed using Chi square, t-test, and Mann-Whitney tests.

Results: There were no differences in demographic and surgical characteristics between the two groups at baseline. The intensity of nausea in the recovery room (P=0.002) and six hours after surgery (P<0.001) were significantly less in the intervention group than the control group.

Conclusion: Based on the findings of this study, acupressure decreases post operative nausea. Acupressure is a simple, noninvasive and cost- effective intervention which can be applied by nurses to prevent post operative nausea.

Background & Aim: Although caring is a complex concept with various definitions, there are no agreement on the exact meaning among researchers. The aim of this study was to compare caring behaviors of nurses from patients&apos and nurses&apos perspectives.

Methods & Materials: The study was conducted among 150 patients hospitalized in Boushehr hospitals and 50 nurses caring for them. Data were collected using quota sampling method via Caring Behaviors Inventory (CBI).

Results: Findings showed that there were significant differences between patients&apos and nurses&apos perspectives on the subscales of the instrument including assurance of human presence and attentiveness to others&apos experiences. Moreover, there was significant difference in total scale of caring behaviors of nurses between patients and nurses (t=2.559, P=0.011).

Conclusion: Nurses believed that they provide care for patients without making estimations of their expectations. It seems that nurses should attend to standard care to fill the gap

Background & Aim: Web-based technologies provide new opportunities for education, research and professional development of nursing. Nurses have few opportunities to use the Internet due to managers&apos obligations not to use the Internet in work hours, and their traditional attitudes to nursing practice. Establishment of a national nursing portal is a useful way to resolve some of these problems. The purpose of the present study was to investigate the experiences of development of nursing portals in some countries and provide helpful recommendations.

Methods & Materials: This was a descriptive- comparative study. Using systematic review of the literature, the least features for nursing portal structures and contents were identified. Then, the identified features were assessed in selected countries through observation or communication with the portal board.

Results: Personalization, user&aposs profile, search engine, platform-independent display, SSO capability, security mechanisms and collaborative capabilities, clinical guidelines, continuing education, electronic learning courses, and evidence-based nursing processes were common features in the nursing portals.

Conclusion: Development of a specialized comprehensive portal that has all of the desirable features can be achieved through clear definitions of strategies on portal development, maintenance, and analysis of user&aposs requirements. The main requirement to integrate services and contents provided by the portal include specific and integrated structure of all entities in nursing services systems.

Background & Aim: Hemodialysis is a common replacement therapy for patients with ESRD, worldwide. Effective and adequate hemodialysis can improve quality of life and reduce complications of renal failure. Enhancing quality of dialysis results in reducing the complications and mortality rate in patients with chronic renal failure. The aim of this study was to assess the adequacy of dialysis in patients undergoing dialysis with Bicarbonate solution in hemodialysis ward of a hospital in Sary.

Methods & Materials: This cross-sectional study was conducted on 50 patients admitted in the hemodialysis ward with chronic renal failure diagnosis. A researcher-made questionnaire was used to gather data. The KT/V formula was used to assess the adequacy of hemodialysis. The URR common characteristic was also measured. Data were analyzed using statistical tests.

Results: The mean age of patients was 54.76±12.55 years. The mean of KT/V and URR were 0.26±0.92 and 0.47±0.09, respectively. The kt/v ratio was lower than 1.2 in 85.2% of the patients and the URR was lower than 65% in 97.8% of the patients.

Conclusion: The hemodialysis adequacy was low in 85.2% of the patients in the hospital and the hemodialysis efficacy indicators were lower than the standard measures. Assessment to find the reasons of low efficacy of hemodialysis is recommended.

Background & Aim: Diet rich in fruits and vegetables is shown to be an important factor in prevention of chronic diseases. Adolescence is a critical period in adopting eating behaviors. Schools are important social environments in adolescents' lives and are important settings for interventions that aim to improve eating behaviors, including fruit and vegetable intake. This study aimed to assess effectiveness of a school-based intervention based on social cognitive theory on fruit and vegetable (F&V) intake of female adolescents in Tehran.

Methods & Materials: This experimental school based field trial was conducted on 296 female students aged 10-13 years old (157 in the intervention and 139 in the control groups). The intervention included classroom nutrition education on F&V and increasing availability of F&V through school buffet. Psychosocial characteristics of the students were assessed using a questionnaire and F&V intake were measured using 24-hr recall method, at baseline and after three months intervention. Descriptive and inferential statistics were used for data analysis.

Results: After the intervention, vegetable and fruit intake were 0.6 and 0.63 servings higher in the intervention group compared to the controls. Knowledge and self-efficacy scores were significantly higher in the intervention group compared to the control group. Home availability and observational learning scores were significantly decreased in the intervention group.

Conclusion: Through the intervention process, many valuable experiences were gained to be used in future interventions.

Background & Aim: Several factors have been reported to be influential in development of the premenstrual syndrome. There are no studies available on relationship between premenstrual syndrome with body mass index in Iran. This study aimed to determine this relationship among university students.

Methods & Materials: This was a cross-sectional study conducted on a random sample of 500 students living in the dorms of Arak University of Medical Sciences. The participants had not stress, anxiety and severe depression on the basis of the DASS21. Data were gathered using Social Status Questionnaire, including demographic, menstrual status, reproductive and eating habits and body mass index measurement items. The participants completed the abbreviated form of premenstrual syndrome evaluation within seven days of bleeding up to two days after onset of bleeding for one cycle. Using logistic regression analysis, the association was assessed by adjusting for confounding variables.

Results: A majority of the students had normal BMI (<25) (90.8%). The results showed that the risk of premenstrual syndrome in the participants with high BMI was 2.43 times more than the participants with normal BMI (OR=2.43 CI=8.33-1.66).

Conclusion: High BMI increased the risk of premenstrual syndrome. Interventions to decrease the BMI should be designed and implemented in overweight and obese patients with premenstrual syndrome.

Background & Aim: It is crucial to assess communication skills among health workers using valid culture-based instruments. This study aimed to develop and assess psychometric properties of the Interpersonal Communication Skills Scale among Zanjan Health Volunteers.

Methods & Materials: In this study, a total of 191 health volunteers participated in a self-rating assessment of the Communication Skills Scale (CSS). Moreover, 14 experts were asked to rate each item based on the relevance, clarity, and simplicity. Through a literature review, we developed an instrument with 43 items. The validity of the instrument was determined using the impact item method, content validity ratio (CVR), content validity index (CVI), face validity and exploratory factor analysis. Reliability of the instrument was reported by Alpha Cronbach coefficient. The CSS finally contained 35 items, divided into two categories: general and specific communication skills.

Results: Of 43 items, those with impact item index over 1.5, CVR over 0.51, and CVI over 0.79 were considered as valid while the rest were discarded resulting in a 35-item scale. Factor analysis was carried out to determine the relationship among the items of the CSS. Exploratory factor analysis reduced the list of items to 30, which were divided into seven groups with a minimum eigenvalue of 1 for each factor, capable of predicting 68.8% of the variance. Internal reliability of the scale was determined by alpha Cronbach coefficient (0.91).

Conclusion: The results of this study indicated that the CSS is a valid and reliable instrument for assessment of the communication skills among health volunteers in Zanjan. These findings could be used for developing similar instruments in other health worker groups.

Background & Aim: Rapid changes experienced after child birth expose mothers to unpleasant experiences such as disturbances in sleep pattern. These experiences threaten health of mothers and infants. Some studies have shown that exercise can be an effective and non-pharmacologic method in improving sleep quality. The purpose of this study was to examine the effect of exercise on sleep quality among postpartum mothers.

Methods & Materials: This was a randomized clinical trial. Eighty primiparous women aged 18-35 years were recruited from health centers in Rafsanjan in 2009. The inclusion criteria were singleton pregnancy, lack of any acute and chronic physical and mental illnesses, having healthy and term babies, and having vaginal deliveries. Participants were randomly allocated to the intervention (n=40) and control (n=40) groups. Women in the intervention group received five 30-minutes sessions of Pilates weekly for eight weeks. The PSQI instrument was used to measure the related variables at baseline, forth and eighth weeks after the deliveries. Data were analyzed using the repeated measures ANOVA.

Results: Significant improvement was seen in the intervention group within eight weeks follow-up the interaction within time and group was significant (P=0.02). Comparison of mean sleep quality between the two groups has shown that the intervention was effective (P<0.001).

Conclusion: The Pilates exercise was effective in improving quality of sleep in postpartum period.

Background & Objective: Due to physical and mental complications, stroke causes disability in self-care and adherence to rehabilitation in patients. The purpose of this study was to assess the adherence to rehabilitation regimen in family caregivers of patients with stroke.

Methods & Materials: In this cross-sectional study, 180 family caregivers of patients with stroke were recruited to the study using convenience sampling method. The participants were asked to complete demographic sheet and the Adherence-of-Therapeutic-Regime Questionnaires during two months of stroke. Data were statistically analyzed using descriptive and inferential tests in the SPSS-16.

Results: Findings indicated that only about 10% of caregivers were in good levels of adherence to the rehabilitation regimen and about 25% of them were weak. The weaknesses of the adherence were related to rehabilitation of motion, cognitive and emotional deficiencies, and also prevention of respiratory and skin disorders.

Conclusion: According to the study, a small number of family caregivers were in appropriate level for adherence to the rehabilitation regimen. The nurses should be able to empower the family caregivers to decrease physical and psychological disorders related to stroke in patients.

Background & Aim: Moral distress, a major issue in nursing, affects nurses in all healthcare sections. The existence of such distress and its consequent job dissatisfaction may pose a threat to nurses&apos physical and mental health, as well as their quality of life and hinder their accomplishment of individual and social goals. The aim of this study was to determine the relationship between the moral distress and job satisfaction In nurses.

Methods & Materials: This cross-sectional correlational study was conducted on 210 nurses employed in the selected healthcare centers of Tehran University of Medical Sciences in 2009. Data were collected using a questionnaire consisting demographic characteristics, the Corley&aposs moral distress scale, and the Minnesota Satisfaction Questionnaire. Data were analyzed using descriptive statistics and independent t-test, analysis of variance, Wilcoxon test and Pearson&aposs correlation coefficient in the SPSS v.14.

Results: According to the findings of the study, the mean of the moral distress was 1.77 out of four and the mean of the job satisfaction score was 3.17 out of 5 indicating a moderate job satisfaction among the nurses. A significant relationship was observed between the moral distress and nurses&apos job satisfaction in the present study, indicating that by decreasing moral distress, job satisfaction increases.

Conclusion: Although numerous factors govern nurses&apos job satisfaction, the observed relationship between moral distress and job satisfaction indicates that identifying and limiting factors influencing these distresses can lead to improved job satisfaction for nurses.

Background & Aim: Motivated faculty promotes nursing students&apos educational level which leads to community health promotion. Attempts should be made to recognize and analyze motivating factors including expectations. This qualitative study attempted to clarify expectations of faculty of Tehran nursing schools on management system.

Methods & Materials: This was a qualitative study. The participants were 14 nursing faculty members of Tehran, Shahid Beheshti, Artesh, Shahed, and Baghiatallah Universities located in Tehran. Purposive sampling was used to recruit the participants. Data were collected using semi-structured interviews with the participants. Qualitative content analysis was used to analyze the data.

Results: Expectations of nursing faculty were explained in eight categories: empowerment of the faculty, organizational support, fairness, appropriate performance evaluation, providing appropriate working conditions, applying appropriate management strategies, attention to welfare and financial problems and promoting quality of education and research.

Conclusion: Understanding the expectations of the nursing faculty and trying to meet them can improve performance of the faculty. Meeting these expectations can enhance motivation and job satisfaction among the faculty.

Background & Aim: Delirium is a common problem among patients with open heart surgery admitted to intensive care units. This study aimed to assess effectiveness of a multifactor intervention on delirium prevention and length of stay in patients with open heart surgery.

Methods & Materials: In this semi-experimental study, we first recruited 195 patients. Among them, 15 patients were excluded during the study due to different reasons. The participants were divided into to study groups. The implemented intervention included staff education, environment changes, and installation of guideline reminding on ward. Patients were assessed for delirium twice a day using the CAM-ICU scale. Demographic characteristics as well as disease and sleep items were completed by the researchers a day before surgery. Moreover, length of stay was recorded by the researchers. Data were analyzed using Pearson Chi-Square, Independent Samples, and the Fisher&aposs Exact Test.

Results: A significant decrease was found in the incidence of delirium in the intervention group: 11.1% Vs 35.6% (P<0.05). Average length of stay in the control and intervention groups was 6.23 Vs 6.30 days, respectively. Length of stay among patients with delirium and patients without delirium was 7.5 Vs 5.8 days, respectively. Patients with delirium were aged 55 and more in both groups.

Conclusion: Multifactor intervention was effective in decreasing the prevalence of delirium. Educational interventions are recommended to improve staffs&apos knowledge and environment changes.

Background & Aim: The objective of this study was to investigate perspectives of managers regarding change management in nursing and midwifery schools.

Methods & Materials: In this qualitative study, we used a descriptive exploratory approach with triangulation. We used snow ball sampling to recruit faculty members of nursing and midwifery schools in Tehran. The participants were included in the study if they had at least 1-year experience as a faculty member. Data were gathered using semi-structured interviews in which a guide and field notes were used. Data were saturated after observing repetition of the codes. Latent content analysis was used for data analysis. The trustworthiness was achieved using a prolonged field experience, member check, peer check and sharing the content with two qualitative research experts.

Results: Ten participants (seven females and three males) aged 38-54 were interviewed. Three participants were employed in highly recognized management levels. Immediately after interviews, conceptual codes were extracted. Suggested themes were classified as concentration in management, managers&apos characteristics, and attitude toward change.

Conclusion: Accordingly, the concept of change management was postulated as the purpose of this study. Furthermore, its influencing factors were identified. The results of this study can be used by faculties of the nursing and midwifery schools to use them according to their organizational culture.

Background & Aim: Pain can detrimentally affect physical functioning, psychological well-being and social interaction. Various attitudinal factors may be associated with inadequate pain control. Hence, studies should be undertaken to gain a better understanding of association between pain control attitudes and use of analgesics and cancer pain intensity. This study aimed to determine relationship between pain control attitudes and use of analgesics and pain intensity in cancer patients with pain.

Methods & Materials: A descriptive cross-sectional study was conducted with 200 cancer patients who underwent chemotherapy or radiotherapy and experienced pain in previous 24 hours. The pain control attitudes, use of analgesics, worrisome about using analgesics and physical and psychological impacts of pain were measured using questionnaires. The cancer pain intensity was measured using the visual analogue scale. Validity and reliability of the instruments were evaluated. Data were analyzed using independent t-test and ANOVA.

Results: About 58% of patients agreed that they would wait before asking for help. Beside, the findings indicated that willing to tolerate pain and perceived control over pain were associated with the time and frequency of taking analgesic and pain intensity in previous 24 hours and last week. Also concerns about addiction to pain-relieving medications were related to the analgesic type and pain intensity within last week (P=0.03), and fear of injection was related to analgesic use and pain intensity within last week (P<0.001).

Conclusion: Many cancer patients had attitudes which could interfere with pain relieving. Suggestions are made for developing patient education programs, accessing effective cancer pain controls and decision making for cancer pain relief.

Background & Aim: Oral care and using mouthwash help to prevent stomatitis. The aim of this study was to investigate the effect of two mouth wash protocols on prevention of head and neck radiotherapy induced-stomatitis.

Methods & Materials: In this single blind clinical trial, 120 individual were recruited. The experiment group (N=40) gurgled with 3cc of Matrices mouthwash and the control group used water mouth wash. The participants were assessed using the WHO grading scale. Data were analyzed using the Fisher exact test and Mann-Whitney U test as appropriate.

Results: There was not significant differences between the experimental and control groups regarding stomatitis intensity in the first day (P=0.371). Tere were significant differences between the two groups regarding stomatitis intensity in days 7 and 14 (P<0.001).

Conclusion: Oral stomatitis is a common condition in patients with head and neck radiotherapy. It makes painful ulcers, dehydration, malnutrition, and potentially life-threatening infection. Matrica mouth wash could prevent and treat induced-radiotherapy ulcer stomatitis.

Background & Aim: Multiple structural factors preside over burn units influence nurses&apos quality of care and their activities. The complexity and multy-dimensional nature of nursing care in these units, creates many challenges. Understanding the perspectives of people&aposs involved is recommended. This study, with a theory-to-research approach, was conducted to assess the frequency of confronting intra and extra organizational factors preside over burn units, the intensity of its related pressure, and correlations among these variables from nurses&apos perspectives.

Methods & Materials: In this cross-sectional, correlational study, 98 nurses working in the Shahid Mottahari burn center were recruited by census. Data was collected using the intra and extra organizational factors instrument, provided based on the previous grounded theory study of the researchers. Intra-organizational factors questionnaire consisted of 58 Likert type statements in eight subscales and two dimensions of frequency (α=0.94) and intensity (α=0.96). Extra-organizational factors questionnaire consisted of eight Likert type statements (α=0.74). Data were analyzed using the SPSS version 14.

Results: The results revealed that the frequency of nurses&apos confrontation with factors related to environment and patients as well as its intensity were more than other factors. Moreover, the intensity of the whole factors was more than its frequency. All the extra- organizational factors were significantly correlated with all intra-organizational factors except for the "absence of employment permission" (P<0.05).

Conclusion: This study explained the importance of intra-organizational factors of a burn center in inducing stress on nurses. In addition to verification of some relationships in the previous mid-range theory, the results of this study also modified some of its aspects. Therefore it added to the existing body of knowledge about organizational factors and job stress in burn units. Moreover, it produced some evidences to use in nursing administration and service, and finally it resulted in some directions to control stress in nurses&apos job.