Background & Aim: This study aimed to assess relationship between perceived benefits/barriers and decisional balance with stages of change for physical activity among high school students in Bandar Abbas, Iran.

Methods & Materials: This cross-sectional study was conducted in high schools of Bandar Abbas, in the south of Iran. A total of 422 high school students were selected. Twenty two participants did not fill out questionnaires completely. A total of 400 questionnaires were analyzed (response rate=94.8%). The perceived benefits/ barriers to exercise and decisional balance were assessed using the Exercise Benefits/Barriers Scale and stages of change were assessed using the Physical Activity staging. Data were analyzed in the SPSS v.16.

Results: The mean age of the participants was 15.9 (SD=1.1) ranging from 14 to 18 years. More than half of the participants (51.8%) were male and 48.2% were female. About half of the participants (49.2%) were engaged in regular physical activities. Fifteen per cent of the participants in the precontemplation stage, 15.8% in the contemplation stage, 20% in preparation stage, 15.8% in action stage, and 33.4% in maintenance stage for physical activity. From precontemplation stage to maintenance stage, the perceived benefits and decisional balance were increased and the perceived barriers was decreased.

Conclusion: The results of this study are in line with the Transtheoretical model. This model can be used as a framework to design interventions for improving physical activity in population.

Background & Aim: Stress is a main problem among nurses which affects their professional performance and personal life resulting in conflict between work and life. The aim of this study was to determine the effect of stress management on work-family conflicts.

Methods & Materials: In a quasi-experimental two-group study, 64 medical nurses were selected randomly to the study from Shahid lavasani hospital in Tehran. Data were gathered using a questionnaire including demographic characteristics, work-family conflict items, and nursing stress scale. Then, the experimental group participated in a 2-day stress management course. The questionnaire was completed by the participants one month later. Data were analyzed in the SPSS v.18.

Results: The mean work-family conflict score was 3.97 in the experimental group at baseline. It declined after the intervention to 3.357 (P<0.001). There was statistically significant difference between the two groups on work-family conflict after the intervention (P=0.007). There was a significant decrease in the job stress from baseline (46.52) to the post-intervention measurement (35.61) in the experimental group (P<0.001). There was a statistically significant difference between the two groups in the mean of job stress after the intervention (P=0.014).

Conclusion: Stress management education declined work-family conflict and job stress among nurses. This education should be used in nursing clinical and educational training programs.

Production of knowledge in nursing and midwifery is essential to develop body of knowledge and improve quality of health care. In recent years, growth rate of scientific publication in Iran was significant as it could be considered as a scientific jihad. Although everyone is proud of this accomplishment, an important question remaining in nursing and midwifery is that how the pace of scientific publication in these fields is consistent with the pace of scientific publication in other scientific fields. This editorial tries to answer this question.

Through searching the Scopus for Iranian papers during 2008-2012 articles, I found 1063 articles in nursing and midwifery indexed in the Scopus. The number of articles was almost doubled per year within the last five years, excluding 2012. It implies coordination of scientific publication in nursing and midwifery with rapid growth of total scientific activities in other scientific fields in the country.

On the other hand, findings showed that only 29 articles (2.7%) published by Iranian nursing and midwifery researchers were review articles. While, in the UK, 13.5% of articles in nursing and midwifery was review articles. This finding along with the importance of review articles as credible scientific evidence for clinical decision-making and improving management procedures shows the necessity of writing review articles by senior researchers in Iran.

Comparing nationality of authors between Iranian articles with the UK articles showed that only 154 Iranian articles (about 10%) had a non-native author while, in the UK articles, about half of the articles had non-English collaborating authors. This finding reveals the necessity for further efforts to international studies.

Through searching the Pubmed and Web of Science for Iranian articles during 2008-2012, we found 390 and 174 Iranian articles, respectively. The lower rate of articles indexed in these two databases, comparing to the Scopus, indicates the necessity of designing and conducting high quality studies and submitting articles in journals indexed in these two databases. Writing articles which observe principles of scientific writing in proper English language can increase the probability of acceptance of articles in more valid journals. Indexing Iranian nursing and midwifery journals in authoritative indexes can increase the rate of scientific publication. It requires more attention of administrators and editors of Iranian scientific journals to this critical issue.

Background & Aim: Job stress can interfere with endocrine function and result in dysfunctional menstrual bleeding patterns. The aim of this study was to assess the relationship between job stress with menstrual bleeding pattern among midwives.

Methods & Materials: In this cross-sectional study, we recruited 150 midwives working in hospitals and health centers of Mashhad using two-stage sampling. Data were collected using a questionnaire including demographic characteristics, Karazek Job Content, a daily diary for menstrual periods to record duration and interval of periods, and the Higham Chart for recording the bleeding amount. The diary was completed for three menstrual periods. Collected data were analyzed using independent t-student, one way ANOVA, Mann-Whitney U, Chi-squared test, correlation test and linear regression in the SPSS-14.

Results: The findings showed that 21.3% of the midwives reported mild job stress, 19.3% had moderate stress and 59.3% reported severe job stress. Mean of the duration of the periods was 7.06 days, the mean interval of the periods was 27.9 days and the mean amount of bleeding was 79.72 cc. There was a significant relationship between job stress and the duration and interval of periods (P<0.001). There was not any significant relationship between job stress with the amount of bleeding.

Conclusion: Our study showed that job stress was related to menstrual bleeding patterns among midwives. It is necessary introduce strategies to decrease job stress and provide professional support for midwives.

Background & Aim: Increase in cancer prevalence results in feeling fear of being diagnosed with cancer among individuals. Understanding concerns of patients diagnosed with cancer helps health care professionals to provide appropriate caring plans. This study aimed to understand main concerns of patients who confront cancer diagnosis.

Methods & Materials: This was a qualitative study with content analysis approach. Fifteen patients with cancer were selected from a specialized hospital, an oncology clinic, and Emdad Center of Cancer patients in Sari using a purposeful sampling method during May 2011 to June 2012. The sample size was completed regarding data saturation. Data were collected using interviews, observations and recording field notes. All interviews were tape-recorded and transcribed verbatim. Data were analyzed using descriptive content analysis and the Granhim and Landmann method.

Results: Three categories including 485 primary codes were emerged. The derived codes were as follows: 1) sever personal and family disturbance 2) imagination of despair and 3) unclear imagination of future. The main code included in all derived codes was life threatening nature of cancer.

Conclusion: The findings showed that life threatening nature of cancer is a source of fear that makes the disease frightening. Clinical staff and nurses should pay more attention to concerns of patients with cancer and design their care plan accordingly.

The harlequin fetus is the most severe type of congenital ichtyosis in which fetus suffers from chapped thick skin, abnormal face appearance, increased or decreased body temperature, respiratory distress, malnutrition, decreased sodium level, convulsion and infection. It happens once every 300 000 births in both genders. Premature birth and death are among consequences of this disorder. The woman was 31 years old. No abnormalities were reported in sonography. The fetus was delivered via normal vaginal delivery. The infant had a harlequin face appearance. The infant was discharged with consent of the parents after two days and passed away 24 hours after discharge.

Background & Aim: Recognizing and modifying organizational commitment and its related factors is important. It seems that nurses&apos attitudes towards learning organizations influence their organizational commitment. This study aimed to determine the relationship between nurses&apos attitudes towards learning organizations and organizational commitment.

Methods & Materials: In this descriptive-correlative study, 719 nurses working in Rasht educational hospitals were recruited to the study. We gathered data using the Porter organizational commitment questionnaire and the Jeong learning organization questionnaire. Data were analyzed using descriptive statistics and the Spearman and t-tests in the SPSS-18.

Results: Most of the nurses were female (94.7%) and registered (35.3%). The mean (SD) age of the nurses was 32.13 (6.98). The mean (SD) of the organizational commitment was 27.10 (42.50). The mean (SD) of the learning organization was 92.72 (10.04). The relationship between the organizational commitment and nurses&apos attitudes towards learning organizations was statistically significant (r=0.482 P<0.0001).

Conclusion: It seems improving nurses&apos attitudes towards learning organizations may result in better organizational commitments.

Background & Aim: Maternal-fetal attachment plays an important role in maternal identity forming. The attachment behavior is different between mothers and most of the reported studies are from Western countries. The aim of this study was to assess maternal-fetal attachment behavior and some related factors among Iranian mothers.

Methods & Materials: This cross-sectional study was carried out in 12 health and medical centers, affiliated to Tehran University of Medical Sciences. Four hundred pregnant women were selected for the study. Data were gathered using two questionnaires. The first one was a self-structured questionnaire and the second one was the maternal-fetal attachment scale. Data were analyzed using the Pearson, Anova and t-test statistical tests. The P<0.05 denoted statistical significance.

Results: Findings showed that the mothers had good attachment toward their fetuses (M=84.72). The race, higher maternal age, higher education, gestational age, planned pregnancy, sex of fetus, and assessing health of fetus had positive effects on prenatal attachment (P<0.05). Tobacco use, multiparity, and high risk pregnancy had negative effects on attachment. There were no relationships between attachment and previous marriage, infertility, abortion, number/type of ultrasound, participation in prenatal classes and healthy baby (P>0.05).

Conclusion: Understanding maternal-fetal attachment behavior could play an important role in quality of prenatal care. Midwives can assess and promote attachment behavior as well as recognize factors influencing maternal-fetal attachment.

Background & Aim: Preterm birth is the main cause of neonatal mortality and morbidity so, prevention of preterm labor is a priority in health care. This study aimed to determine relationship between house works with preterm labor.

Methods & Materials: In this case-control study, 150 term pregnant women (control group) and 150 preterm pregnant women (case group) delivered in Izadi hospital in Qom were selected in 2008-2009. The data were collected using the "physical activity in pregnancy" scale. Data were analyzed using the Chi-squared test, t-test, and logistic regression. The P-value less than 0.05 was considered as significant level and the adjusted OR was reported for all variables. We used the SPSS- 16 for analyzing the data.

Results: According to the findings, there was no significant relationship between house work regarding duration and severity of activity in pregnancy with preterm labor.

Conclusion: There was no relationship between house work in pregnancy and preterm labor. Further studies are recommended.

Background & Aim: Pregnancy can conflict with sexual function that can be affected by physical and psychological changes during pregnancy. The aim of this study was to compare sexual functions between nulliparous and multiparous pregnant women referred to health centers in Eastern district of Guilan.

Methods & Materials: This cross-sectional study was carried out in Guilan during 2009-2010. We used convenient sampling method to select 554 pregnant women. Data were gathered using a questionnaire including demographic characteristics, sexual function and fear of harm to fetus. The SPSS-16 was used to analyze the data by the Mann-Whitney U and Generalized linear models. The level of significance was set at 5%.

Results: There was no significant difference between nulliparous and multiparous pregnant women regarding sexual function in the first and second trimesters of pregnancy (P=0.353, P=0.251). There were significant differences between nulliparous and multiparous pregnant women regarding sexual desire (P=0.002), arousal (P=0.01), orgasm (P=0.01), pain (P=0.02) and sexual function total score (P=0.016). There was significant difference between nulliparous and multiparous pregnant women regarding sexual function (P=0.008).

Conclusion: Sexual counseling and rehabilitation programs should be compiled as part of the comprehensive care of prenatal care especially for multiparous pregnant women.

Background & Aim: Fatigue is a premature symptom in patients suffering from chronic obstructive pulmonary disease. This study aimed to determine effect of the home-based pulmonary rehabilitation on fatigue among patients with COPD.

Methods & Materials: In this clinical trial, 36 patients were recruited among from 100 patients with COPD according to inclusion criteria in Masih Daneshvari hospital in 2010. Participants were allocated into two control and intervention groups using random block sampling. In the intervention group, the pulmonary rehabilitation program was implemented during three educational sessions in three consecutive days. Fatigue was measured using the Fatigue Severity Scale (FSS) before and seven weeks after discharge. Data were analyzed using descriptive and inferential statistical tests (Independent and paired t-test, chi-square and covariance analysis).

Results: At baseline, the mean scores of fatigue were 47.11 and 47.50 in the experimental and control groups, respectively (P=0.902). After the intervention, the mean scores of fatigue reached 21.94 and 54.64 in the experimental and control groups, respectively (P<0.001).

Conclusion: According to results of the study, home-based pulmonary rehabilitation nursing could decrease fatigue in patients with COPD.

  Background & Aim: Access to quality care is important in delivering health services. Patients' safety and satisfaction are indicators of quality of care evaluation. Competent nurses may deliver quality care . This study aimed to investigate the impact of using competent nurses on patients’ safety and satisfaction .

  Methods & Materials: In t his interventional study with non-equivalent control group, we selected 120 patients admitted to the emergency department of Imam Khomeini hospital in 2012 using convenience sampling method . Nursing care for the experimental group (n=40 ) was provided by nurses who had high competency scores and in the control group ( n=80), nursing care was provided by usual emergency department nurses . Data were collected using the patient satisfaction with nursing care quality (PSNCQ), and patient safety inventory. Data were analyzed in the SPSS v.16 using descriptive and inferential statistics . The significance level for all statistical tests was considered at P<0.05 .

  Results: Mean age of the intervention and control groups were 48.1 ( ±12.5) and 40.5 ( ±16.7), respectively (P<0.018). There was a significant difference between the two groups in terms of employment (P<0.009). The two groups were similar in terms of other variables such as gender, marital status, level of education, having health insurance , and the reasons for seeking admission . The results showed that there were significant differences between the two groups in patients’ safety and satisfaction with nursing care (P<0.001). Regression test was used to eliminate the effects of age and job satisfaction the results showed effect of intervention on the patients’ safety and satisfaction with nursing care .

  Conclusion: These findings indicated that using competent nurses in providing nursing care promotes patients’ safety and satisfaction with nursing care. Training nurses focusing on the level of competency is required in scheduling, staffing, and implementing nursing care to enhance safety, patient satisfaction , and quality of care.

  Background & Aim: Hysterectomy is a common gynecologic surgery leading to great concerns in women. This study aimed to determine the effect of foot massage on anxiety level after hysterectomy.

  Methods & Materials: In this double-group randomized clinical trial, 60 women undergone hysterectomy were selected using convenience sampling method and were randomly allocated into two intervention or control groups. Patients in the intervention group received foot massage three sessions during three consecutive days (every session lasted 20 minutes). In the control group, the researcher was only beside the women for 20 minutes. The Spilberger anxiety questionnaire was used to measure the anxiety level. Data were analyzed using repeated measures ANOVA and independent t-test.

  Results: The mean of the anxiety score was not significantly different between the two groups before the intervention (P=0.21). After the intervention, there was significant difference between the two groups in the anxiety scores (P<0.001). There was also significant difference between the two groups in the anxiety scores one week after the surgery (P<0.001).

  Conclusion: Foot massage can reduce anxiety in patients who underwent hysterectomy.

  Background & Aim: Reducing maternal anxiety has a critical role in maternal and fetal mental and physical health. This study aimed to assess the effect of two anxiety reducing techniques including relaxation and maternal-fetal attachment training on anxiety in third trimester and postpartum depression among primipara women.

  Methods & Materials: In this clinical trial, 126 pregnant women were randomly selected and divided into three groups including relaxation training, maternal-fetal attachment skills training, and control group. The participants completed a demographic questionnaire, the Spillberger and Beck questionnaires and written consents at baseline. The participants completed the questionnaires after the intervention too. The one way ANOVA and paired t-test were used to analyze the data. 

  Results: At baseline, the mean total anxiety, state and trait anxiety and depression scores were not significantly different between the groups. The ANOVA showed differences in the mean score of anxiety after the intervention (P=0.03) in the intervention groups. There were statistically significant differences between the attachment and control groups (P=0.01) and the relaxation and control groups (P<0.001) in terms of the mean score of state anxiety. The ANOVA showed a reduction in the mean score of state anxiety after intervention in the attachment (P=0.02) and relaxation groups (P=0.01). There was significant difference after the intervention in the mean score of maternal depression (P=0.002) between the attachment and relaxation groups with the control group (P=0.01, P=0.01 respectively). 

  Conclusion: A ttachment and relaxation trainings can reduce maternal anxiety and post-partum depression. Pregnancy visit is an important opportunity to screen maternal anxiety and prevent post-partum depression using simple and non-expensive training programs.

  Background & Aim: There is little information regarding relationship between maternal dietary pattern and infant anthropometric parameters at birth. This study was carried out to determine relationship between dietary patterns in pregnancy with infants' anthropometric parameters .

  Methods & Materials: In this cross-sectional study, 94 pregnant women (GA: 37-40 weeks) referred to Ahvaz Razi hospital were selected. Anthropometric parameters were measured. The dietary intakes were assessed using a semi-quantitative food frequency questionnaire. Factor analysis was used to identify dietary patterns. Statistical analysis was done in the SPSS. 

  Results: In this study, three major dietary patterns including "healthy", "traditional" and "western" dietary patterns were identified. After adjusting of confounders (age, physical activity, energy intake, pregnancy weight gain and infant sex), the relationship between dietary patterns with birth weight, height and head circumference were exhibited in three models. The relationship between healthy dietary pattern and infant weight, height and head circumference at birth was significantly positive in all models (P<0.05). Western dietary pattern had significant negative relationship with head circumference in the model 1 and 2. Moreover, it had negative relationship with birth weight in the model 1 (P<0.05). Traditional dietary pattern did not show any significant relationship with anthropometric parameters at birth.

  Conclusion: The present study found significant relationship between maternal dietary patterns with anthropometric parameters at birth. Further prospective studies are suggested to confirm the findings.

  Background & Aim: Vascular events and strokes are third leading causes of death worldwide. There are also major causes of human morbidity. Various pharmacological and non-pharmacological treatments are proposed to patients with stroke. The purpose of this study was to determine effect of foot reflexology, as a non-pharmacological procedure, on systolic and diastolic blood pressures in patients with stroke.

  Methods & Materials: In this clinical trial, 68 patients with stroke were selected and divided randomly into two experiment (n=34) and control (n=34) groups. Each patient in the experiment group received foot reflexology for 30 minutes. Data were recorded in the demographic and blood pressure record form. Data were analyzed using t-tests and ANOVAs in the SPSS-20. 

  Results: There were no significant differences between the mean systolic and diastolic blood pressures of patients in experiment and control groups at baseline. The blood pressure was significantly reduced among the experiment group after receiving the foot reflexology (P<0.05). The mean systolic blood pressure was significantly reduced in the experiment group after 10 and 30 minutes of massage and the diastolic blood pressure was reduced significantly in all measured times (P<0.05).

  Conclusion: Results showed positive effects of foot reflexology on reducing blood pressure in patients with stroke. Foot reflexology should be recommended as a supplement treatment in patients with stroke.

  Background & Aim: Cervical cancer is the fourth common cancer worldwide. Pap smear is a usual t est to screen cervical cancer. The aim of the present study was to determine factors associated with Pap smear screening among married women aged 15-49 years in Lamerd health centers based on the Protection Motivation Theory .

  Methods & Materials: In this cross-sectional study, 220 married women aged 15-49 years were selected. Data were gathered using a questionnaire designed based on the Protection Motivation Theory. The questionnaires were completed via individual interviews with the participants. Validity and reliability of the questionnaire were approved. Data were analysed using the Kruskal-Wallis, U-Man Whitney test and c ² in the SPSS-16.

  Results: Most of the participants ( 40%) had a high school diploma and 70% of them were housewives. Most of the participants (65.6%) had used the test once at least. There were statistically significant relationships between the use of Pap smear with the protection motivation against cervical cancer (P<0.001 ), perceived self-efficacy ( P =0.002 ), perceived response efficacy ( P =0.007 ) and perceived costs ( P <0.001 ) .

  Conclusion: Regarding the statistically significant relationships between the constructs of the Protection Motivation Theory and the use of Pap smear screening test among women , it is recommended to design educational programs based on the Protection Motivation Theory to encourage married women for using Pap smear screening test.

  Background & Aim: The effect of perceived stress on students’ health depends on their coping abilities. Resilience is a coping strategy for dealing with the stress. The aim of this study was to determine the relationship between the perceived stress with resilience in undergraduate nursing students .

  Methods & Materials: In this cross-sectional study, 309 undergraduate nursing students of Tehran University of Medical Sciences were selected during the first semester of 2012-2013 using the stratified sampling method. Data were collected using the Perceived stress scale and the Connor-Davidson Resilience Scale (CD-RISC). The data were analyzed using descriptive and inferential statistics in the SPSS-14 . 

  Results: Findings revealed that most of the students (99.3%) had a moderate or high perceived stress. There was a statistically significant relationship between the perceived stress with the resilience (P £ 0.001, r=-0.38) .

  Conclusion: The school of nursing should provide facilities and opportunities for students in their 4-year educational program to learn stress management strategies including increasing resilience ability.

  Background & Aim: Multiple Sclerosis (MS) is a chronic disease of central neurologic system that has a wide effect on neurological function and can cause disability or poor quality of life in patients. The purpose of this study was to assess the effect of the Tai Chi Chuan on quality of life in women with the MS .

  Methods & Materials : This was a clinical trial which covered 34 women with MS in Iran Multiple Sclerosis Society in 2012. The participants were selected using purposive sampling and were randomly assigned to the experiment (n=16) and control (n=18) groups. Intervention was Tai Chi Chuan classes twice a week for 12 weeks. In this study, demographic questionnaire and Multiple Sclerosis quality of life questionnaire (MSQOL-54 scale) were used to collect data . Data were analyzed using the Chi-squared, independent samples T-test, paired samples T-test, Mann-Whitney U and Wilcoxon in the SPSS v.18.

  Results: There were no significant differences between the mean quality of life and its subscales among patients in the experiment and control groups at baseline except for the emotional well-being subscale. After the Tai Chi training intervention, significant differences were found between the two groups in the mean of some subscales of the quality of life including role limitation due to emotional problems, pain, emotional well-being, energy, social function, health distress, overall quality of life, physical health composite score, mental health composite score and also total quality of life score (P<0.05).

  Conclusion : The results suggested that Tai Chi Chuan could be an alternative exercise intervention to increase quality of life in patient with the MS.

  Background & Aim: An important goal of nursing care in the Neonatal Intensive Care Unit (NICU) is to provide holistic care as well as the best possible outcome. Understanding perceived needs of mothers is valuable to achieve these goals. This study aimed to compare perceptions of nurses and premature infants’ mothers about mothers’ needs in the NICUs.

  Methods & Materials : This was a cross-sectional study in which 63 nurses and 63 mothers with premature infants were selected from the NICUs of four educational hospitals affiliated to the Mashhad University of Medical Sciences through stratified sampling method in two months. Data were gathered using the NICU Family Needs Inventory of Ward and were analyzed using descriptive-analytical statistical methods in the SPSS v.16.

  Results: Among the subscales related to family needs, the following items were reported to be important by mothers: Proximity (95.3%), Assurance (94.1%), Information (91.1%), Support (79.7%) and Comfort (72.8%). On the other hand, nurses believed that the following items were the most important needs of the mothers: Assurance (80.3%), Proximity (75.2%), Information (70.8%), Comfort (66.3%) and Support (64.8%).

  Conclusion : According to study findings, nurses should periodically assess needs of the mothers in the NICUs to be aware of the actual needs instead of placing subjective assumptions on mothers needs. This can improve effective communication and interaction with mothers and enhance satisfaction of the mothers with care.