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Background & Aim: Urinary incontinence is a common disorder in women. Pelvic floor muscle exercise is one of the effective treatment methods. Self-efficacy is considered an effective and strong predictor of willingness to perform and continue these exercises. In Iran, there is no appropriate tool for assessing self-efficacy. So this study was performed to determine the psychometric properties of the Broome scale in women with urinary incontinence.
Methods & Materials: A psychometric study of the Broome scale was conducted on women with urinary incontinence who referred to health centers affiliated to Tehran University of medical sciences in 2015.In this study, following processes were implemented: translation, back translation, face validity, content validity using CVR and CVI, reliability using Cronbach’s α coefficient, and construct validity using explanatory factor analysis.
Results: The face validity was confirmed through the modification of ambiguous items based on the patients’ views. Content validity (CVR= 0.8 and CVI= 0.8 to 0.9) and reliability (Cronbach’s α= 0.96) were also confirmed. Explanatory factor analysis showed two factors with eigen value more than 1 including pelvic floor exercise self-efficacy in usual and special situations. These factors explained 82.08 percent of the total variance.
Conclusion: The reliability and validity of the Broome scale were confirmed for using by Iranian women with urinary incontinence, and this scale can be used to measure these women's self-efficacy in performing pelvic floor exercises.
 

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Background & Aim: Spiritual care along with other nursing interventions balance body and soul. This study aimed to determine the effect of spiritual care on death anxiety in hemodialysis patients with end-stage of renal disease.
Methods & Materials: A clinical trial (IRCT2016308226961N1) was performed in Hamadan’s Shahid Beheshti and Besat hospitals in 2016. A total of 60 hemodialysis patients with end-stage of renal disease were randomly assigned into two groups of intervention (30 patients) and control (30 patients). In the intervention group, the spiritual care program consisted of protective care, supporting the patient’s rituals and using the support systems, was performed in hemodialysis ward at the patient’s bedside. The control group only received routine nursing care. The Templar’s death anxiety questionnaire was completed by both groups before and after the intervention. Data were analyzed by descriptive and inferential statistics using the SPSS software version 16.
Results: The average score for death anxiety before the intervention between the intervention group (8.10±2.26) and control group (8.53±2.47) had not significant difference (P=0.482), while the average score for death anxiety after the intervention had statistically significant difference (P=0.004) between the intervention group with median value of 8.0 (6.00-8.25) and control group with median value of 9.0 (7.00-10.25), and the patients’ death anxiety reduced in the intervention group.
Conclusion: Spiritual care program reduced death anxiety in hemodialysis patients with end-stage of renal disease. Nurses can use spiritual care program to reduce patients’ death anxiety.
 

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Background & Aim: The premenstrual syndrome (PMS) is a set of physical and psychological symptoms that occurs periodically and affects women’s social and individual functionings. This study aimed to investigate the effect of stress management group counseling on the symptoms of premenstrual syndrome.
Methods & Materials: This semi-experimental study (IRCT2016052127994N1) was conducted on 44 students with PMS (22 in the intervention group and 22 in the control group) from Zanjan University of Medical Sciences in 2016. Data were collected using a demographic characteristics form and premenstrual symptoms screening test (PSST). Descriptive and inferential statistics including independent t-test, Chi-square, ANCOVA and repeated measurement test were used for data analysis via the SPSS software version 21.
Results: Before treatment, the mean scores of mood-behavioral symptoms, physical symptoms and the impact of symptoms on life had not any significant differences between the two groups. At the first month after treatment, mood-behavioral symptoms (P<0.001) and the impact of symptoms on life (P=0.007) were different between the two groups. Two months after the intervention, the mean scores of mood-behavioral symptoms in the intervention group (53.2±4.84) were significantly different from those in the control group (70.2±4.81). There was a significant difference in the mean score of physical symptoms between the intervention group (36.7±5.87) and control group (64.9±7.84). Also, the mean score of the impact of symptoms on life had a significant difference between the intervention group (36±4.73) and control group (58.3±2.73) (P<0.001).
Conclusion: Stress management group counseling is effective in reducing the symptoms of premenstrual syndrome, and it can be used as a non-pharmacological method with no side effects.
 

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Background & Aim: Nurses play an important role in the health system and their turnover disrupts its performance. The aim of this study was to investigate intention to turnover and its relationship with healthy work environment among nursing staff.
Methods & Materials: This cross-sectional study was conducted on 295 nursing staff from Imam Khomeini hospital complex in Tehran in 2016. Nurses were selected by the stratified random sampling with a proportional allocation, and completed a demographic data form, the Healthy Work Environment questionnaire and the Anticipated Turnover Scale (ATS). Data were analyzed by descriptive statistics, independent t-test, one-way ANOVA, Pearson/Spearman correlation coefficient and multiple linear regression tests using the SPSS software version 20.
Results: The mean score for the intention to turnover was 36.21 (SD=4.38) ranged from 12 to 60. “Authentic leadership” and “skilled communication” domains obtained the highest (9.60±3) and lowest (8.97±2.74) scores respectively. There was poor correlation between the meaningful recognition domain and the anticipated turnover score (r=-0.135, P=0.024). In addition, the anticipated turnover score was significantly higher in male nurses than in female nurses (P=0.023).
Conclusion: Although there was no relationship between anticipated turnover and healthy work environment in this study, considering the importance of nurses’ recruitment and retention, there is a need to investigate the reasons for turnover, including characteristics of work environment, and take necessary measures.
 
 

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Background & Aim: Prostate carcinoma is the most common cancer among men and the second lethal cancer. The present study aimed to investigate the prostate cancer screening behaviors and its related cognitive psychological factors among men over 50 years of age using the health belief model.
Methods & Materials: This cross-sectional study was performed on 300 men over 50 years of age in Hamadan, selected by cluster sampling method. Data collecting tool was a questionnaire consisted of three sections: demographic information, prostate cancer screening behaviors and health belief model constructs. Data were analyzed using Chi-square test, Fisher's exact test and logistic regression through the SPSS software version 18.
Results: Findings revealed that 12% and 9% of the participants reported having a digital rectal examination (DRE) and prostate specific antigen (PSA) testing respectively. Perceived benefits and perceived barriers were the predictors of prostate cancer screening behaviors (P<0.05). Also, there was a significant relationship between prostate cancer screening behaviors and age and a history of prostate problems (P<0.05).
Conclusion: Given that the health belief model is effective in predicting prostate cancer screening behaviors, using these findings in designing educational interventions for people over 50 is recommended.
 

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Background & Aim: Diabetes is the most common metabolic disease that needs self-management. The aim of this study was to compare the effects of loss- and gain-framed messages on knowledge, self-efficacy and self-management in diabetic patients.
Methods & Materials: In this randomized clinical trial (IRCT2016122931653N1), 112 patients with type 2 diabetes referred to the 17th Shahrivar Diabetes clinic in Borazjan in 2017, were divided into three groups including loss-framed message, gain-framed message, and control. The data were collected by questionnaires in three steps; before, one week and three months after intervention. Chi-square test, one way analysis of variance and repeated measures analysis of variance were used to analyze the data on the SPSS software version 22.
Results: Before the intervention, mean scores for knowledge, self-efficacy and self-management in loss-framed messages group and gain-framed messages group were lower than control. One week and three months after the intervention, mean scores for knowledge, self-efficacy and self-management in both the loss-framed messages and gain-framed messages groups showed a significant increase compared to the control group (P<0.001). One week after the education, self-management score in the gain-framed messages group was 102.26±11.20, in the loss-framed messages group was 111.53±13.73 and in the control was 88.75±11.41. Three months after the education, self-management score in the mentioned groups were 105.58±11.80, 108.72±15.39 and 88.49±13.51, respectively.
Conclusion: The results of this study showed that designing and implementing educational programs based on loss-framed messages and especially gain-framed messages can improve knowledge, self-efficacy and self-management behavior in diabetic patients.
 
 

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Background & Aim: Vaccination is the most common painful procedure in childhood. This study aimed to compare the effect of Hugo point massage with and without ice on the injection-related pain of pentavalent vaccine in infants.
Methods & Materials: This study is a blind randomized clinical trial (IRCT2016052127982N1) conducted on 90 healthy, two-month old infants with normal weight, referred to Gonabad Fayazbakhsh health center to inject pentavalent vaccine in 2016. Infants were randomly assigned into three groups including 1) massage on Hugo’s point with ice 2) massage on Hugo’s point without ice and 3) control group. Data collection tool includes demographic information form and infant’s pain measurement tool. Data were analyzed using Chi-square test, Kruskal–Wallis test, analysis of variance and post-hoc Tukey HSD through the SPSS software version 16.
Results: There was no significant difference in pain intensity before vaccination between three groups. After vaccination, mean pain score for the first group was 7.70±1.26, for the second group was 8.03±1.06 and for the third group was 9.23±0.89. Also, crying duration in the first group was 35.03±23.12, in the second group was 40.39±21.62 and in the third group was 61.28±24.00. Both variables in the intervention groups were significantly lower compared to the control group (P<0.001) but there was no significant difference between the two intervention groups (P=0.586 and P=0.654).
Conclusion: Hugo’s point massage with and without ice can reduce the injection-related pain of pentavalent vaccine in infants and be used as a simple non-pharmaceutical method available to control vaccination pain.
 

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Health (hygienic) literacy is a cognitive skill and an important and effective issue in the healthcare system that was first proposed in 1974 in an educational panel about health education. Since then, this concept has been discussed by the researchers in various fields of literacy and health, and many definitions have been presented for it. Usually, health literacy is defined as a wide range of knowledge and skills in accessing, appraising, understanding and applying health information (1).
The importance of health literacy impact on the health outcomes of the patients has been well recognized and it has an important role in individual’s decision-making regarding their health needs (2). Health literacy as a social and cognitive skill has various aspects including accessing, appraising, understanding and applying. The ability to understand the educational content, as one of its aspects, has a significant importance in the patients (3-6). In recent years, health literacy has been recognized as an important skill that patients require for making an appropriate health decisions in difficult situations they encounter. Improving patients’ health literacy would cause outcomes such as increasing the patients’ potential to make informed decisions, decreasing health-threatening risks, increasing prevention of the diseases, improving patient safety, and improving quality of life and patient care (7-9).
To educate people, usually their general literacy would be considered, not their health literacy; while there is a significant difference between general literacy and health literacy. General literacy means having the ability to read and write and having basic skills. In contrast, health literacy is defined as a cognitive and social skill determining the individuals’ ability to access, understand, and apply information in order to promote health (10). Studies have shown that limited health literacy is associated with various complications in different aspects of health including lack of access to appropriate health services, less willingness to follow up treatments, less compliance with medication, increased number of visits to the emergency ward, increased duration of hospitalization, and increased mortality rate, and it has a significant effect on using healthcare services (3-6).
Furthermore, the negative economic effect of low health literacy on the patients and healthcare system could not be ignored. These issues would indicate the need for paying more attention to individuals’ health literacy.
According to a study conducted by Montazeri et al in Iran, it has been revealed that half of the Iranian population has a limited health literacy and this limitation is more common in the vulnerable groups such as the elderly, housewives, unemployed people and those with lower education levels; this would put them at more health risks (2). Also, results of various studies have shown that some health information is not appropriate for the audience and would not address their needs; whereas the effect of limited health literacy could be improved using appropriate health information. So, the challenging issue regarding these individuals is how to train them (regarding understanding health information); there are various strategies for resolving this issue such as limiting the information provided at each patient’s visit, avoiding technical terms, speaking slowly, finding educational content tailored to individuals’ ability to read, using pictures for explaining important concepts, encouraging people for asking more questions and assessing individuals’ understanding of the education provided using teach back and show me methods (11).
In this regard, in 2011, Centers for Disease Control and Prevention (CDC) designed the Health Literacy Index as a tool for providing appropriate educational content based on people’s health literacy. This comprehensive checklist comprises 63 items organized into 10 criteria; its criteria and items are shown in table 1. According to this checklist and based on its ten criteria, the educational process (content, procedure and evidence) would completely be evaluated to limit the effect of health literacy on the understanding of information provided to individuals (12).
 
Table 1. The criteria of the health literacy index

Criterion	Items	Evaluated subject
Plain language	8	Writing style (short and easily readable sentences) Terms (avoiding technical terms) numbers and data (ease in understanding the content)
Clear purpose	8	Precision, summaries and reviews Number of key points purpose of material (purposiveness) Using visual elements in the educational content
Supporting Graphic	6	Explanatory labels Graphic and images of the educational content in relation with the text to help the understanding of the abstract concepts
User involvement	7	Interactive strategies (the level of attention received by the audience and the extent of their active participation through the column of counseling, answer and question, games or competitions and storytelling narrations) Audience response
Skill-based learning	3	Focus on behavioral skills (modifying a health behavior and providing examples related to this modification)
Audience appropriateness	6	Match between audience and material (cultural and social appropriateness to the audience in terms of their experiences, values and beliefs) Audience identified
Instructions	6	User instructions Instructions for using the educational content regarding its technicality, applicability and comprehensiveness
Development details	3	Authors’ contact information Recent review of the studies
Evaluation methods	13	Process, formative and outcome evaluations
Strength of evidence	3	Evaluation findings

 
Andrade and colleagues studied the impact of using this index in providing educational materials for falling in the elderly. The results of this study showed that all the educational information is not suitable for audience and does not meet their needs. However, with the help of Health Literacy Index, it is possible to provide educational materials that are fit for the level of health literacy of elderly (7).
Due to the Low health literacy is very common particularly in the elders, it is crucial to provide educational materials that are consistent with the level of health literacy in target groups. Regarding the small number of studies have been conducted on the impacts of using health literacy index, It is imperative that the researchers in the related fields provide empirical evidence for its efficiency and effectiveness.
 
 
 

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Background & Aim: In pregnancy following stillbirth, the parental relationship and attachment to the dead child are denied, and this can impair the mother’s attachment to the new child. The present study aimed to determine the effect of cognitive behavioral training on maternal-fetal attachment in subsequent pregnancy following stillbirth.
Methods & Materials: This quasi-experimental study was performed on 100 pregnant women with the history of stillbirth, referred to health centers in Zahedan in 2017. Mothers were selected using convenience sampling and assigned into two groups of 50 each. Data were collected by a demographic questionnaire and the Cranley maternal-fetal attachment scale. After pre-test, the intervention group received 4 sessions of cognitive behavioral training during 4 weeks. After 8 weeks, the post-test was performed for two groups and data were analyzed using independent t-test, chi-square, Fisher's exact and ANCOVA tests through the SPSS software version 21.
Results: The mean score for maternal-fetal attachment was not significantly different in the baseline but was significantly higher in the intervention group (92.36±11.89) than in the control group (80.90±16.36) after the intervention (P<0.001). The adjustment for the pre-test score, optimism and visit numbers in ANCOVA the mean score for maternal-fetal attachment in the post-test were still significant (P<0.001).
Conclusion: Considering the effect of cognitive behavioral training on the promotion of maternal-fetal attachment, it is recommended that this training be integrated into the care program for pregnant women with a history of stillbirth.
 

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Background & Aim: Waterpipe smoking during pregnancy is a health problem, and interventions must be designed for its cessation. The present study was conducted to examine the effect of motivational interviewing (MI) on self-efficacy to quit hookah smoking in pregnant women.
Methods & Materials: The randomized clinical trial was conducted on 140 pregnant women who smoked hookah and lived in the marginal settlements in Zahedan in 2017. The convenience samples were randomly assigned to intervention and control groups. Data were collected using demographic characteristics and self-efficacy to quit hookah smoking questionnaires. Participants in the intervention received four group sessions of MI, while those in the control only received usual recommendations for quitting hookah smoking. The post-test was performed eight weeks after the completion of the intervention. Independent t-test, paired t-test, Chi-square, and Analysis of Covariance (ANCOVA) were used for data analysis through the SPSS software version 21.
Results: The demographic characteristics and gestational age of women were comparable between two groups, but the duration of hookah consumption in the intervention was more than the control (P=0.008). While the mean score of self-efficacy of two groups in pre-test was alike, in the post-test the score of self-efficacy in the intervention (60.85±7.25) was higher than the control (22.77±3.79) (P<0.001).
Conclusion: Given that MI approach has a positive effect on self-efficacy to quit hookah smoking, it is suggested that this counseling strategy is integrated into health care programs for pregnant women smoking hookah.
Clinical trial registry: IRCT201609240299954N5
 

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Background & Aim: Given the importance of the physical and mental health of pregnant women and the negative effects of worry on maternal and fetal health, identifying the factors affecting the reduction of worries is necessary. Therefore, the present study was performed to determine maternal worries and their relationship with coping strategies.
Methods & Materials: This analytical, cross-sectional study was performed on 465 pregnant women 14-40 weeks referred to health centres in Hamadan in 2015-2016. Data were collected using the obstetric and socio-demographic characteristics questionnaires, the Billings and Moos Coping Strategy and the Cambridge Worry Scale (CWS). Descriptive and inferential statistics including Spearman correlation and One-way analysis of variance were used to determine relationship between worries and coping strategies. A p-value <0.05 was considered significant.
Results: The mean (SD) of worry score was 25.8 (15.1), with achievable scores of 0 to 80. Thus, 67.3% were not worried, 30.1% expressed a small amount of concern and 2.6% had a great deal of concern. The comparison of the total score of coping strategies and the two subscales of problem-focused and emotion-focused coping strategies in the three groups indicated that only the emotion-focused strategy score was different in these groups (P<0.005).
Conclusion: The findings of the study indicate that there is a direct correlation between maternal worries and use of emotion-focused strategy. Therefore, it is suggested that midwives help pregnant women to reduce worry by training coping strategies in order to increase the use of problem-focused strategy.
 

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Background & Aim: Family-centered care is a concept for describing the approach to caring for children and their families in health services and its main element is the involvement of parents in child care. This study aimed to compare the perception of family-centered care from the perspectives of nursing staff and mothers of hospitalized children in children’s wards.
Methods & Materials: This study was a cross-sectional study conducted on 82 mothers of hospitalized children and 60 nurses working in children’s wards of Afzalipour hospital in Kerman in 2017. In this study, a questionnaire on the family-centered care perception from the perspectives of nurses and mothers was used for data collection. Data were analyzed through SPSS software version 20 using t test, analysis of variance and Pearson correlation coefficient.
Results: Average scores for the perception of family-centered care from the perspective of nurses (3.17±0.79) and of the mothers (2.47±0.85) had significant differences between the two groups (P<0.001). In two groups, the highest average was related to the area of cooperation and the lowest average was related to the support area.
Conclusion: Findings showed nurses’ and mothers’ perceptions of family-centered care were positive but nurses have significantly more positive perception than mothers. This can be promising and nursing staff are required to be diligent about mothers’ participation in care so that the child receives better care.
 

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Background & Aim: The most common complication of peripheral intravenous catheter use is phlebitis. This study aimed to determine the effect of Arnebia Euchroma on the prevention of peripheral intravenous catheter-related phlebitis.
Methods & Materials: A double-blind randomized clinical trial done on 120 patients hospitalized in CCU and heart wards of Shariaty hospital in Tehran in 2017. The convenience samples were allocated into the two groups of control and intervention. After the insertion of an IV catheter (by sterile technique, in the site of upper limb without any signs of phlebitis), Arnebia Euchroma poultice for the intervention group and placebo poultice for the control group, was applied to the skin in the distal portion of IV catheter at 3×3 cm from the catheter insertion site. Then, this site was covered by sterile dressing. The patient was monitored every 12 hours by removing the dressing, and the poultice was applied again. Data were analyzed by descriptive and inferential statistics using the SPSS software.
Results: The two groups were homogeneous in terms of age and sex, but were different in the number of hospitalization days. While no phlebitis was observed in the baseline, there was a significant difference between the two groups (42.37% for intervention group vs 0% for control group) at the hour of 12. By adjusting the effect of hospitalization days, the difference was still significant (P<0.001).
Conclusion: Arnebia Euchroma poultice was effective in the prevention of phlebitis. Thus, this poultice can be used when inserting a peripheral intravenous catheter.
Clinical trial registry: IRCT2017012432147N1
 

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Background & Aim: One of the important issues that affects the quality of hemodialysis is recirculation. Some researchers have suggested that the direction and distance of needle cannulation can affect the amount of recirculation. Therefore, this study aimed to investigate the effect of direction and distance of needle cannulation on recirculating of arteriovenous fistula in hemodialysis patients.
Methods & Materials: This clinical trial was performed on patients referred to the dialysis ward of Kamkar-Arabnia hospital affiliated to Qom University of Medical Sciences in 2016. The amount of recirculation was measured in 22 patients by urea based method, in four consecutive sessions. In each session, the distance and direction of the needles were three centimeters in opposite direction, three centimeters in same direction, six centimeters in opposite direction, and six centimeters in same direction. Data were analyzed using Stata and GEE test.
Results: The average age of participants was 53(16±0.75) years. In 41 dialysis cases (out of 88), the amount of recirculation was higher than 10%. The odds ratio for more than 10% recirculation for a distance of three centimeters compared to six centimeters was 2.05 (1.07-3.93) and for same direction compared to opposite direction was 1.98 (1.03-3.78).
Conclusion: The results of this study showed that the insertion of needles at a distance of six centimeters in opposite position had the lowest chance of recirculation. Therefore, the attention to proper insertion of needles can be effective in reducing recirculation and increasing the quality of dialysis.
Clinical trial registry: IRCT2016082929581N1
 

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Background & Aim: Anxiety is one of the most common psychiatric disorders in the family of patients with traumatic brain injury. This study aimed to determine the effect of providing information about the patient’s condition on the anxiety level of the family members of hospitalized patients with traumatic brain injury.
Methods & Materials: This quasi-experimental study was conducted on 90 family members of traumatic brain injury patients admitted to Shahid Bahonar hospital in Kerman in 2016. The participants were selected by the consecutive sampling method and were assigned to intervention and control groups. In the intervention, the participants were informed by the nurse about changes in the patient’s condition during the first three days of admission to intensive care unit. During this period, the control received routine care. Data collection tool was the Spielberger anxiety inventory. Independent and paired t-test were used to compare the mean scores of anxiety using the SPSS software version 16.
Results: There was no statistically significant difference in the mean scores of overt, covert and general anxiety between the two groups before the intervention (P>0.05). However, after the intervention in the experimental group, the mean scores of overt anxiety (45.51±7.26), covert anxiety (45.42±6.51) and general anxiety (90.93±12.72) decreased (P<0.05) compared to the mean scores of overt anxiety (49.22±9.42), covert anxiety (49.02±9.15) and general anxiety (98.24±17.67) in the control group.
Conclusion: Providing planned information on changes in the condition of hospitalized patients with traumatic brain injury can reduce the anxiety of family members of these patients.
Clinical trial registry: IRCT20180206038642N2
 

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The World Health Organization (WHO) has introduced palliative care as a way to improve the quality of life of patients with incurable diseases and their families. This care begins with the diagnosis of the disease, and continues throughout the illness (1). Palliative care improves the quality of life of patients with life-threatening diseases and their families. Its purpose is to relieve suffering through the identification, evaluation, and relief of pain and other physical, psychosocial and spiritual problems (2).
Palliative care is required for many diseases. According to reports, every year about 40 million people in the world need palliative care, but only 14% of them receive it, of whom 78% live in low-income or middle-income countries. According to the World Health Organization, patients who require palliative care services, suffer from cardiovascular diseases (38.5%), cancer (34%), chronic pulmonary diseases (10.3%), AIDS (5.7%), and diabetes (4.6%). Other patients with diseases, such as dementia, kidney failure, multiple sclerosis, Parkinson’s disease, rheumatoid arthritis, neurological diseases, congenital anomalies, and resistant tuberculosis may also need palliative care services (1). Palliative care can be offered to patients through various models, including hospital-based palliative care, hospice-based palliative care and home-based palliative care (3). Studies have shown that home-based palliative care has a very beneficial effect on the physical, mental, psychological, social and economic dimensions of patient’s life, and reduces the cost of health system, shortens the length of hospitalization, reduces hospital complications and prevents hospital readmission (4-6). This type of care also facilitates the continuity of post-discharge care and helps patient to easily benefit from the facilities of different centers (7). On the other hand, most people prefer to receive care at their homes with their families (8). Studies have shown that home-based palliative care is clinically and economically effective and leads to the satisfaction of patients and their families. Also, the World Health Organization in 2014 has introduced home-based palliative care as one of the main elements of the health systems all around the world (1). However, reports indicate that many countries in the world do not have palliative care programs in their health care system (7), and the lack of government support for palliative care services, lack of prepared professional staff to provide palliative services, limitation in access to narcotic analgesics, resource constraints, lack of policy-makers’ familiarity with palliative medicine, the negative attitude of society towards palliative care and socio-cultural issues have been mentioned as barriers to palliative care in the world (1, 9,10).
Iran’s health system is faced with increasing number of chronic patients and shortages of manpower and ICU beds in health centers. Most patients with life-threatening diseases in Iran are frequently admitted to hospital during the last days of their lives. Despite the shortage of hospital beds, especially in the critical care units, these patients occupy these beds and receive specialized medications until the end of their lives and eventually many of these patients die on ICU beds in hospital (11). While in many cases, hospitalization of incurable patients in critical care units does not have any positive effects on patients’ recovery, and is considered a futile care (12), which increases the costs of health system, poses financial burden on patient’s family, and leads to dissatisfaction and work burnout in healthcare staff (13). On the other hand, many of these patients prefer to spend the last days of their lives at home with their family and be in close contact with their relatives. Evidence suggests that palliative care in Iran is only offered in isolated and limited centers. Most patients are deprived of this kind of care, and home-based palliative care does not have any place in Iran’s health system (14). Patients with incurable conditions who require palliative care services are lost in the system, and in most cases do not receive proper and timely services they need (15). Also, the traditional attitude of healthcare staff towards the management of incurable conditions, the lack of transparency in the protection of healthcare staff against discontinuation of unnecessary treatments or unreasonable expectations of patients and their families, as well as social and cultural differences are barriers to the promotion of palliative care in Iranian society. Another problem in providing home-based palliative care services is the defect in the payment process and insurance coverage of end-of-life patients (16,17). Therefore, given the high prevalence of chronic and incurable illnesses, the increasing number of elderly population, limited critical care beds, shortages of human resources, limited financial resources and equipment in health centers, and taking into account the benefits of home-based palliative care, healthcare system authorities should consider this care method to be one of the important priorities of the health system so that patients can maintain their quality of life and also experience peace during the last days of their lives. Considering the limited research in this field, further research is required on the management of various dimensions of home-based palliative care in order to provide suitable models for the provision of home-based palliative care services in Iran.
 

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Background & Aim: Insufficient health literacy is a major barrier to self-care in patients with heart failure. The purpose of this study was to determine relationship between health literacy and self-care behaviors in patients with heart failure.
Methods & Materials: In this correlational study, 100 patients with heart failure who were referred to teaching hospitals in Qom were selected through the convenience sampling method in 2017. The data collection tools were the heart failure-specific health literacy scale, the self-care of heart failure index (SCHFI) and the hospital anxiety and depression scale (HADS). Data were analyzed using descriptive statistics, the Pearson’s correlation coefficient and multiple liner regression analysis on the SPSS software version 16.
Results: More than half of the patients had a moderate level of self-care. The highest and lowest health literacy scores were respectively related to critical health literacy (10.47±2.56) and functional health literacy (9.14±3.74). The result of multiple regression analysis showed that only functional health literacy was a better predictor of self-care behaviors in patients with heart failure (β=0.30, P=0.014).
Conclusion: The findings showed that functional health literacy was an important predictor of self-care behaviors among patients with heart failure. It seems necessary to design effective interventions in order to improve patients’ skills for analyzing functional information and decision making in self-care.
 

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Background & Aim: Empowerment is a dynamic, positive, interactive and social process, leading to the improvement of quality of life (QOL) in patients with chronic disease. The purpose of this systematic review and meta-analysis was to determine the effect of family-centered empowerment model (FCEM) on QOL in adults with chronic diseases.
Methods & Materials: By searching FCEM in Persian databases including SID, MagIran, IranMedex, IranDoc, and googlescholar, Scopus, Pubmed, Web-of-science, Proquest, and Sciencedirect, all relevant studies were extracted. The methodological quality of the papers was examined using Cochrane-risk-of-bias. Data analysis was carried out through the random effects model and heterogeneity by I² index. The data were analyzed using the STATA software version 11.0.
Results: Of the 647 initial studies, only 8 studies examined the effect of FCEM on the QOL in adult patients using SF-36. The pooled standardized mean difference of the 8-dimensions of QOL included: social-functioning (1.781), Physical role limitation (1.416), bodily pain (0.987), general health (1.352), social functioning (1.010), general health (1.122), emotional role limitation (0.656), and vitality (1.361).
Conclusion: The implementation of FCEM had a significant effect on the 8-dimensions of QOL based on the SF-36 questionnaire. The implementation of FCEM is recommended in order to improve the QOL of adult patients with chronic disease.
 

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Background & Aim: Couples face many problems in pregnancies following In vitro fertilization (IVF) compared to normal pregnancies. The majority of studies have focused on women, and men have received less attention. So, this study aimed to explore the perceptions of men awaiting the first child following IVF.
Methods & Materials: This qualitative study was carried out in Shahid Motahari hospital in Urmia during 2017-2018. Data were collected using 19 individual in-depth semi-structured interviews. Participants were selected among men whose wives got pregnant by IVF, through purposeful sampling, until data saturation was reached. Data were analyzed through conventional content analysis approach using the MAXQDA software version 10.
Results: Four categories of "hope and fear of treatment outcome", "fear of social stigma", "financial concern", and "need for participation and training" were emerged from data analysis.
Conclusion: Men whose wives got pregnant through IVF have expectations and needs that must be addressed. On the one hand, the men are concerned about the social stigma of infertility and donation, the outcome of treatment, and the economic problems of treatment, and on the other hand they expect to be involved in the process of treatment and prenatal care.
 

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Background & Aim: Needlestick injury is an occupational risk. Medical university students are more likely to prone to this kind of injury in comparison to other students due to their limited knowledge, skills and clinical experiences. The present systematic review and meta-analysis aimed to estimate the prevalence of needlestick injury in medical university students in Iran.
Methods & Materials: In the present systematic review and meta-analysis, 22 papers written by Iranian researchers published in Persian and English, were included without time limitations. The articles were found by searching Iranian (Magiran, Scientific Information Databases (SID) and IranMedex) and international (Google Scholar, Web of Science, PubMed and Scopus) databases. Data were analyzed using meta-analysis method and the random effects model.
Results: The overall prevalence of needlestick injury among medical university students was 47% (95% CI: 39-55). There was no relationship between vaccine coverage, age of samples, and sample size with the prevalence of needlestick injury. The prevalence of needlestick injuries significantly decreased with increase in the publication years of articles (P=0.03), and significantly increased (P=0.049) with lack of reporting.
Conclusion: Considering the high prevalence of needlestick injury in the students of medical sciences universities, it is of great necessity to design educational programs focusing on the proper use of sharp and cutting instruments as well as the importance of reporting and modifying professional behavior such as avoiding the reinsertion of needles in order to reduce the incidence rate of needlestick injuries.