Background & Aim: Primary dysmenorrhea is highly prevalanet and causes much work loss and discomfort. Regard to critical role of women in family and society it is necessitate that to betaken proper investment for improving their mental and physical health.

Methods & Materials: In this study 100 student suffer from primary dysmenorrhea were selected by targeted sampling and take their in two equal groups, case (acupressure group) and control (sham group) randomly. Initially in addition to personal identity, we recorded their history of menstruation, physical activity, vital signs, menstrual pain intensity. Treatment was given during two consecutive menstrual cycles coincident with pain and bleeding by acupressure in case group, and pressure in control group in two time of 15 minutes and 30 minutes interval during 6 hours after onset of dysmenorrhea in each cycle. In case group the treatment was given on lumbar, abdomine, foreleg and ear points, and in control group on placebo points by single blind method. Pain rating was done with use of V.A.S (Visual Analgesic Scale) in 30 min, 1 hr, 2hr and 3hr interval after treatment.

Results: The results showed that mean pain scores before (8.21.6) and after (2.61.3) in case group have significant difference. Also there is significant difference between mean pain score before and after treatment in case and control groups (p<0.001).

Conclusion: This study showed that acupressure at specific points in lumbar, abdominal, ear reduce the pan intensity and psychic and mental due to primary dymenorrhea. Therefore acupressure could be used as a non-medicament, inexpensive and safe method in decrease of pain of dysmenorrhea in girl and women.

Background & Aim: Disorders of intelligence is associate with lack of growth in physical, social and educational dimensions. Also it can cause many problems for patient and their family in context of care and maintenance of patient. Psychiatric nurse recognize this problems and helping to resolve them. They can play the effective role to acceptance of mentally retarded adolescent by their family.

Methods & Materials: This research is a descriptive analytical cross-sectional study. Out of research population 406 subject were selected among sponsors of mentally retarded adolescent through convenient sampling (199 subjects had accepted their young adults in their families “daily class” and 207 subjects who had repelled their mentally retarded children “nightly class”) Data were collected through interview and filling questionnaire. And then were analyzed through SPSS software by using descriptive statistics and statistical tests like χ2 and t-test (in depended group).

Results: Findings of this research showed that among demographic characteristics of clients like age, level of education, causes and extent of mental-retardedness of Adolescents and acceptance by the family there is a significant correlation (p<0.05). There are also meaningful relation among individual factor such as ability to wear clothes, ability to feed, observing individual hygiene, precedence of lack of control on urine and stool, precedence of sleep disorder in form of insomnia, record of sensitivity and quick resentment, affliction to psychological disease, the problem of setting up communication with others, profile of hurting oneself and others, making noise and disturbance for others and background of escaping from home, and acceptance of mentally retarded young adult by family (df=1 p<0.001).

Background & Aim: Regarding to increasing of life expectancy, Women spend a greater proportion of their life in menopause that is associated with complications and makes disability for them. One of the safe treatments for these complications is herbal therapy.

Methods & Materials: This research is a semiexperimental study. Randomized cluster sampling method was used to select 50 menopaused women ranging from 45 to 55 years old. Experimental group used vitagnus (40 drops daily) for three months. The data was collected by interviewing and a structured questionnaire and daily diary. The data was analyzed by descriptive (percent, mean, standard deviation) and inferencing (2, t-test, Mcnimar, repeated ANOVA) statistical methods by SPSS software.

Results: The results showed a significant reduction in early menopausal complications after intervention (p<0.05). The most major improvement in menopaused women was realated to hotflash (52.2%) and night sweat (51.3%). The other complications showed moderate improvement. Conclusion: Vitagnus is effective in improving of early menopausal complications and therefore doctors and midwives can prescribe vitex instead of HRT in menopausal women.

Background & Aim: Pain is the most common compliant of the patients and its reduction or elimination had been always demand of most patients and health care providers. Various methods have been proposed to pain, which we can mention to attention deviation strategies. The study aims to compare these strategies and choose the most effective one method for control the pain.

Methods & Materials: The research is a quasi-experimental one by which 230 students of one of the universities of Tehran were called out and participated in the test of tolerance to cold pressure induced pain. 120 participants that their tolerance were a point of standard deviation lower than the whole group were selected and were randomly set in 4 groups (3 experimental groups and 1 control group). These groups composed of 30 people were instructed a method of attention deviation (like desirable imagery, application of concentration point, counting down). The participation’s in control and experimental groups were tested by cold pressure and data were analyzed by SPSS through descriptive indices and One-Way Analysis of Variance (ANOVA).

Results: Results show that the average score of pain toleration in experimental groups were significantly higher than control group (p<.001). Meanwhile the average point of pain toleration in desirable imagery group were significantly higher than the average point of application of concentration point, counting down groups (p<.001).

Conclusion: The attention deviation strategies were effective in increasing of the experimental pain toleration.

Background & Aim: Performance appraisal is one of the most important duties for nursing managers. This will improve the quality of nursing care, and it needs suitable approaches and effective strategies in nursing services. The aim of this study is to determine the impact of performance appraisal using management by objective approach on nursing care quality.

Methods & Materials: This was a quasi-experimental and single-blind study that was carried out in two surgical units of an affiliated hospital of Tehran University of Medical Sciences. 80 patients were selected using a randomized sampling. The quality of nursing care were controlled in both experiment and control units before and after the performance appraisal procedure. The procedure was programmed on the basis of management by objective approach for six months in the experiment unit. In the intervention unit, nursing performance appraisal was done three times and in every time head nurse and supervisors participated in giving feedbacks and recommendations for the nurses. At the end of the intervention, quality of nursing care was assessed in both groups blindly. The results were compared and statistically analyzed.

Results: Significant difference was found between quality of nursing care in the experiment and control units (P<0.001). Quality of nursing care was significantly different before and after intervention in the experiment unit (P=0.009).

Conclusion: Performance appraisal using management by objective approach could increase the quality of nursing care. As a result, using nursing performance appraisal plans according to the basis of MBO could be an effective evaluation way to access the quality of nursing care.

Background & Aim: Exclusive breast feeding is highly recommended for children under six months and the best time for starting supplementary food is the end of sixth months. Inadequate feeding can lead to malnutrition. Since infants&apos supplementary feeding pattern is influenced highly by the socio-cultural status it is necessary to study the subject in diverse conditions. This study aimed to investigate supplementary feeding pattern in 6-12 months children referred to Ilam clinics in 2002.

Methods & Materials: In this study, 364 mothers with 6-12 months children were selected using convenient sampling method from 10 health care centers. Data were collected using a four-sectioned questionnaire including mothers and their babies demographic characteristics, feeding pattern (frequency, the type of milk), supplementary food (the age of onset and the type of the first supplementary food, the time of starting mixed foods, and the source of information about supplementary food) and mothers&apos performance about feeding with supplementary food. The questionnaire was filled via interview.

Results: Findings showed that the growth curve in 84.8% of babies was in the health road. About 38% of babies were the first child. In 50.9% of samples, supplementary food was started before 6 months of age and in 49.9% of the cases, it was started after 6 month old. Supplementary feeding accompanied with breast feeding in 83.5% of the infants. The most used supplementary food was rice mucilage (40.8% of the babies). The interval between starting one supplementary food and the other one was 3-4 days in 50.2% of the cases. Also 80.8% of samples started feeding in the amount of one spoon and increased it gradually. The majority of mothers (64%) did not add sugar, salt and spices in order to attract their babies. As well, 75.6% of samples used spoon and cup for feeding and 92.9% knew the safe time for keeping cooked food in the refrigerator. The source of information about supplementary feeding in 65.4% of mothers was health care providers and in 5% were books and booklets.

Conclusion: Findings indicated that more than half of mothers began supplementary feeding for their children before 6 months old without pursuing any accepted pattern. It seems that usual educational programs in Ilam were unable to answer all the problems aroused in this issue. Hence, educating mothers using other methods such as visual teaching material is recommended.

Background & Aim: Dysmenorrhea is a common problem in young women. Although dysmenorrhea is not life threatening, it can have adverse effects on quality of life. Various treatments are offered for dysmenorrhea including vitamin E supplements. This study investigated the effect of vitamin E on primary dysmenorrhea.

Methods & Materials: In this before-after clinical trial, 200 female students who suffered from primary dysmenorrhea were recruited to the study at Mashhad University of Medical Sciences. First, they filled a questionnaire including demographic characteristics and the pain measurement chart (duration and severity). Then, they were divided into three groups: low, moderate and severe dysmenorrhea groups. Vitamin E (200 mg) tablets were administered to them and they were requested to have them once/day for five days (two days before and three days after the beginning of the menstruation). They filled the pain measurement chart (duration and severity) after two treatment periods. Data were analyzed using t-student, chi-square, and variance analysis tests in SPSS software.

Results: The age of the students ranged 19-26 years old. The severity of dysmenorrhea was mild, moderate, and severe respectively in 28%, 60%, and 14% of the students. The mean of painful menstrual days was 2.05 in the first month, and 2.08 in the second month before using vitamin E. After using vitamin E, painful menstrual days were 1.63 in the first month and 1.64 in the second month. Regarding duration of painful days, all of the participants felt pain in the first day of menstruation. After using vitamin E, about one sixth of the participants in the first month and one fifth of them in the second month had no pain at first day. The severity of pain was 5.18 before using vitamin E that decreased to 3.40 after the intervention.

Conclusion: Vitamin E administration in women, who suffer from primary dysmenorrhea, significantly reduces the severity and duration of pain. It can be used as an alternative treatment method in affected women.

Background & Objective: Assessment of mental health is one of the most important aspects of assessing health status. Entering to the university is a challenging life event for young adults because students encounter with changes in social communication, expectations and roles. As a result, they are susceptible for experiencing stress and anxiety that could affect their functions. The aim of this study was to determine the mental health status and related stressors among Hamadan Medical Sciences University Students.

Methods & Materials: In this cross-sectional study, 180 medical sciences&apos students were selected using stratified sampling method. Data were collected using the Stressor questionnaire and the SCL90. Data were analyzed by SPSS.

Results: The study showed that 57.1 percent of the students were female. The ages ranged 18-22. Most of the students (94.8 percent) were single. Most of the students had no mental disorders (66.1%). Mild and moderate mental disorders were 29.4& and 4.4%, respectively. Mean of mental health score was 72.99 (±46.02). Mental health status was correlated with marital status, concerns about family, changes in religious activities, concerns about the future, working in the hospitals, problems with friends, sexual problems, and the number of experienced stressors (P<0.05).

Conclusion: Experiencing stressors threatens students&apos mental health status and provide a potential cause for mental disorders.

Background & Aim: The present research attempted to investigate the effect of time management training on work-life conflict among two hospitals&apos nurses.

Methods & Materials: In this randomized trial, we recruited all nurses of two public hospitals (n=106) in Hamadan and Tehran according to the inclusion criteria. We used balanced (permuted) block randomization for assigning the study sample into control (n=53) and intervention (n=47) groups. Six individuals did not participate in the study. Data were collected using two instruments: 1) work-family conflict scale and 2) time management behaviors scale. For content validity, ten experts in the field of the study commented on the items. The reliability coefficients (Cronbach&aposs alpha) for these scales were 0.86 and 0.75, respectively. All participants completed the questionnaires at baseline. The time management skills were taught in the intervention group for eight hours. One month later, all participants in two groups completed the questionnaires again.

Results: Considering the baseline characteristics, the groups were homogenous. Independent sample t-test indicated no significant differences between the two groups in all dimensions before the intervention (P>0.05). There was significant difference between two groups in the work-family conflict after the intervention (P<0.001). Also, the paired t-test showed significant difference in work-family conflict before and after the intervention in the intervention group (P<0.001).

Conclusion: According to our findings in the present research, time management training intervention had positive effect on work-family conflict among hospital nurses.

Background & Aim: Breastfeeding is the most cost-effective, health-promoting, and disease-preventing activity that new mothers can perform. Many researches have focused on identifying factors that influence breastfeeding initiation and duration. An important and modifiable factor is the perceived self-efficacy of mothers for breast feedings. It refers to a mother&aposs perceived ability to breastfeed her newborn and is a dominant variable in the duration of breastfeeding. The purpose of this study was to assess the relationship between self-efficacy and breastfeeding.

Methods & Materials: A descriptive, longitudinal, analytic approach was used in this study. The three-part questionnaire was administered to the eligible pregnant women (437 pregnant women) who were at least in 37 weeks of gestation and intended to breastfeed. They were then contacted again at one and four months postpartum to determine their infants&apos feeding level and method. The questionnaire was re-administered to the participants at that time.

Results: The results showed that 80.4 percent of participants had exclusive breastfeeding during one month. There was no significant relationship between antenatal breastfeeding self-efficacy and the breastfeeding. The self-efficacy was significantly related to breastfeeding outcomes at one month. Mothers with high self-efficacy were significantly more likely to breastfed their babies exclusively at one and four months postpartum than the mothers with low self-efficacy.

Conclusion: Maternal breastfeeding self-efficacy is significantly related to breastfeeding duration and level. Measuring breastfeeding self-efficacy not only identifies high risk mothers, but also provides important information to health care providers in providing support to new mothers.

Background & Aim: Premenstrual syndrome (PMS) is a common psychosomatic disorder that affects 30-50% of women in reproductive ages. The purpose of this study was to determine the effect of a counseling program on premenstrual syndrome related symptoms.
Methods & Materials: This study was a randomized clinical trial in which the effect of a 3-sessioned counseling program on the PMS symptoms were assessed in 123 adolescent with PMS. The program included information providing, life style alteration, and providing stress management skills on symptoms of PMS. The participants were randomly allocated to intervention (n=67) and control (n=61) groups. Participants completed the demographic questionnaire, the PMS symptoms&apos daily record scale, and the symptom checklist 90-revised (SCL-90-R). Data were analyzed using the SPSS-11.5.
Results: The comparison of baseline data showed no significant difference between two groups regarding demographic characteristic and the PMS related symptoms. There were significant differences in the mean of total PMS severity, somatic symptoms (P<0.001), anxiety, interpersonal sensitivity, and hostility (P<0.05) between two intervention and control groups. There was not any significant difference in depression between intervention and control groups (P=0.11).
Conclusion: Group counseling resulted in a significant reduction in severity of total PMS, somatic symptoms, anxiety, interpersonal sensitivity and hostility in intervention group compared to the control group. There was no statistically significant difference in depression between two groups.

 

Background & Objective: Osteoporosis is a serious public health concern known to have several etiologic factors. This study compared lifestyles among postmenopausal women with normal and abnormal bone marrow densitometries (BMD).

Methods & Materials: In this case-control study, 81 postmenopausal women (33 cases with abnormal BMD and 48 control individuals with normal BMD) were selected using simple random sampling from Osteodensitometry center of Shariati hospital in Tehran. The BMD at lumbar spine and femoral neck had been measured with DXA. The Lifestyle was assessed using a questionnaire containing items about taking calcium, vitamin D, hormones, and Alendronat, doing physical activity, consuming tea and cola, and smoking. Reproductive characteristics were also collected via a questionnaire. Data were analyzed using χ2 test and independent sample t-test. Crude and adjusted odds ratios and relevant 95% confidence intervals were calculated through logistic regression, using SPSS v.13.

Results: The results showed significant differences between two groups in weight (P>0.001), BMI (P=0.022), number of pregnancies (P=0.002), number of children (P=0.004), duration of lactation (P=0.0002), dietary calcium intake (P≤0.001), and period of calcium supplement intake (P=0.002). The average of acquired scores of lifestyle factors in the case group was significantly lower than the control group (P=0.037). Inappropriate lifestyle had increased risk of the disease (OR=3.36, 95%, CI: 1.10-10.26). Meanwhile in the multivariate analysis, only insufficient intake of calcium was found to be a risk factor (P=0.002) for osteoporosis.

Conclusion: In conclusion, the results of this study showed positive effect of calcium intake on bone mineral density.

Background & Objective: It is essential to conduct studies on factors related to obesity in both reproductive ages and menopausal period. The aim of this study was to describe the prevalence of general and android obesity and to assess determinants of overweight in pre- and post-menopausal women.

Methods & Materials: In this cross-sectional, random survey of households, about 610 women 20-65 years were recruited. Data were collected via interviews with the participants. Weight, height, waist and hip circumferences were measured as well. The Body Mass Index (BMI) and the waist to hip ratio (WHR) were calculated. Overweight and general obesity were defined as 25≤BMI<30 and BMI≥30, respectively. Android obesity was defined as WHR≥0.85.

Results: The prevalence of overweight and general obesity was 90.6% in the premenopausal women and 72.6% in the post-menopausal women. About 75% and 41.9% of pre- and post-menopausal women had android obesity, respectively. Low literate post-menopausal women had significantly more general and android obesities. In addition, postmenopausal women with more parity had more android obesity. Pre-menopausal women with low literacy and housewives had significantly more general and android obesities. In addition, pre-menopausal women with more parity had less general obesity and more android obesity. In these women, android obesity was increased with age and decreased with physical activity.

Conclusion: The prevalence of general and android obesities was high in Islamshahr women, especially in the post-menopausal women. This result indicates that the women have potential risks for various diseases.

Background & Aim: Gestational diabetes is a major concern during pregnancy. Psychological factors such as self-efficacy play important role in adherence of the treatment, control of blood glucose, and the outcomes of the pregnancy. The main purpose of this study was to determine correlations of self-efficacy in women with gestational diabetes attending to educational medical centers of Iran University of Medical Sciences in Tehran.

Methods & Materials: In this descriptive correlational study, we recruited 100 women aged 15-49 years old with gestational diabetes and singleton pregnancies using consecutive sampling method. Data were collected using Diabetic Self-Efficacy scale.

Results: The mean age of the women was 31 years. The majority of the women (66%) had moderate economic status and more than half (60%) had no higher education. Sixty eight percent of the study participants were obese or overweight. About 33% of the participants were nullipara and 69% had wanted pregnancies. The results showed that 43% of the women had low self-efficacy. The self-efficacy scores were significantly correlated with education (P=0.005) and occupation (P=0.016).

Conclusion: Self-efficacy is an important determinant of self-management and self-control in gestational diabetes. Regarding low self-efficacy among the women, it seems that implementing educational-counseling strategies to enhance self-efficacy can be helpful to promote optimum self-care among women with gestational diabetes

Background & Aim: Primary dysmenorrhea is a common medical disorder in young women that affects their quality of life. According to the research studies, overweight and obesity increase biosynthesis of the prostaglandin and consequently increase the severity of dysmenorrhea. The aim of this study was to examine the prevalence and severity of primary dismenorrhea and its relation to anthropometric parameters.

Methods & Materials: In this descriptive-analytical study, 388 students from Ahwaz University of Medical Sciences were selected using random cluster sampling. Demographic data were collected using a questionnaire. The height and weight, BMI, fat mass, waist and hip circumferences, waist to hip ratio (WHR) and waist to height ratio (WHtR) were measured. Visual Analogue Scale (VAS) was used to evaluate the severity of dysmenorrhea. Data were analyzed using Pearson correlation test. The p<0.05 was considered to be significant.

Results: Mean age of the participants was 20.7±1.8 years. The mean age at menarche was 13.4±1.2 years. Moderate or severe dysmenorrheal were experienced by 71.65% of the participants. The severity of dysmenorrhea was significantly related to body fat mass, waist circumference, hip circumference and WHtR (P<0.05). However, there was no significant relationship between the severity of dysmenorrhea with weight or BMI.

Conclusion: Anthropometric parameters that are associated with central obesity such as waist circumference and WHtR are more related to the severity of dysmenorrhea. Increased visceral fat mass is a more effective predictor for dysmenorrhea. More studies are needed to clarify these relationships.

Background & Aim: HIV/AIDS is a well-recognized global problem in the world, including Iran. It is necessary to comprehend and understand lived experience of HIV positive patients. The present study was designed and conducted to better understand the perspectives and experiences of HIV positive patients about the role of the spirituality and religious beliefs in their lives with HIV/AIDS.

Methods & Materials: This qualitative study was conducted using an interpretative phenomenological approach. In-depth, audio-taped and semi-structured interviews with 19 participants were conducted to collect data. Data were transcript. Observations were also recorded in comprehensive field notes. A hermeneutic approach was used to analyze the data, according to the method developed by Diekelmann.

Results: According to the findings, participants aged between 21 and 56 years of old at the time of contamination to the HIV. Almost half (47.4%) of the participants had CD4 counts under 200 cells/mm3. Analyzes of the data revealed three main themes: (a) Redefining religious values and communicating with God (b) Compensation and (c) Individual development. The themes included some sub-themes.

Conclusion: Experiencing difficult conditions in HIV positive individuals provide them with an opportunity to return to religious values, redefine themselves and give meaning to their lives, rather than fear or disappointment. Communicating with other HIV positive patients and religious experts are suggested as additional appropriate strategies.

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: 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 & 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: 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.