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Background & Aim: Error always occurs in the health system and it can lead to irreparable consequences. Therefore, error prevention must be taken into account by the health systems. Detection of factors contributing to error is a key factor for the prevention of error. Hence, the aim of this study was to explore factors contributing to nursing error in emergency department.

Methods & Materials: This study was conducted using a qualitative approach. 17 emergency nurses participated in this study. Semi-structured interview was used to collect the data. Sampling was started as the purposive sampling and continued until the saturation of data was reached. Data were analyzed using the Elo & Kyngas (2008) qualitative content analysis approach. To achieve trustworthiness, participants were selected with maximum variation in terms of age, gender, work experience, and educational background.

Results: The analysis of data led to the emergence of 500 open codes and four categories including the predisposing factors of nurse-related error, predisposing factors of organization-related error, predisposing factors of error related to the culture of emergency department and predisposing factors of patient-related error.

Conclusion: Factors contributing to nursing errors in emergency department were very wide and multifactorial. Identifying the factors contributing to error is a first step to prevent errors. For reducing nursing error, nursing managers should pay special attention to the contributing factors of error identified by this study and implement interventions to reduce and mitigate these factors.

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Background & Aim: Patients’ assessment is fundamental to nursing practice and the more precise assessment nurses can perform, the better outcomes patients can achieve. Better practice requires suitable knowledge, skills and attitude regarding the importance of physical assessment. This study aimed to determine correlation between knowledge-skill and the importance of physical assessment in nurses employed in hospitals.

Methods & Materials: In this descriptive correlational study, 300 nurses employed in the medical, surgical, ICU and CCU wards of hospitals affiliated to Kerman University of medical sciences, were chosen conveniently in 2016. The data collecting instrument included demographic data, knowledge-skill and the importance of physical assessment items. Data were analyzed by the SPSS software version 19 using correlation coefficient test, linear regression and ANOVA.

Results: The mean score of knowledge-skill was 3.14(±0.74) and the median (mode) score of importance was 4(0.52). There was a significant and positive correlation between knowledge-skill and the importance of physical assessment. The nurses had higher knowledge-skill scores for those skills that they had considered more important. The most effective variable on the correlation between knowledge-skill and importance was education.

Conclusion: Nurses’ self-assessment of their skills in performing physical assessment was at a low level but they considered all skills important. Effective educational programs can fulfill the nurses’ needs for physical assessment skills.

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Background & Aim: Mothers during pregnancy face many concerns. Identifying mothers’ strategies to manage those concerns can help healthcare providers to promote their mental health. The aim of this study was to explore pregnant mothers’ strategies for the management of their concerns during pregnancy.

Methods & Materials: This qualitative study was conducted in Gorgan city during 2014-2015. The study participants were 20 pregnant women and three of their husbands as well as three experienced midwives who were selected using purposive sampling and interviewed through semi-structured interview. Data were analyzed through conventional content analysis using the MAXQDA software.

Results: Data analysis led to the emergence of five main categories including the utilization of purposive knowledge acquisition, reliance on the leverage of spirituality, thinking management and stress control, the effort to maintain and improve familial interactions and emotional preparation for pregnancy.

Conclusion: The five strategies used by pregnant women to manage their concerns, were identified in this study. Midwives can play an important role in implementing these strategies and empowering pregnant women.

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World’s health systems have entered a critical period of human resource shortage. The shortage of qualified nurses has been suggested as one of the most important barriers to achieve effective healthcare systems (1). According to the WHO (2014), there is currently a shortage of 7.2 million health care providers at the international level. This shortage is estimated to reach 12.9 million by 2035 (2). In other words, in order to develop healthcare systems, achieve positive outcomes and ensure patient’s safety, recruiting well-qualified nurses is a global concern (3). Nursing shortage in Iran has also become a concern for managers and a major challenge to the healthcare system. The nursing deputy of the Iran Ministry of Health and Medical Education reported that the number of nurses working in health care settings is estimated to be 140,000, but there is a need for 2,60,000 nurses to deliver ideal levels of health care (4). While, qualified nurses adequacy is one of the essential components of the nursing professional practice environment (5). Poor nursing work environment, inadequate resources, imbalanced workload, disproportionate nurse-patient ratio, high bureaucracy (5), lack of supportive management, low salaries, and reduction in employment are major challenges that have caused Iran’s healthcare system to face a serious crisis of nursing shortage despite a large number of young nursing graduates (6). Evidence suggests that the nursing practice environment has a significant role in the retention of expert nurses, the quality of care and, safety of patients (7). Poor nursing work environments are related to adverse patient outcomes, including an increase in mortality rate, patient falls, and medication errors (8, 9). In addition, unhealthy workplaces are important causes of turnover, efficient nurses’ intention to leave, early retirement, job dissatisfaction and burnout (10, 11). Therefore, efforts to create environments that attract and retain nurses are worthwhile. Different strategies have been proposed to improve the nurses’ work environment. In this regard, making workplace attractive is a basis for increasing the quality of nursing practice environment (12).
Today, there are hospitals called "Magnet Hospital" that are renowned for attracting and retaining expert nurses. The Magnet hospital was first used in the United States. In the early 1980s, concurrent with nursing shortage crisis in the United States, extensive studies were begun to examine the organizational structures of Magnet hospitals. In a study, the American Academy of Nursing (AAN) identified 41 hospitals that were known to attract and retain qualified nurses, and used the term "Magnet" as a gold standard for nursing practice in these hospitals (13). Magnet hospitals are evaluated in terms of achieving goals in five areas including transformational leadership, structural empowerment, new knowledge, innovation, and empirical outcomes and development (14). Magnet hospitals with a more different organizational structure than non-Magnet ones play an important role in nurses’ job satisfaction and retention (15). One of the main reasons for the attractiveness of these hospitals is the existence of work environments focusing on decentralized decision-making, autonomy, control over practice, resource adequacy, supportive management, effective inter-professional communication, and career development (16). In other words, the organizational attributes of Magnet hospitals lead to the nurses’ empowerment by increasing autonomy and authority, and subsequently improving job satisfaction. These hospitals have designed a set of work environment standards to support professional nursing practice (17). Many studies have shown that Magnet hospitals provide a healthier environment with higher job satisfaction for nurses and better outcomes for patients, compared to non-Magnet ones (18, 19). In recent years, the development of Magnet hospitals has rapidly grown in various countries. Considering the complexity of nursing shortage phenomenon, paying attention to the factors influencing the nurses’ attraction, retention and productivity is important to overcome the challenge of nursing shortage (20).
Conclusion
The nurses’ dissatisfaction with the work environment and consequently, the shortage of competent and educated nurses, is a major challenge to Iran’s health system. Therefore, solving this crisis is vital to prevent adverse health consequences. In this regard, nursing managers and health policy-makers can create a quality work environment using the features of Magnet hospitals to increase the attraction and retention of health care professionals, especially nurses. This will not only result in the nurses’ job satisfaction but will also increase the quality of care and ensure the patients’ safety.
 

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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: 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: 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: 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: Women's health is important in middle age, and lifestyle, including healthy eating, has an impact on it. This research was aimed to determine the effect of an educational program based on BASNEF model on nutrition in middle-aged women.
Methods & Materials: This clinical trial was conducted on 95 women under coverage of the healthcare centers affiliated to Tehran University of Medical Sciences in 2016. The demographic characterizes and the BASNEF constructs regarding nutritional behavior were measured by questionnaire before and eight weeks after the intervention. The intervention was performed in three one-hour sessions. Data were analyzed by descriptive statistics, Chi-square and Mann-Whitney U tests using the SPSS software version 16.
Results: Before the intervention, both groups had not any significant differences in all variables and constructs. After the intervention, in the experimental group, the median and interquartile range were 10±3 for knowledge, 38±10 for attitude, 3±1 for subjective norms and 1±1 for behavioral intention. But in the control group, the scores were 6±2 for knowledge, 37±5 for attitude, 4±1 for subjective norms and 1±1 for behavioral intention. There was a significant difference between the two groups (P˂0.05). However, the scores of enabling factors were not significantly different between the two groups of intervention (3±1) and control (3±1) (P=0.4).
Conclusion: Designing and implementing the educational program based on BASNEF model not only can improve the knowledge and attitude about healthy nutrition in middle-aged women, but also modify their behavioral intention.
Clinical trial registry: IRCT2016042427566N1
 

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Background & Aim: Active participation of families can be an influencing factor on delirium in patients hospitalized in the ICU. The present study was conducted to investigate the effect of scheduled visits on delirium intensity in elderly patients hospitalized in the ICU.
Methods & Materials: This clinical trial was conducted on 70 elderly patients hospitalized in the ICU of Ali ibn Abi Talib hospital in Rafsanjan from November 1, 2017 to March 1, 2018. In the intervention group, patients were visited in two out-of-schedule sessions for three days in the morning and night. The control group received routine visits for 3-5 minutes. To assess delirium, the Neecham questionnaire with a scoring scale of 19-30 was used. The data were analyzed using the SPSS software version18.
Results: There was no statistically significant difference between the two groups in terms of age, sex and educational level. Before the intervention and one day after the intervention, no significant difference was observed in delirium score between the two groups. However, on the second day in the intervention group, the median and interquartile range for delirium were 27(3) and in the control group were 25(2) (P<0.0001). On the third day after the intervention, differences between delirium score in the intervention and control groups were 27(3) and 25(3), respectively (P<0.0001).
Conclusion: Scheduled visits can be considered an effective non-pharmacological method for preventing delirium in elderly patients hospitalized in the ICU.
Clinical trial registry: IRCT20150519022320N7
 

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Background & Aim: Concerns over limited equipment and resources particularly in the intensive care units have raised the issues of medical futility, futile treatment, and futile care. Considering that there is no consensus in the definition of the concept of futile care, this study aimed to explore the concept of futile care, especially in terms of clarifying it with the concept of futile treatment.
Methods & Materials: This is a qualitative study conducted using the conventional content analysis approach. In this study, 22 nurses, eight medical specialists, four medical ethics specialists, and one sharia specialist, were purposively recruited with the consideration of maximum variation. Data were collected using individual, in-depth, semi-structured interviews.
Results: The main theme of the study was “care is never futile: care as goal”. This theme is consisted of four main categories including: 1. care as an indispensable service; 2. care as an ongoing process focused on human existence; 3. care as a sacred and essential process in Islam; 4. the necessity for differentiating between care and cure: futile treatment instead of futile care.
Conclusion: Although, in some cases, and depending on the circumstances, medical interventions may be futile, care is never futile. According to the findings of this study, the terms medical futility and futile care cannot be used interchangeably because interchangeable use of these terms can devalue the nature of care. Thus, it is necessary to use the term of “futile treatment” instead of “futile care”.
 

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Background & Aim: Pregnancy is one of the enjoyable and evolutionary aspects of women’s life, which is often associated with many stresses and concerns. Counseling is one of the most appropriate interventions to reduce concerns and increase the decision-making power of pregnant women. This study aimed to determine the effect of solution-focused group counseling on pregnant women’s worries.
Methods & Materials: A randomized clinical trial was conducted on 108 pregnant women with gestational age of 6 to 19 weeks and a score of worry ≥55, from May to September 2017 in health centers of Sabzevar University of Medical. The intervention group received a solution-focused counseling and the control group received routine prenatal care. Concerns of pregnant women were evaluated before, after, and two months after the intervention using the Farsi version of Cambridge Worry Scale. The data were analyzed using t-test, chi-square, and repeated measure analysis of variance through the SPSS software version 22. A P value less than 0.05 was considered statistically significant.
Results: The mean score of worry before the study was 58.9±5.9 for the intervention group and 58.8±4.37 for the control group, and no significant difference was observed. After the intervention, these values for the intervention group and the control group were 34.6±13.3 and 57.7±8.78, respectively. Two months after the study, these values were 31.1±10.1 and 54.6±10.9, respectively. The analysis of variance with repeated measurements showed that pregnant women’s concerns about childbirth, fetal health, maternal health, and family relationships were significantly reduced after the intervention and two months later (P<0.001). Women’s worries about socioeconomic issues were not significantly reduced after the intervention and two months later in comparison with the control group (P=0.563).
Conclusion: The solution-focused counseling is an effective way to reduce pregnant women’s concerns about maternal and fetal health, family relationships and childbirth. It can be used in conjunction with pregnancy care.
Clinical trial registry: IRCT20180123038485N1
 

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Background & Aim: Menopause has been recognized as a critical stage in women’s life. Menopausal symptoms and problems can affect women’s health and well-being. Health promoting behaviors may be useful in alleviating these symptoms. The purpose of this study was to determine the effect of couple counseling on severity of menopausal symptoms in women.
Methods & Materials: In a quasi-experimental study, 80 women with their husbands were selected by the convenience sampling method from health care centers in Zahedan in 2017, and were assigned to either experimental or control group. The data gathering tool included a demographic questionnaire and Menopuse Rating Scale questionnaire. Couple counseling for the intervention group was conducted in four 60-minute sessions. Data were collected before and 12 weeks after the intervention, and analyzed by independent and paired t-test, analysis of covariance and χ2 using the SPSS software version 21.
Results: There was no significant difference between the two groups in terms of demographic variables, but the mean of score changes for menopausal symptoms in the intervention group was -1.42±1.95 and in the control group was -0.10±1.10. The independent t-test showed a significant difference in the mean of score changes for menopausal symptoms in the two groups (P<0.0001).
Conclusion: Given that couple counseling has a positive effect on severity of menopausal symptoms in women, it is suggested that this counseling strategy be integrated into healthcare programs for menopausal women.
 

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Background & Aim: Creating and maintaining a safe environment is an important part of care in psychiatric wards. The results of previous studies indicated that some features of the physical environment facilitate the ward’s safety. The experiences of people who are most likely to be present in these environments can be the best source for identifying these features. Therefore, this study was conducted to explain patients’ and employees’ perceptions toward the features of a safe physical environment in psychiatric wards.
Methods & Materials: In this exploratory qualitative descriptive study, seven patients at discharge time and nineteen employees working in psychiatric wards were interviewed about their experiences in psychiatric wards and 84 hours of field observation was done. The data were analyzed using a qualitative content analysis approach according to the method proposed by Graneheim and Lundman.
Results: The results showed a safe physical environment in psychiatric wards meant “having an accident-free environment”. This theme was abstracted from two main categories included “Accidents prevention through design” and “having a natural life environment”, which, according to the experience of the staff, is required to balance the two. The subcategories of “having the design of accidents prevention” were “eliminating or modifying accident-causing objects”, “wards based on the characteristics of the patients” and “conditions for facilitating staff performance” and the subcategories of “having a natural life environment were “meaningful activities", “healthy and pleasant conditions” and “preserved privacy”.
Conclusion: According to the results of the study, it is necessary to create a physical environment free of accidents and at the same time to meet the daily needs of patients in order to prevent physical and psychological damage to patients and staff in psychiatric wards.
 

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Background & Aim: The success of the surgical safety checklist in reducing surgical mortality and morbidity largely depends on the degree of compliance with the checklist and correct implementation of its components by the staff. The aim of this review is to determine the challenges of effective implementation of the surgical safety checklist and to provide solutions for its more effective implementation.
Methods & Materials: In the present systematic review, all the relevant qualitative papers published from 2010 to October 2018, were examined. A  literature search was done in databases SID, Iran Medex, Iran doc, Magiran, Science Direct, Medline/PubMed, Web of Science, Scopus, ProQuest, Google Scholar, Cochran Library with keywords patient safety, surgical procedures, operative, checklist, World Health Organization, implementation science, qualitative research and their equivalent terms in Persian. Inclusion criteria were articles written in English or Persian, qualitative studies and relevant to the objectives of the study. Exclusion criteria were review articles, posters, presentations, letters to editor and quantitative studies.
Results: The findings of the review of 14 qualitative studies showed that the most important challenges in effective implementation of the surgical safety checklist were unpredictable priorities, lack of collaboration and coordination of the surgical team members, mismatch between the checklist and hospital setting, lack of patient’s cooperation and lack of a planned approach towards implementing the checklist. The strategies to improve the implementation of the surgical safety checklist included checklist localization, improving the collaboration and coordination of all the team members, training and practicing, patient participation, and active organizational leadership.
Conclusion: The introduction of the surgical safety checklist to the health care setting is a permanent challenge and requires ongoing evaluations and its integration into the workflow in the hospital, active and effective leadership, explanation of why and how to use it by managers and receiving support from the organization. Continuous education, performance evaluation and the participation of all the surgical team members in the implementation of the checklist are key factors for effective implementation of the surgical safety checklist.
 

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Background & Aim: Menstrual health is an important aspect of adolescent health. Most girls do not have proper information about menstrual health, and incorrect information from unreliable sources makes problems for them. Aim of this study was to compare small group-based education with maternal participation and routine education on adolescent girls’ menstrual health behaviors.
Methods & Materials: This randomized clinical trial study was performed on 60 high school students with regular menstruation in the groups of intervention and control. Among high schools in Mashhad in 2018, two schools were assigned to one of two groups by lottery. Menstrual health education was provided to the intervention group in four sessions as the groups of 3-4 people. For mothers in this group, two 2-hour sessions with the same content were held and the students in control group received routine education. Data were collected by a questionnaire on menstrual health behaviors, before the intervention, after the end of the first and second menstrual cycle. Data were analyzed by Mann-Whitney, Chi square and independent samples t-test using the SPSS software version 16.
Results: before the intervention, there was a statistically significant difference in the menstrual health behaviors score (P=0.199). After the intervention, mean score of menstrual health behaviors (the end of the first and second menstrual cycles) significantly increased (P<0.001) for the two groups. Also, mean score of menstrual health behaviors for the intervention group was significantly higher than that of for the control group (P<0.001).
Conclusion: The small group-based education with the participation of mothers in comparison to routine education was more effective in promoting menstrual health behaviors in adolescent girls. This method is recommended to health planners for education of health issues, including menstrual health.
Clinical trial registry: IRCT20180904040952N2
 

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Background & Aim: Physical activity is a health behavior that helps one's mental and general health, improves the health of women during preconception period and reduces pregnancy and birth complications. The aim of this study was to predict physical activity based on the BASNEF model constructs during preconception period among women referred to Uremia health centers.
Methods & Materials: This cross-sectional study was conducted on 230 women during preconception period, who were selected using the multistage sampling method in 2018. The data collection tool was a researcher-made questionnaire containing sociodemographic information, the BASNEF model constructs, and a short form of the international physical activity questionnaire. Data were analyzed using logistic and linear regression and t-test through the SPSS software version 16.
Results: The results showed that 61.3% of women had low levels of physical activity. Knowledge (β=0.2, P<0.003), attitude (β=0.15, P<0.017), and enabling factors (β=0.18, P<0.004) significantly explained their intention to do physical activity. Also, among the predictive variables, knowledge (P<0.001) significantly explained physical activity.
Conclusion: Low rate of women's physical activity during preconception period calls for designing an intervention based on BASNEF model in order to influence knowledge, attitude and enabling factors.
 

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Background & Aim: Self-control is the capacity to organize cognitive and emotional responses in order to provide continuous and adaptive behavior with ideal standards for long-term goals. Due to the high levels of care burden of patients with chronic disease, this study aims to explain the concept of self-control in the family caregivers of patients with chronic disease based on the family-centered empowerment model.
Methods & Materials: Data were collected through in-depth, semi-structured interviews with 26 participants (19 caregivers, four nurses and three patients with chronic disease) from June 2016 to August 2017 in southwestern of Iran. Data were analyzed using the directed content analysis approach. The documents recording, accurate description of details, member checking, peer checking, and maximum variation of participants, were considered for ensuring the trustworthiness of the data.
Results: “Transcendental self-control” of family caregiver was explained by four conceptual categories: “caregiver insight", "value prioritization in care", "acceptance of care responsibilities" and "committed care". By predicting the potential risks of playing the care role and deeply understanding the conditions of care while paying attention to the value prioritization outcome-centered and virtue-based care, the family caregiver accepts the care burden through positive thinking and expediency and modestly offers "committed care" while having competent care experiences.
Conclusion: The explanation of self-control concept based on family-centered empowerment model in the real field creates a clear understanding of this concept and leads to "commitment care" by family caregivers of patients with chronic diseases and in turn provides a basis for reducing workload in the clinical setting.