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Background & Aim: Nurses have the major role at care continuity and health promotion. They frequently affect total productivity in a organization. However, the nurses believe that due to several barriers they have not desire productivity, therefore the health care have been left at level of quality. The aim of this research are assessing nurses&apos view about productivity and role of human resource on it.

Methods & Materials: This study has been done based on grounded theory method. Open interviews has been used for gathering of data. Sampling was purposive in beginning study but so that study was proceeding and categories were completed, it changes to theoretic sampling. Constant comparative analysis was method of data analyses.

Results: Essential themes emerged from the data in human resource category. These are: systemic calculating number of staff, accurate staff select and use criteria for them, provide adequate staff from various categories in total year&aposs day, accept patient when as coordinate to in charge nurse and well communication. These make necessary groundwork for productivity. Then accidents that emerged from inappropriate quantity and quality of human resource will be decreased. These enhance nursing productivity the biggest group of health care services. Model of Productivity and human resource effects on it’s, from nurses&apos view, has concluded of this research.

Conclusion: In nurses&apos view that participates in this research, human resource can affect on productivity process and improve it, then it lead to develop quality care- health care vision and goal.

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

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

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

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

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Background & Aim: Implementation of the motivational program by nurse managers can improve nurses&apos performance and behaviour, provide better care for patients, and promote patients&apos satisfaction. This study aimed to determine the effect of implementation of the motivational program designed using "Expectancy Theory" by head nurses on patients&apos satisfaction.

Methods & Materials: This was a quasi-experimental study conducted in medical and surgical units of two hospitals in Zanajn in 2011. Data were gathered using a patient satisfaction questionnaire. The reliability of the questionnaire was confirmed (α=0.72). Fourty participants were selected and allocated in two study groups. The groups were matched for some variables before the intervention. The motivational program was implemented in the intervention group for five months. The program had two designing and implementation phases including: 1) determining nurse managers&apos expectancies from nurses, assessing nurses&apos attitudes about valuable rewards, founding reward management committee and management improvement committee, and providing evaluation checklists for nurses&apos performance 2) implementing standards of nursing care and patient education by nurses, monthly evaluation of nurses by head nurses and collaborative members of the reward management committee, determining level of rewards based on the results of nurses&apos performance evaluation, and giving reward to nurses at the end of each month in a reward ceremony. Data were analyzed using the Paired t-test, Independent t-test, Mann-Whitney, and Chi-squared in the SPSS v.16.

Results: There were no significant differences between the two groups at baseline dealing with the demographic variables. The results showed that patients satisfaction was significantly higher in the intervention group after the intervention (P<0.05).

Conclusion: This motivational program designed based on the "expectancy theory" has clear steps to be implemented among nurses and can be used as a practical guide by nurse managers to improve patients&apos satisfaction.

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

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

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

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

  

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  Background & Aim: Need assessment for promotion reproductive health is important subject and development a questionnaire is essential. Thus the aim of this study was development of questionnaire of intention to use of oral contraception in withdrawal users based on construct of Theory of Planned Behavior (TPB).

  Methods & Materials : In-depth interviews were conducted to elicit the salient beliefs relevant to oral contraception among withdrawal users. Then a cross-sectional study carried out in Tehran, Iran for validate of questionnaire. Participants recruited from attending five family planning clinics of public health services in the Eastern district of Tehran, Iran. Validity and reliability was evaluated using concurrent, content validity and Cronbach's alpha and test- retest respectively. Factor structure of the questionnaire was extracted by exploratory factor analysis (EFA). Confirmatory factor analysis (CFA) conducted to assess how well the EFA extracted model fits observed data. The SPSS version 16 and Lisrel programs were used to analyze the data.

  Results: Reliability and validity were confirmed. The principal component analysis revealed a three-factor structure for the questionnaire including attitude, subjective norm and perceive behavior control that explained 50.4 percent of the total of variance.

  Conclusion : In general, the findings suggest that questionnaire of intention to use of oral contraception in withdrawal users based on Theory of Planned Behavior is a reliable and valid measure.

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  Background & Aim: The ultimate goal of self-care behavior is patients' empowerment. There are limited studies on perspectives of patients with Parkinson's disease on self-care. This study aimed to explore for the process of self-care in patients with Parkinson’s disease during 2011 to 2013 .

  Methods & Materials: This exploratory qualitative study was carried out using grounded theory method. Data were collected via semi-structured in-depth interviews and field notes. We interviewed with 12 patients with Parkinson 's disease and four family caregivers . Participants were selected from two neurology clinics. Interviews were conducted at participants' homes or nursing homes. Data were analyzed using the Corbin and Strauss (2008) approach . 

  Results: Concepts of study were identified using a micro and general analysis. The 'fear of becoming crippled' was identified as a main concern. Strategies used in response to context included 'independency', 'spiritual care', 'informed self-care' and ‘seeking treatment’. 'Striving for taking independent self-care' was the most important process. Demographic, familial and social factors had important roles in self-care processes of patients with Parkinson's disease .

  Conclusion: The process of self-care in patients with Parkinson’s disease depends on the context and severity of the signs and symptoms. Health care providers especially nurses can support patients with Parkinson's disease in achieving maintain independence in self-care. In addition, attention to self-care behaviors with focus on person as self-care agent can considerably increase control and management of life .

  

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Background & Aim: Unhealthy snacks consumption has an important role in childhood obesity. The aim of this study was to evaluate the effect of an educational intervention for mothers on the consumption of healthy snacks in children aged 1-5 years using social cognitive theory.

Methods & Materials: This quasi-experimental study was (IRCT2013062912456N2) conducted on 126 mothers who had children 1-5 years old in 2013. The mothers were selected from Hamadan health centers and divided into two groups of intervention and control. The intervention consisted of four sessions, a booklet, a short video, and 6 written messages. The constructs of SCT and food consumption frequency were assessed at baseline, 10 days after the last session and 2-months after the intervention. The data were analyzed by Chi-square test, independent t-test, repeated measures and covariance analysis using SPSS software version 16.

Results: At baseline, the two groups were similar in the demographic characteristics, the constructs of SCT, and unhealthy snacks consumption frequency (P>0.05). Considering that the interaction effects of group and time in the repeated measurement analysis of variance were significant, the means of two groups were compared at each stage using independent t test and significant differences between the two groups were observed at two stages after the intervention.

Conclusion: This intervention had a positive effect on the consumption of healthy snacks. Therefore, SCT and the implemented procedure could be used to develop interventions to modify snack consumption patterns in children.

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Background & Aim: The delay in childbearing is associated with a reduction in the total fertility rate and increase in the risk of pregnancy at an older age. Social learning theory has mostly been used to clarify the interaction between personal and environmental factors and behavior. In order to understand the factors underlying delayed childbearing, the present study aimed to predict the factors affecting the delay in first childbearing among young married women using the Bandura’s social learning theory.
Methods & Materials: This cross-sectional correlational study was conducted on 284 married women referred to the health centers and OB/GYN clinics of teaching hospitals in Mashhad in 2015-2016. The data collecting tool was comprised of five questionnaires regarding to personal and social factors. Data were analyzed by descriptive statistics, Pearson and Spearman correlation co-efficient, linear regression and multivariate regression using the SPSS software version 16.
Results: The mean age of participants was 27.99±4.2, and the mean interval between marriage and the first child was 3.22±1.96, which was 1.25 years more than that of ideal spacing between marriage and childbirth. Multiple linear regressions showed negative and positive fertility motivations, perceived maternal self-efficacy, martial relationship, the number of sisters and childbearing-related religious beliefs had a significant effect on the interval between marriage and first childbirth (P<0.01).
Conclusion: The individual and environmental factors predicting delay in the first reproductive behavior were identified using the Bandura's social learning theory. The both factors should be considered in designing intervention programs for increasing fertility rate.
 

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Background & Aim: Some women, throughout their life cycle, experience unintended pregnancy and had to decide on continuing or terminating it. Although the decision-making process always recurs, few studies have so far shed light on this complex, and context-based process. The aim of the present study was to explore Iranian women’s decision-making process to abort or continue an unintended pregnancy.
Methods & Materials: This was a qualitative study using grounded theory approach. Data were collected through unstructured, in-depth interviews with 29 participants in Tabriz from March 2016 to May 2017. The participants were selected through the purposeful sampling method and data collection were continued until reaching data saturation. Data analysis was carried out concurrently with the data collection, using the MAXQDA software version 10.
Results: Data analysis gave rise to four axial categories: “perceived threats”, “resistance mixed with indecision”, “values and supportive resources”, as well as “acceptance and confirmation of decision”. This means that the decision-making process among women with unintended pregnancy initially starts with a perceived threat as a main concern leading to their resistance towards accepting such a pregnancy, then exposure to threats arising from abortion can cause indecision and uncertainty in practicing abortion. In this respect, given the social support, women affected by religious values make efforts to choose the procedure with the least harm and threats and maximum acceptability and confirmability. “Confirmation of decision” is as well the outcome of the interactive process of decision-making.
Conclusion: What can differentiate the theory of decision-making on abortion or continuation of an unintended pregnancy from the general theories of decision-making is its sociocultural confirmability. Social acceptance of abortion and childbearing in line with moral evaluation of fetal development directs the confirmability process of decision-making about unintended pregnancy.
 

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Background & Aim: Self-care education is one of the effective ways to improve the quality of life and health in patients with heart failure. The purpose of this study was to determine the effect of applying the specific situation theory on the quality of life in patients with heart failure.
Methods & Materials: In a clinical trial study, 80 patients with class 2 or 3 heart failure, referred to 12 Farvardin hospital in Kahnooj in 2018 were included. Data collection tool included a three-part questionnaire: demographic variables, Left Ventricular Dysfunction Scale to assess patients' quality of life, and Self-care Heart Failure Index. The questionnaires were completed at the first visit and three months after follow-up. Data was analyzed using independent and paired t-test, ANOVA, Pearson correlation through the SPSS software version 20.
Results: Before the intervention, there was no significant difference in the scores of quality of life and self-care between the two groups. After the intervention, the mean score of quality of life and self-care dimensions increased (P<0.001). Regarding self-care after the intervention, the highest score was related to self-care confidence with mean and standard deviation of 21.43 and 3.30 respectively, and the lowest score was related to self-care management with mean and standard deviation of 17.45 and 5.5 (P<0.001).
Conclusion: Paying attention to the dimensions of self-care based on a specific situation theory can lead to a better understanding of these patients’ problems and appropriate planning, and in turn improvement of the quality of life. Since in this study, most of the participants were illiterate, using visual teaching aids, adjusting the schedule according to the patient's conditions and readiness, and if necessary, family involvement can have positive results. It appears necessary to consider the underlying factors in the implementation of self-care programs, especially in people with lower levels of education and income.
Clinical trial registry: IRCT20141109019862N6
 

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Background & Aim: Various factors play a significant role in shaping the professional identity of nursing students, and among these factors, the impact of the hidden curriculum holds utmost importance. However, this process remains still unknown.  The aim of the study is to explore the role of hidden curriculum in the formation of professional identity among undergraduate nursing students.
Methods & Materials: This is a qualitative research using the grounded theory approach. The participants in this study included 35 undergraduate nursing students from Tehran University of Medical Sciences during the 2020-2021 academic year who participated in semi-structured interviews. The interviews lasting between 30 and 60 minutes were conducted with each participant. Subsequently, the interviews were transcribed and analyzed following the framework proposed by Strauss and Corbin in 2008.
Results: After analyzing the data, three main categories and 12 subcategories have emerged. The theory developed in this research was formed through the core category of “identity instability within the nursing profession”. The main categories that emerged were “ambiguity and lack of motivation in professionalization”. The study identified "the governance of a discriminatory culture" as the underlying process, while “the promotion of demotivation resulting from inefficient patterns” served as the basis of this study.
Conclusion: Based on the study's findings, the process of developing a professional identity can be metaphorically likened to a river. In this analogy, discrimination serves as the clouds hovering over this river, casting a shadow on the identity development process. While inefficient patterns can be likened to lightning bolts that further complicate the process. Furthermore, the rocky bed of the river, symbolizing the lack of motivation among learners towards professionalism, makes it even more challenging to build a strong professional identity.
 

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Background & Aim: The availability of information regarding people's experiences of returning to work after heart surgery, taking into account the socio-cultural context of Iranian society, is limited. The aim of this study is to discover the process of returning to work after heart surgery.
Methods & Materials: A qualitative study using the grounded theory approach was conducted between 2021 and 2022. Through purposive and theoretical sampling, 21 participants who had undergone heart surgery and were in the process of returning to work were selected. They were chosen from the cardiac surgery ward of Amiralmomenin Hospital in Kordkuy, as well as among patients seeking treatment from cardiac surgeons in Golestan province. Data were collected through conducting semi-structured interviews and taking field notes. Data analysis was conducted using the method proposed by Corbin and Strauss in 2015.
Results: "Feeling of doubt about return-to-work", "perceived psycho-social support", "personal and occupational factors", "unfavorable consequences of heart surgery" and "limited support from governmental/non-governmental institutions" were determined as contextual factors influencing the process of return-to-work. Moreover, "effort to adjust the job", "situation evaluation" and "self-management" were introduced as strategies, while "adaptability to the job" were identified as the consequence of returning to work. Finally, the core variable of the study was determined to be "the thoughtful effort to match the job".
Conclusion: Based on the results, it was determined that several individual and environmental factors influence the process of return-to-work for people who have undergone heart surgery. To facilitate a successful return to work, it is crucial to provide psycho-social support from both the family and work environment. It is recommended that policy makers in the health and social affairs sectors take active steps to empower people during the post-recovery period. Additionally, fostering collaboration between the Ministries of Labor and Health, as well as insurance organizations, can greatly facilitate the return to work of individuals after heart surgery.

 

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Background & Aim: The high prevalence of cesarean section in most developed countries, exceeding 50%, has led to detrimental effects on maternal and child health. Vaginal birth after cesarean (VBAC) is a beneficial way to reduce cesarean rates. This study aimed to determine the effect of theory of planned behavior-based training on the intention and behavior of VBAC in pregnant women with previous cesarean section.
Methods & Materials: In this randomized controlled trial study, a convenience sample of 70 pregnant women with a history of cesarean section, referred to comprehensive health centers in Ardabil in 2020, were randomly assigned to either the intervention or control group. The intervention group received four weekly education sessions based on the theory of planned behavior structures, while the control group received standard care. Data were collected using a researcher-developed questionnaire at three time points: before, immediately after, and four weeks after the intervention. Data analysis was conducted using SPSS software version 16, employing independent t-test, Fisher’s exact test, chi-square test, and repeated measures ANOVA at a 95% confidence level.
Results: Repeated measures ANOVA revealed significant differences in mean scores of attitude, subjective norm, perceived behavior control, intention, and awareness over time between the intervention and control groups (P<0.001). However, the educational intervention did not lead to a behavior change.
Conclusion: Based on the findings, it is imperative for health planners to focus on providing organizational support and fostering a positive attitude among obstetricians and midwives to prioritize the implementation of VBAC.
Clinical trial registry: IRCT20200519047509N1