Iranian Journal of Nursing and Midwifery Research最新文献

Background: Care burden is one of the consequences of caring for schizophrenic patients, caregivers need high resilience to have their best performance in caring for these patients and reduce their care burden. Psychiatric nurses should implement coherent programs to support these caregivers. Therefore, this study aimed to determine the effect of telenursing on the care burden and resilience of family caregivers of schizophrenic patients.

Materials and methods: This research was a before-after quasi-experimental study with a control group. Participants included 44 family caregivers of schizophrenic patients referring to the Razi Educational and Therapeutic Psychiatric Center in Tehran in 2023-2024. Participants were included via purposive sampling method and based on inclusion criteria. Data collection tools included demographic questionnaire, standard Zarit Burden Interview (ZBI), and Connor-Davidson Resilience Scale (CD-RISC). In addition to routine care, the intervention group also received telenursing care.

Results: Findings of this study showed that between intervention and control group, except for dimensions of positive acceptance of change, secure relationships (p = 0.007) and trust in one's instincts, tolerance of negative affect, and strengthening effects of stress (p = 0.02) of resilience, there were no statistically significant differences in other discussed variables such as care burden and resilience.

Conclusions: In this study, telenursing did not have a positive effect on all dimensions of resilience and care burden, but considering its potential and its positive effect on some dimensions of resilience, it is recommended that studies with longer intervention periods be conducted on other problems of family caregivers.

Background: Mandala coloring is effective in reducing anxiety. However, it has received little attention as an adjunctive therapy to manage children's anxiety. This study aimed to explore the impact of mandala coloring on the anxiety of children with Cystic Fibrosis (CF).

Materials and methods: The participants in this clinical trial study were 120 children aged 6-18 years with CF with mild-to-moderate anxiety admitted to Mofid Hospital in Tehran. The children were randomly divided into two groups: intervention and control. The children in the intervention group performed mandala coloring exercises every evening for 30 minutes for 6 consecutive days. The level of anxiety in the children in both groups was measured using the Spielberger State-Trait Anxiety Inventory before the intervention and 6 days after the first measurement. The collected data were analyzed using the independent t-test.

Results: An analysis of the mean anxiety scores before and after the intervention showed a significant decrease in the anxiety level in the Mandala group (Z = -3.74, p < 0.05). Moreover, a significant decrease was observed after the intervention between the children in the mandala and control groups in terms of average anxiety levels (U = 1206, p < 0.05). An intergroup comparison showed that state anxiety was significantly different between the two groups (U = 1143, p < 0.05), but no statistical difference was observed in terms of trait anxiety (p > 0.05).

Conclusions: The results indicated that holding six mandala coloring sessions reduced the anxiety of children with CF. Thus, mandala coloring is recommended as a complementary non-pharmacological method to reduce children's anxiety.

Background: Self-efficacy of care is based on health-promoting behaviors that are formed through dealing with disease conditions and the ability to treatment adherence and management of complications. This study was conducted to design and validate an assessment tool for adolescents with mental disorders.

Materials and methods: This study employed a mixed-methods approach to develop a questionnaire aimed at measuring self-efficacy of care among adolescents with mental disorders. Content validity was assessed using both qualitative and quantitative methods, while exploratory and confirmatory factor analyses, convergent validity, and reliability were evaluated through quantitative approaches. Participants, including nurses, psychologists, and adolescent patients, were selected through convenience sampling. The data was analysed using SPSS (version 25.0, Chicago: SPSS Inc.) and LISREL (version 8.72, Jöreskog and Sörbom, 2005) software.

Results: Initially, an item pool consisting of 87 items was generated based on findings from the original research. Following face and content validation, and subsequent exploratory factor analysis, 28 items across four factors were identified: "health information seeking behavior", "adaptation of life to disease conditions and treatment", "adaptive coping", and "social self-care". The factorial structure of the questionnaire was confirmed through confirmatory factor analysis. Convergent validity, assessed using the General Self-Efficacy Scale, was positive and statistically significant (P < 0.01). The reliability of the questionnaire was high, with a Cronbach's alpha coefficient of α =0.93. Test-retest reliability also confirmed the instrument's stability (r = 0.92). Finally, all indicators specified in the COSMIN checklist were confirmed.

Conclusions: The questionnaire demonstrated strong internal consistency and confirmed construct validity. Therefore, this instrument can be reliably used in both clinical and research practices.

Background: Ethical conflict is an integral part of the clinical environment, and nursing students face similar conflicts. Identifying these conflicts aids their educational development. This study aimed to explore factors influencing the formation of ethical conflicts in nursing students during their training.

Materials and methods: This qualitative review and meta-synthesis, conducted in Iran in 2024, followed Sandelowski and Barroso's seven-step model. A comprehensive literature search (2000-2023) was performed to identify qualitative studies on nursing students' ethical conflicts in educational settings. Databases searched included PubMed, Scopus, Web of Science, and ProQuest, alongside the search engine Google Scholar, using keywords such as ethical conflict, clinical education, and nursing students. The identified studies were assessed using the Mixed Methods Appraisal Tool (MMAT).

Results: From 3469 primary studies, 11 articles showed that the most important factor was the professional-educational conflict in an incompatible environment. In this study, we found three main factors related to professional ethics, organizational interactions, and care skills, and different subgroups were identified in each main category.

Conclusions: This meta-synthesis identified ethical conflicts in educational environments as a significant factor among healthcare providers. The findings emphasize the need for a deeper investigation of ethical conflicts, particularly in clinical education, using both quantitative and qualitative methods. Additionally, it is recommended that educational programs focus on ethical decision-making, improve organizational support for interactions, and conduct regular ethical assessments to create a more supportive professional environment and ultimately enhance patient care.

Background: The aim of this study was to apply Machine Learning (ML) algorithms to predict the impact of care burden on the psychological well-being of caregivers of patients with Chronic Kidney Disease (CKD).

Materials and methods: This cross-sectional study employed an ML approach to analyze data from 200 primary family caregivers of CKD patients undergoing hemodialysis. The caregivers were selected through convenience sampling from hospitals affiliated with Mashhad University of Medical Sciences. Caregivers completed the demographic form, the Novak and Guest Pressure Care Questionnaire, and Ryff's Scales of Psychological Well-being. Four ML algorithms: Random Forest (RF), logistic regression, decision tree (DT), and Support Vector Machine (SVM) with Linear, Polynomial, and Sigmoid Kernels, were evaluated using Python and the Scikit-Learn module in the Anaconda environment.

Results: The RF model achieved the highest accuracy score of 0.70, followed by the polynomial SVM model with 0.68. The SVM linear model scored 0.62, logistic regression and DT models both scored 0.58, and the SVM sigmoid model had the lowest accuracy score of 0.54. The RF algorithm also achieved superior levels of the Area Under the Curve (AUC) (0.72) and sensitivity (0.72%). Eight key predictors of psychological well-being were identified: caregiver burden, age, education, economic situation, number of care days, family members, dialysis days, and the amount of assistance offered by family members to the caregiver.

Conclusions: The RF algorithm, a robust ML tool, effectively analyzed datasets to reveal insights into the relationship between caregiver burden and caregiver well-being in CKD patients.

Background: Vitamin D deficiency in patients with type 2 diabetes (T2D) is recognized as a risk factor for developing vascular complications and poor disease control. This study aimed to determine the effect of vitamin D supplementation on ankle-brachial index (ABI) in patients with T2D.

Materials and methods: This two-group clinical trial was conducted among 56 patients with T2D. Participants were recruited through sampling conducted in the diabetes clinic of Velayat Hospital in Qazvin, Iran. They were allocated to the intervention and control groups using a simple blocked randomization method. The intervention group received an oral dose of 1000 IU/day of vitamin D. Data were collected using a checklist that included demographic information, laboratory measurements, and ABI.

Results: After the intervention, the score in the intervention group (ABI < 0.9: t₃₂ = 4.082, p < 0.001) was significantly different from the control group (ABI ≥ 1.3: t₂₀ = -2.711, p = 0.013). After the intervention, significant differences were also observed regarding the mean ranges of vitamin D (t₅₄ = 10.07, p < 0.001), fasting blood glucose (FBG) (t₅₄ = -2.97, p = 0.004), 2-hour post-prandial blood glucose (2hpp) (t₅₄ = -2.55, p = 0.013), and hemoglobin A1c (HbA1c) (t₅₄ = -3.02, p = 0.004) between the two groups.

Conclusions: The results of this study revealed that a daily intake of 1000 IU of vitamin D significantly improved the ABI, serum concentration of vitamin D, FBG, and HbA1c in patients with T2D. These findings suggest that vitamin D supplementation may be considered an effective approach for preventing arterial diseases and improving blood sugar control.

Background: Early Mobilization (EM) after a myocardial infarction is an effective strategy to reduce complications associated with immobility. However, heart-focused anxiety (HFA) can hinder exercise capacity and negatively impact self-reported physical health. Consequently, we aimed to evaluate the effect of the current EM program on HFA in patients who have experienced an acute myocardial infarction (AMI).

Materials and methods: In this randomized controlled trial, patients with AMI were selected using a convenience sampling method and were randomly assigned to either the intervention group (n = 30) or the control group (n = 30). The measurement tools included a section on demographic information, a patient activity checklist, and the Cardiac Anxiety Questionnaire (CAQ). The intervention group underwent a six-stage EM program, while the control group received standard care. Data analysis was performed using SPSS Version 20, employing independent and paired t-tests.

Results: The comparison of the average HFA score and its components before the intervention showed no significant differences (p > 0.05). After the trial, the HFA score showed a significant decrease (t = -3.065, p = 0.003) compared to the control group. Its components, including attention (t = -2.040, p = 0.046) and fear (t = -2.259, p = 0.028), also decreased significantly, while avoidance (t = -1.608, p = 0.114) did not show a significant change.

Conclusions: This EM program, initiated about 6 hours after admission to the CCU, decreased the CAQ score. Thus, this program is an affordable and nondrug approach recommended to prevent complications from immobility.

Background: Breastfeeding is essential for infant health, yet many mothers face difficulties in milk production, often linked to psychological stress. Neuro-Linguistic Programming (NLP) is a psychological method that may improve emotional wellbeing and lactation outcomes.

Materials and methods: A quasi-experimental study was conducted in Sorong, Southwest Papua (March-April 2024), involving 70 breastfeeding mothers with infants aged 0-6 months. Participants were randomly assigned to an intervention group (n = 35), which received a 4-week NLP program, or a control group (n = 35), which received standard breastfeeding education. Each NLP session lasted 60 minutes weekly. Outcomes included daily breast milk volume (measured with calibrated cups), stress (Perceived Stress Scale, PSS), and emotional wellbeing (maternal self-confidence, emotion regulation, and marital satisfaction). Assessments were conducted at baseline, immediately post intervention, and 1 month later.

Results: The intervention group showed a significant increase in milk production (from 450 ml to 600 ml/day; p < 0.05), while the control group remained stable. Stress scores declined in the intervention group (PSS: 22.4 to 14.5), with minimal change in the control group. Emotional wellbeing improved significantly across all domains in the intervention group compared to controls (p < 0.05).

Conclusions: NLP significantly enhances emotional wellbeing and milk production among breastfeeding mothers. These findings support incorporating NLP-based psychological strategies into maternal health programs, particularly in high-stress or low-resource settings. Further research with larger and more diverse populations is recommended.

Background: The recommendation to breastfeed is based on its numerous benefits. Challenges in breastfeeding success involve both the mother and baby. Immediate skin-to-skin contact after birth helps the baby learn to suckle naturally. This review aims to explore breastfeeding interventions and outcomes throughout the breastfeeding journey.

Materials and methods: The research employed a scoping review methodology to assess breastfeeding interventions and outcomes in postpartum mothers. The scoping review followed Arksey and O'Mallee's (2005) methodological framework, and the literature search was conducted using databases such as PubMed, Scopus, Cochrane Library, and Web of Science. Duplicate articles were removed, and the remaining articles published between 2000 and 2023 were reviewed by multiple authors to ensure alignment with the established criteria.

Results: Twenty-four articles of the review regarding breastfeeding interventions encompass nutritional support for mothers, maternal massage, education, and relaxation techniques. As for the outcomes associated with breastfeeding, the review examined factors such as milk production, postpartum comfort, breastfeeding support, self-efficacy in breastfeeding, breastfeeding knowledge, duration of breastfeeding, breastfeeding success, and maternal stress levels.

Conclusions: This scoping review highlights the potential benefits of maternal massage and educational interventions for improving breastfeeding outcomes in postpartum mothers. Practical applications could include offering maternal massage services or training, comprehensive breastfeeding education programs focused on skills, knowledge, and self-efficacy, and tailored support for mothers facing low milk supply or breastfeeding challenges. Future research should optimize such interventions' timing, delivery methods, and cultural adaptations across diverse breastfeeding populations.