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Background: Dysfunctional stress-coping styles may accelerate negative emotional self-efficacy in the mothers of preterm neonates. This study was conducted to determine the effect of applying problem-solving skills on stress-coping styles and emotional self-efficacy in mothers of preterm neonates.Methods: This randomized clinical trial was conducted from January 2020 to February 2021 in 4 neonatal intensive care units (NICU) of Mashhad, Iran. 60 mothers were selected using convenience sampling method and randomly assigned to control and intervention groups. The intervention group was divided into groups of 3-5 people to attend 6 sessions of at least 60 minutes held 3 times a week for two weeks and received training on problem-solving skills. The control group received routine care. Data were collected using demographic characteristic forms, problem-solving inventory, ways of Coping Questionnaire, and the emotional self-efficacy scale. The tools were initially filled out by both groups and re-completed at the end of the second week after the intervention and four weeks later. Data were analyzed using SPSS version 21 and the significance level of less than 0.05. Independent and paired t-test, Mann-Whitney, Chi-square, Fisher’s exact test, repeated measures, and Bonferroni post hoc test were used.Results: Analysis of variance with repeated measures showed that in the intervention group, there was an increase in the scores of problem-focused style (before: 37.9±6.3; immediately: 46.2±5.3; one month later: 47.5±5.6) (P

Introduction: Patient safety is the most important priority in the healthcare system. Medical universities always attempt to find innovative and more effective educational methods to improvethe students’ abilities for clinical decision-making and quality and safe care. Thus, this study was designed to evaluate the effect of scenario-based learning on the knowledge, attitude, andperception of nursing students about patient safety.Methods: This quasi-experimental study was conducted between September 2023 and January 2024. The study sample comprised 78 nursing and midwifery students from the fourth and fifth semesters of their bachelor’s degrees, each of whom was systematically reviewed. The participants were allocated to the intervention (n=43) and control groups (n=35) randomly, using simple randomization. The educational content was presented via scenario-based learning for participants in the intervention group, while it was presented through lecture and discussion in the control group. The questionnaire was standardized and structured, and its validity and reliability were assessed. Data gathering was performed one month after the intervention using a knowledge, attitude, and practice questionnaire. Data were analyzed in SPSS software version 16 using descriptive statistical methods and inferential tests, including the chi-square test, independent T-test, paired T-test, and ANCOVA. Results: The study findings indicated that there were no significant differences in attitude (P=0.152) and perception (P=0.264) scores between the intervention and control groups before the intervention. However, after the intervention, a significant difference was observed (P

Abstract Background Thalassemia is one of the most common genetic disorders. Patients with beta-thalassemia major confront serious clinical and psychosocial challenges in their all lives, which require coping strategies. It appears that psychological interventions are necessary to improve their coping skills. The aim of this study was to determine the effect of applying emotional intelligence components on coping strategies in adolescents with beta- thalassemia major. Methods This randomized clinical trial study involved 60 teenagers with beta- thalassemia major who were divided equally into intervention and control groups. The experimental group participated in 9 sessions of an emotional intelligence program consisting of 90 min, held both virtually and in person, two sessions per week. We investigated problem-focused and emotion-focused (including positive emotion-focused and negative emotion-focused) coping strategies of both groups of adolescents using the Billings and Moos questionnaire before the intervention, immediately after the intervention, and one month after the intervention. Data were analyzed using SPSS 21. Then, according to the research objectives, independent t-tests, Chi-square, Mann–Whitney, repeated measures Analysis of Variance (ANOVA) and Bonferroni test were used. Results In experimental group, the mean score of problem-focused (problem-solving, cognitive evaluation) and positive emotion-focused (social support) coping increased from (14.2 ± 2.6) and (5.0 ± 0.5) before the intervention to (29.6 ± 3.1) and (10.9 ± 1.3) one month after the intervention, respectively (P

Abstract Background The motivation of caregivers plays a crucial role in the treatment, follow-up, and care of children with intellectual and developmental disabilities. Previous studies have focused on the older people and end-stage diseases, while giving less attention to the motivation of mothers caring for children with special needs. This study aimed to explore the motivations of mothers caring for children with intellectual and developmental disabilities in Iran. Methods This study employed a qualitative approach, guided by the Self-Determination Theory. Purposeful sampling was initially used, followed by theoretical sampling until data saturation was achieved. Data were collected through semi-structured interviews with 26 mothers of children with intellectual and developmental disabilities. Mayring’s seven-step directed content analysis approach was utilized for coding and categorization. The research adhered to ethical standards and ensured data trustworthiness through credibility, dependability, confirmability, and transferability measures. Results The findings revealed that mothers’ caregiving motivations could be classified into four main categories: (I) intrinsic, (II) identified-extrinsic, (III) introjected-extrinsic, and (IV) external-extrinsic. Additionally, twelve sub-categories were identified within these four main categories. Conclusion The findings revealed that mothers demonstrated varying levels of intrinsic and extrinsic motivations in caring for children with intellectual and developmental disabilities. By recognizing and enhancing the diverse sources of motivation, healthcare providers and policymakers can better support mothers in their caregiving roles, ultimately contributing to improved outcomes for both the mothers and their children.

Introduction: Cognitive rehabilitation has an effect on the improvement of symptoms of dyscalculia disorder such as executive function and quantitative reasoning and affects other children's functions. Aim: The purpose of the present study was to investigate the effectiveness of cognitive-computer software on the executive function and quantitative reasoning of 7-12-year-old children with dyscalculia. Method: It was a semi-experimental research design of pre-test-post-test and follow-up with a control group. The statistical population included all children with dyscalculia in Isfahan city in 2022-2023. 45 children with dyscalculia disorder were selected by purposeful sampling and placed in two control and experimental groups.. For the experimental group, Captain Log (2020) cognitive-computer training program was implemented in 10 sessions of 60 minutes; But the control group did not receive any intervention. The research tools included the fifth version of Wechsler's intelligence scale (Wechsler, 2014), continuous performance computer test (Rosold, 1956), Wisconsin card sorting test (Grant and Berg, 1948), Tower of London test (Challice, 1982). The data obtained from the research were analyzed with SPSS software version 26 and using the analysis of variance test with repeated measurements. Results: The results showed that Captain Log computer cognitive software had a significant effect on executive function (attention, error elimination and correct answer, problem solving and cognitive flexibility) (p0.05). Conclusion: Based on the findings of the research, it can be concluded that the cognitive rehabilitation of Captain Log's cognitive-computer program can be used as an efficient method to improve the cognitive ability of 7-12-year-old children with dyscalculia.

Abstract Background Detecting a health-promoting lifestyle in colorectal cancer (CRC) survivors is of paramount importance to manage disease complications, prevent their recurrence, and enhance survival; however, no specialized tool has yet been provided to measure the lifestyle of these patients. Accordingly, this study aimed to develop and determine the psychometric properties of the Health-Promoting Lifestyle Scale in CRC Survivors (HPLS-CRCS). Methods This study was a mixed study with an exploratory sequential design in two phases. Concept analysis was performed in the first phase according to Schwartz-Barcott and Kim’s (2000) hybrid model to explain the concept, identify dimensions, and generate items. In the second phase, psychometrics including validity (face, content, and construct) and reliability (internal consistency and stability) were determined. Responsiveness, interpretability, ease of use, item weighting, and scale scoring were also determined. Results After explaining the concept, an initial scale encompassing 211 items was developed, content and item analyses were conducted, and the items decreased to 89 items after the face validity assessment. For construct validity, confirmatory factor analysis (CFA) was conducted with a sample size of 500 survivors, and convergent validity was performed for the Persian version of the Health-Promoting Lifestyle Profile II (HPLP-II). Accordingly, 80 items were classified into six factors: activity and rest, spiritual growth, health responsibility, nutrition, interpersonal relationships, and psychological management, with RMSEA = 0.055, χ2/df = 2.484, and χ2 = 6816.516. The reliability of the scale was confirmed, Cronbach’s alpha was between 0.865 and 0.928, and the intraclass correlation coefficient (ICC), the standard error of measurement (SEM), the minimal important change (MIC), and the smallest detectable change (SDC) were 0.896, 3.36, 13.86, and 19.87, respectively. Conclusion The HPLS-CRCS consists of 80 items in six dimensions and is a valid and reliable scale for evaluating the health-promoting lifestyle in CRC survivors. Using this scale to evaluate the healthy lifestyle in these survivors can lead healthcare providers to detect deficiencies and plan the lifestyle of CRC survivors during the post-treatment period.

Introduction: Health-promoting lifestyle (HPL) among the survivors of colorectal cancer (CRC) is essential to reduce CRC complications, prevent its recurrence, and improve survival. Nonetheless, there is no comprehensive definition for the concept of HPL in CRC survivors. This study aimed to define the concept of HPL among CRC survivors based on the existing literature. Methods: This integrative review was conducted in 2021 using Whittemore and Knafl’s method. The national and international databases of SID, Magiran, ProQuest, Medline, ScienceDirect, Web of Science, and Scopus were searched. Quality appraisal was performed using the Mixed Methods Appraisal Tool (MMAT) and the data were analyzed using the four-step approach proposed by Whittemore and Knafl. Results: After data evaluation, 167 documents were included in final analysis. In total, 1863 codes were generated and categorized into eighteen main categories and the three main themes of antecedents, attributes, and consequences. Accordingly, HPL among CRC survivors was defined as "a set of behaviors in the areas of health responsibility, physical activity, nutrition, spiritual growth, psychological management, and interpersonal relations which are affected by socio-demographic characteristics, clinical characteristics, psychological status, physical conditions, time and place limitations, and patient education, and lead to better disease prognosis, better general health status, better bio-psycho-social status, and better quality of life". Conclusion: The definition of HPL among CRC survivors provided in the present study can be used in counseling, educational, supportive, and care programs for CRC survivors in order to improve their quality of life and survival.

Abstract Background Inborn errors of amino acid metabolism are chronic conditions that have many sequels. Mothers of these children are facing different challenges which are underdetermined. This study was done to explore lived experience of mothers caring for these children. Methods This is an interpretive phenomenology with van Manen’s approach which has 6 steps. Data were gathered by convenience and purposeful sampling. Nine mothers with different experiences were interviewed and the interviews were audiotaped. Results Six final themes were revealed from the exploring mothers’ experiences including the future tied to the past, psychosis in the shadow of a lost ideal child, rebellion and blaming, the ways of escaping difficulties, self-forgetting in the shadow of full-time care, passing difficulties in the duality of hope-hopelessness, caring in a continuum of isolation-socialization. Conclusion Mothers have multiple challenges in taking care of their children, especially psychologically and financially. So, nurses must plan programs for helping mothers of children with inborn errors of amino acid metabolism to reduce the effects of disease on mothers and consequently the children and the whole family.

Background & Aim: Today, ageing is a challenge for health and care systems, and one of its main consequences is an increase in the readmission rates. Therefore, in all countries, efforts are being made to reduce the readmission rate. The Readiness for Hospital Discharge Scale was designed to understand patients' readiness levels for discharge. This study was conducted to translate and evaluate the psychometric properties of the Readiness for Hospital Discharge Scale. Methods & Materials: In this methodological study, a convenience sample of 500 elderly patients admitted to hospitals affiliated with Mashhad University of Medical Sciences was selected in 2020-2021. The instrument was translated using the forward-backwards method. The psychometric properties of the final version of the instrument were assessed by employing exploratory and confirmatory factor analysis (validity) and Cronbach's alpha and the Guttman's split-half coefficient (reliability). Results: In the factor analysis, all items had a factor loading above 0.3 and, all of them were retained. The goodness of fit indices confirmed the model and a good fit of the model. The Cronbach's alpha coefficient for the whole scale and the Guttman's split-half coefficient were 0.92 and 0.86, respectively. Conclusion: The results of our study supported the four-dimensional structure of this instrument and indicated that this instrument has adequate validity and reliability. Therefore, nurses and doctors can use this tool as a suitable method to measure the elderly patients' readiness for discharge and to achieve a safe transfer from the hospital to home.

Abstract Background Precise examination of breast cancer survivors’ lifestyles can lead to improved planning and implementation of care and counseling interventions to increase their survival rate and improve their quality of life. Therefore, a valid and reliable instrument needs to be developed. Therefore, the present study aimed to determine the psychometric properties of the Persian version of the Healthy Lifestyle Instrument for Breast Cancer Survivors (HLI-BCS). Methods This methodological study was conducted on 420 Iranian breast cancer survivors between May and November 2022. Participants were selected using convenience sampling. The face, content, construct validity, convergent, and reliability of the Persian version of the HLI-BCS were assessed. Results After assessing face, content, and construct validity, the Persian version of the HLI-BCS with five factors and 20 items was provided. The total Cronbach’s alpha and intra-class correlation coefficient (ICC) were calculated as 0.86 and 0.79, respectively, which were at acceptable levels. A healthy lifestyle in breast cancer survivors was observed to have strong and significant relationships with quality of life in general (p

Background: Clinical failures are considered as a serious problem in the health system and a threat for patients’ safety. The nurses' performance was poor during the blood products transfusion for children. One of the main obstacles to implement a national blood policy in developing countries is the lack of trained staff.Aim: To determine the effect of a designed training program based on the ADDIE model (analysis, design, development, implementation, evaluation) on nurses’ performance regarding blood transfusion for children.Method: This randomized clinical trial (RCT) study was performed in Bint Al-Huda teaching hospital at Al- Nasiriya City in Iraq. The study started from July 2021 to March 2021 and involved 60 nurses. Data was collected using a demographic data questionnaire and the observational checklist of nurses’ performance regarding transfusion of blood and blood products. At first, nurses’ performance regarding transfusion of blood and blood products to a child was checked. Then, the intervention group received a designed training program based on the ADDIE model. Again, nurses’ performance was assessed. Finally, data were analyzed with SPSS 25 software. P0.05), but in post-test stage, the scores of the intervention group were higher (M=36.40±3.08 versus M=10.85±4.53; P

Objectives: The main purpose of this article is to achieve the main challenges of not using library applications. To achieve this goal, three basic questions were raised: what are the three main challenges of using mobile library applications? What is the priority of these challenges in Iranian university libraries? What is the communication model for these challenges?Methods: This research is of an applied-developmental type with a mixed Method approach, because a part of the data is collected from the study of texts and qualitative content analysis, and another part is obtained from the survey, and for modeling, the structural-interpretive method, which is a quantitative method. The research community in the first part: articles of the 10-year period from 2010 to 2020 with the keywords "library", "application", and "mobile", have been used in ProQuest, Science Direct, Elsevier, Emerald, Scopus, and Google Scholar databases. The collection tool in the second part of this research was a 25-question questionnaire made by the researcher based on the Likert scale; the community of the second part included librarians of medical sciences libraries in Tehran and specialists in the design of simulations, whose number was about 70 people. And the research community in the third part included two groups: 7 library and information professors, 7 application design specialists, and a total of 14 people as an expert panel based on targeted sampling with the criteria of designing at least 1 successful application for specialists and carrying out a research project practical or theoretical for professors.Results: The study of various texts showed that there are 5 main challenges for using mobile applications in libraries: challenges related to the financial situation, cultural challenges, technical challenges, knowledge and expertise challenges, and interpersonal communication challenges. The prioritization of these challenges from the point of view of library professors and experts in the field of applications were cultural, financial, knowledge and expertise, technical, and interpersonal communication challenges, which were different from the results obtained from the structural-quantitative modeling section; In the structural-interpretive modeling section, these challenges are divided into two: 1. Technical, knowledge and specialization and cultural challenges, these challenges have a great power of influence as well as the power of dependence, they are also related to each other and to the challenges of the second level; But the challenges of the second level, which include; 2. financial and interpersonal communication challenges; which are very close to the first level in terms of influence and dependence, but these two challenges are actually more effective than the first level from the point of view of experts, in the sense that the challenges of the first level are often considered as fixed challenges, while the challenges of the second level can be changed and They have more adjustments. Among the components of the second level of the financial challenge in MICMAC analysis, it was identified as a key component; As it is drawn in the model, this challenge has a general and major impact on other challenges, and changes in it can change other challenges and even solve the challenge in some cases.Conclusions: Library administrators and planners can be advised to use cultural library applications first to pursue cultural issues because changes in financial challenges do not seem to be within their control.

Introduction: Oropharyngeal colonization with pathogenic organisms contributes to the development of ventilator-associated pneumonia (VAP) in intensive care units (ICUs). Oral hygiene care (OHC) is a very effective method for reducing the risk of VAP in these patients. This study aimed to evaluate recent OHC strategies to decrease VAP. Methods: Randomized clinical trials (RCTs) published in the PubMed, Scopus, Embase, Cochrane Library, and Web of Science databases from inception to September 10, 2020 were reviewed to compare the effects of selective oropharyngeal decontamination (SOD) on the incidence of VAP in adult patients requiring mechanical ventilation. Results: Out of a total of 1098 articles reviewed, 17 eligible studies were included for final analysis. The results showed that the use of chlorhexidine for oropharyngeal decontamination reduces the incidence of VAP. However, it had a small effect on gram-negative resistant bacteria. Also, it was observed that the combined use of colistin and chlorhexidine was more effective than chlorhexidine alone in preventing VAP. The results of studies on the use of toothbrushes to reduce the incidence of pneumonia are unclear since they used chlorhexidine at the same time. However, tooth brushing is one of the best ways to maintain oral hygiene. Using povidoneiodine, Nanosil, and non-absorbable topical antibiotics reduced the incidence of VAP, while Iseganan did not show a significant effect in this regard. Conclusion: The prophylactic use of topical bactericidal agents in critically-ill patients is effective in reducing the incidence of VAP. However, the use of non-absorbable topical antibiotics is more effective than other methods in oropharyngeal decontamination.

Background: Spiritual sensitivity is the child’s ability to be spiritually aware of what is happening both outside and within him or herself, and the further ability to respond accordingly. On the other hand, play is one of the strategies to develop children’s capabilities. Yet, there is limited information about the relationship of play and spiritual sensitivity. The present study aimed to evaluate the effects of meaning-centered play on children’s spiritual sensitivity. Methods: This two-group randomized controlled trial was conducted on 120 children aged 10–11 who were recruited from two centers affiliated to the institute for intellectual development in Mashhad, Iran, by convenience sampling between May 2016 to January 2018. Samples were allocated to intervention (60) and control (60) groups through random allocation. In the intervention group, a meaning-centered play intervention was implemented in twelve 45-minute sessions, twice a week and for six weeks. The control group had the usual trend of the center’s plays and programs. Spiritual sensitivity was measured via the Spiritual Sensitivity Scale for Children (SSSC) before and after the end of the intervention. The data were analyzed via the SPSS software (v. 20.0) using Chi-square, independent-sample t test, Mann-Whitney U and Wilcoxon signed-rank tests. The significance level was less than 0.05. Results: Although the groups did not significantly differ from each other concerning the pretest mean scores of spiritual sensitivity and its subscales (P>0.05), the posttest values of these scores in the intervention group were significantly greater than the control group (p

Background: Premature birth is a crisis for mothers and affects resilience. Premature babies are atrisk for developmental disorders. The Kangaroo Mother Care (KMC) can reduce maternal stress andimprove the growth of the baby. This study aimed at assessing the effect of home visit based on thecontinued KMC on maternal resiliency and development of premature infant.Methods: This randomized controlled trial conducted on 50 pairs of mothers and premature babieswith gestational age of 26-32 weeks who were admitted to Neonatal Intensive Care Unit of Om-al-Banin Hospital, Mashhad, Iran in 2019. The KMC is practiced routinely for all eligible newborns in thishospital. The experimental group continued the KMC one month after discharge at home and receivedtwo home visits. Resiliency of the mothers was assessed in admission, discharge, and one monthafter discharge with the Connor and Davison questionnaire and the development of the newborns wasassessed in two months of adjusted age with Ages and Stages Questionnaire (ASQ). Data analysis wasperformed using SPSS software version 16 and t-test, Mann-Whitney, ANOVA, Friedman, Chi-square,Fishers exact. The significance level was set at p

Objective: Understanding the experiences of survivors and healthcare providers about health-promoting lifestyle (HPL) in colorectal cancer (CRC) survivors is important in planning for coping with the disease, managing treatment side effects, increasing survival, and improving quality of life (QOL). This study was conducted to explore the experiences and perspectives of CRC survivors and healthcare providers about HPL in CRC survivors. Methods: This descriptive qualitative study was performed in 2020 at Omid and Imam Reza Hospitals in Mashhad, Iran. Participants were CRC survivors (n = 12) and healthcare providers (n = 33) who were selected by purposive sampling. Data were collected using in-depth semi-structured interview by face to face and then analyzed by Zhang and Wildemuth content analysis method. MaxQDA software was used to organize the data. Results: Following the treatment of cancer, CRC survivors seek to make changes in lifestyle and they choose a HPL that maintains or improves their health. HPL in CRC survivors includes nutrition, activity and rest, health responsibility, interpersonal relations, spiritual growth, and psychological management. The results showed that HPL can lead to motivation, the ability to self-care and improve daily performance, reduce treatment complications, and increase the QOL. Conclusions: CRC survivors can help change their lifestyle patterns with healthy eating, treatment adherence, regular physical activity, and good sleep habits. Furthermore, effective personal and social relationships, spiritual growth, and management of psychological disorders develop health-promoting behaviors in them. CRC survivors also face challenges and limitations in their life after treatment; identifying the components of a HPL in CRC survivors can lead to desirable care, treatment, education, and counseling services.

& Aims: This study aimed to determine the effect of peer education on the self-efficacy of dialysis patients referred to Urmia Teaching-Medical Hospital, Urmia, Iran. Methods: This clinical trial was conducted on 60 dialysis patients who were selected using the convenient sampling and random allocation methods in 2019. They were then divided into two experimental and control groups of 30 cases per group. Before the intervention, demographic characteristics form and dialysis patient self-efficacy questionnaires were utilized to collect information. Subsequently, peer education intervention was designed based on the educational needs of the patients in different domains. The experimental group was then subjected to the intervention during the two sessions of dialysis individually and face to face. One month after the end of the second session, the self-efficacy questionnaire of dialysis patients was given to both groups, and the data were analyzed using SPSS software (version 19). Results: At the pre-test stage, the independent t-test showed no significant difference between the control and experimental groups in terms of self-efficacy scores (P>0.05). However, a significant difference was observed between the control and experimental groups in terms of the self-efficacy scores at the post-test (P

Background: Different complications of colostomy in neonates can lead to readmission, surgery, and even death. Therefore, prevention of colostomy complications highlights the empowerments of mother to care for the neonate and reduce maternal distress. Aim: The present study aimed to determine the effect of maternal empowerment programs on neonatal colostomy complications and maternal distress tolerance. Method: This randomized clinical trial was conducted on 60 mothers of newborns aged 1-90 days with colostomy referred to two specialized pediatric centers in northeastern Iran in 2019. The control group received a training session. The intervention group, in addition to one training session, participated in two sessions of maternal empowerment program regarding the care of neonates with a colostomy. The collected data were analyzed in SPSS software (version 21) using ANOVA, Friedman, and Mann-Whitney U tests. Results: The two groups were homogeneous considering demographic variables (P

Difference and variety are phenomena that have existed since the formation of human societies. In such a situation, Tolerance makes it possible for different individuals and groups to coexist. On the other hand, mass media can exacerbate development and social solidarity by consolidating and deepening religious, national, cultural and historical links. Therefore, considering the widespread use of virtual social networks, and considering that today, different ethnic groups and groups, regardless of geographical boundaries and physical distances, have been able to connect and expand increasingly diverse communications , this research it tries to explain the interplay of new media and ethnic tolerance among the citizens of Tehran.The findings suggest that independent variables, each independently affect the dependent variable of the research, and in spite of the presence of numerous and diverse ethnic groups, the media can, by creating consensus among different groups, as an important factor in maintaining the dignity of individuals Have an effective role in achieving national unity.

Objectives: The prevalence of drug abuse among pregnant women is increasing worldwide, putting their infants at the risk of many disorders. Neonatal abstinence syndrome (NAS) is considered as a neurological disorder in infants who are exposed to narcotics during pregnancy. Breastfeeding is implicated to markedly reduce the incidence and severity of the NAS, as well as the need for therapeutic agents. Therefore, the present study aimed to investigate the duration of exclusive breastfeeding and the hospital stay of infants with NAS, as well as the challenges ahead and solutions to extend the lactation period in drug-addicted mothers. Methods: A number of review articles indexed in PubMed, Google Scholar, and Medline databases were scrutinized in this study. The chosen review articles surveyed experimental/quasi-experimental studies that were published during 2004-2018 using keywords including NAS, drug-addicted mothers, exclusive breastfeeding barriers, and continued breastfeeding. Results: According to the results, the duration of continued breastfeeding in drug-addicted women was short and it failed in the first six months after delivery. The critical factors interfering with continued breastfeeding were categorized into individual, family, and social barriers. In addition, social barriers consisted of fear and misconception about lactation, the lack of awareness and motivation, along with the lack of family support and health care centers. The findings suggest that mother’s training during the pregnancy, mother-infant rooming-in, and mother-infant skin-to-skin contact could be potentially applied to extend the duration of the lactation in drug-addicted pregnant women. Conclusions: In general, hospitals should provide a comfortable environment to encourage drug-addicted women to breastfeed infants with the NAS. It seems that providing resources and facilities where drug-addicted women could discuss barriers to breastfeeding, as well as gaining access to lactation counselors and other professional practitioners would help mothers to continue breastfeeding.

Dear Editor, After treatment, Colorectal cancer (CRC) survivors often seek to improve their lifestyle and dietary patterns. One of the common habits adopted for this purpose is the use of dietary supplements (1) attempted by survivors to prevent recurrence of the disease, reduce side effects, improve physical and mental health, strengthen the immune system, cope with stress, and improve life expectancy (2). After the diagnosis of cancer and completion of treatment, at least 50% of survivors tend to use more than two or three supplements. Nonetheless, the beneficial effect of dietary supplements after CRC is a debated issue (1, 2). Supplement use is also controversial due to its unknown association with chemotherapy and radiotherapy. Moreover, clinical guidelines for using dietary supplements are not elucidated. According to the European Society for Clinical Nutrition and Metabolism (ESPEN) and World Cancer Research Fund/American Institute for Cancer Research (WCRF/AICR), the use of supplements is recommended only in case of specific deficiencies. American Cancer Society (ACS) recommends that patients avoid the overdose of dietary supplements. National Cancer Institute (NCI) also recommends avoiding vitamin and mineral supplements during and after treatment (3). The literature is void of sufficient and conclusive evidence to support or rule out the association of post-diagnosis dietary supplements with progression and recurrence of cancer, and the published results are contradictory. Calcium and vitamin D supplements have been demonstrated to reduce the risk of recurrent adenomas, cancer-specific mortality, and all-cause mortality. Nevertheless, the use of multivitamins, vitamin C, calcium, vitamin D, and vitamin E supplements is not associated with the prevention of colon adenoma recurrence. Furthermore, the use of B vitamins was reported to cause intestinal adenomas but did not indicate pathological findings of disease progression (4). On the other hand, calcium, vitamin D, and folic acid (B9) are effective in reducing the rate of intestinal polyps and improving the side effects of treatment, while the effects of zinc and selenium consumption are not clear (5). In some studies, however, no protective role was attributed to folic acid supplements. There is even a possibility of adverse effects of folic acid on cancer progression, increased recurrence, and metastases (3, 6). Not until further studies clarify the relationship between dietary supplements and treatment effectiveness, recurrence, and survival improvement in CRC survivors, should health care providers exercise caution in recommending dietary supplements. In addition, CVR survivors should be assessed for supplement use and be aware of the precautions for using supplements. We do not yet have a comprehensive understanding of the effects of the type and dosage of vitamin and mineral supplements and how they are used after cancer diagnosis and during treatment. This requires the design and implementation of targeted and comprehensive studies to understand the diverse and potential effects of dietary supplements. Therefore, both health care providers and survivors should understand the potential risks regarding the use of dietary supplements and be careful about their recommendations and use. Conflicts of Interest The authors declare that they have no conflict of interest.

Background: Rheumatoid arthritis is the most prevalent chronic rheumatologic disease of children. The quality of life (QOL) in these individuals is affected by physical pain, discomfort, treatment complications, and frequent absences from school leading to academic failure. No research similar to the present investigation was performed in this area. Aim: We aimed to evaluate the problems of children with rheumatoid arthritis. Moreover, we assessed the effect of family-centered empowerment on the QOL of these children. Method: This randomized clinical trial was performed on 60 children aged 8-12 years diagnosed with rheumatoid arthritis in Akbar Pediatrics Hospital, Mashhad, Iran in 2018. The subjects were divided into test and control groups. The four stages of family-centered empowerment model, namely improvement of knowledge, self-efficacy, self-esteem, and assessment were executed for the test group. After a month, the inventory of pediatric quality of life was completed again. Data analysis was performed by Mann-Whitney U test, independent t-test, and paired t-test using SPSS version 16. Results: No significant difference was observed between the groups regarding age (P=0.351). In addition, the post-intervention QOL of the test group was significantly higher than the control group (P=0.004). There was a significant difference between the pre- and post-intervention QOL in the test group (P < 0.001). Implications for Practice: This study indicated the effect of family-centered empowerment model on the physical, emotional, educational, and social dimensions of QOL of children aged 8-12 years diagnosed with rheumatoid arthritis. As a result, this model is recommended to empower the children with this disease or other chronic diseases and their caregivers.

Background: Baby colic is one of the most common digestive problems in infants. Due to its several and unknown causes, colic treatment depends on the parent's individual and social education and support. Aim: This study aimed to determine the effect of mothers' educational supportive care program on the pain intensity and crying caused by colic in infants aged 1-5 months. Method: This study was conducted based on a randomized controlled clinical trial. This study included 88 infants with colic who were referred to a specialized pediatric clinic at a public hospital in eastern Iran. The patients were randomly divided into the intervention and control groups. The educational supportive care program was implemented for eight days and the infant crying duration and frequency were recorded each day. On the other hand, the control group received the clinic routine care. Subsequently, the data were analyzed in SPSS software (Version 21). Results: The two groups were homogeneous in terms of demographic variables (P

Background: To make the best use of written information in education pamphlets, suitability criteria developed for instructional materials. Moreover, client satisfaction with the quality of written materials provided in hospitals for patients needs to be taken into account. Aim: Therefore, the present study aimed to assess the suitability of patient education pamphlets and patient satisfaction among teaching hospitals in Mashhad, Iran. Method: A total number of 542 patient education pamphlets developed in 11 teaching hospitals in Mashhad was collected via a census method and their suitability was investigated using Suitability Assessment of Materials (SAM) instrument. Subsequently, satisfaction with education pamphlets among 2820 hospitalized patients was evaluated using a questionnaire designed based on SAM instrument. The association between the suitability of the given pamphlets and patient satisfaction was also determined. Descriptive statistics and the Chi-square test were used to analyze the findings. Results: The results revealed that 33.3% and 66.7% of the given pamphlets fell into the superior and adequate categories in terms of suitability, respectively. With regard to the satisfaction level, 0.7%, 26.4%, and 72.9 % of the patients were poorly, fairly, and completely satisfied with the pamphlets, respectively. Moreover, the pamphlets rated the higher suitability by patients obtained the higher satisfaction scores. Implications for Practice: The results of this study indicated a need for reconsiderations in some suitability factors for the pamphlets. In this respect, the factors of cultural appropriateness as well as layout and typography rated as acceptable.

BACKGROUND: Patients with a vegetative state (VS) are completely dependent on caregivers in all physical aspects of their lives. Caring for such patients comes with a great deal of difficulty for family caregivers. As a result, family caregivers must be fully trained and prepared for this role. The present qualitative study was conducted to investigate the educational challenges faced by family caregivers of VS patients for home care preparedness. MATERIALS AND METHODS: The present qualitative study was conducted through the conventional content analysis method from August 2020 to September 2021 in two provinces of Iran (Sistan and Baluchestan Province; and Razavi Khorasan Province). Fourteen family caregivers of patients in a VS were included in the study. Semi-structured and in-depth interviews were employed to collect data. The Graneheim and Lundman method was utilized to conduct the data analysis using MAXQDA2020 software. Data collection continued until data saturation and the identification of main categories. RESULTS: As indicated by the data analysis, three categories of “unmet educational needs,” “confused caregiver,” and “searching for practical knowledge” which included 19 sub-categories described the experiences of family caregivers of patients in a VS concerning challenges they went through in preparation for patient care at home. Participants' experiences revealed that despite the inadequacy of educations provided by health-care providers on knowledge and skills required by family caregivers, they were committed to caring for the patient and trying to acquire the required knowledge. CONCLUSION: Results indicated that inadequate education and the lack of family caregivers' contribution to caring for the patient in the VS during their stay in the hospital impedes their acquisition of adequate knowledge and skill to care for patients at home. Therefore, healthcare system policymakers should be planning to eliminate the educational barriers faced by family caregivers and expand the educational activities of hospitals' homecare centers to provide educational support of family caregivers after the patient's discharge.

Background: Surgery is a stressful experience in children. Therefore, the familiarization of this population with treatment processes by means of appropriate training tools and techniques can be an effective way to control their anxiety. Aim: The aim of this study was to determine the effect of a preoperative preparation program on anxiety in school-age children undergoing surgery using a factorial design. Method: This clinical trial was conducted on 81 children aged 6-12 years as candidates for elective surgery at Doctor Sheikh Hospital in Mashhad, Iran, in 2016. A preparation program was implemented with two methods (i.e., displaying video tutorials with and without nurses’ explanations) and on two different days (i.e., prior to and on the day of operation) using a factorial design. The estimation of children’s anxiety was accomplished by using the Revised Children’s Manifest Anxiety Scale administered before training and prior to operating room admission. The data were analyzed by statistical tests in SPSS software, version 16. Results: The study groups were comparable in terms of demographic characteristics (P>0.05). There was no significant differences among the four groups regarding manifest anxiety based on the place of referral (i.e., department or clinic) (P=0.22), presentation or non-presentation of explanations by nurses (P=0.12), and their interaction effects (P=0.22). Implications for Practice: No significant difference was observed among the four groups in terms of manifest anxiety. Therefore, all four training methods were effective in reducing anxiety in children. Consequently, each of these methods can be used depending on human resources and infrastructure of each department.

Background: Lack of mobility and motor impairments can intensify mental health problems in the elderly. Muscle weakness is one of the most important cause of fall in the old individuals. Muscular performance is regarded as one of the significant components of quality of life in older adults. Aim: This study aimed to investigate the effect of resistance training using Thera-Band on muscular strength and quality of life among the elderly. Method: This randomized clinical trial was conducted on 70 elderly people referring to the health centers of Mashhad in 2016. The participants were randomly assigned into two groups of intervention and control. The intervention group was subjected to lower- and upper-extremity resistance training with Thera-Band performed two thirty-minute sessions a week for six weeks. However, the control group did not receive any training. Data collection was performed using a dynamometer and the short version of the World Health Organization Quality of Life. The data were analyzed in SPSS version 16 using independent t-test, Mann-Whitney U test, paired t-test, Chi-square test, and exact Chi-square. Results: The mean ages of the individuals in the intervention and control groups were 69.7±6.1 and 77.2±6.2 years, respectively. After intervention, the mean scores of quality of life (P>0.001) and muscular strength in the upper and lower extremities (P>0.001) were significantly higher in the intervention group than those in the control group. Implications for Practice: Resistance training with Thera-Band could enhance muscular strength and improve quality of life in the elderly. It was concluded that the promotion of this exercise program could have a positive effect on the muscular strength and quality of life among this population.

Background: Surgery is a stressful experience for children, and preoperative anxiety in children could be affected by the level of parental anxiety. Aim: The aim of this study was to determine the relationship between anxiety in school-age children before surgery and parental state-trait anxiety. Method: This descriptive study was performed on 81 children within the age group of 6-12 years admitted for elective surgical operation and 128 parents in Doctor Sheikh Hospital, Mashhad, Iran, 2016. Children's anxiety and parental anxiety were measured before the entrance of the patients to the operating room via Revised Children's Manifest Anxiety Scale (RCMAS) and Spielberger’s State-Trait Anxiety Inventory, respectively. The data was analyzed in SPSS, version 16, using the relevant statistical tests. Results: The results of Pearson product-moment correlation test showed a positive correlation between children's anxiety and fathers' state anxiety and between children's anxiety and mothers' state anxiety (r=0.27, r=0.41; P=0.005, P=0.040, respectively). However, no statistically significant relationship was observed between children's anxiety and parents' trait anxiety, age of children, as well as parents' educational level, occupation, and level of trait anxiety. Implications for Practice: Considering the association between parents' state anxiety and children's anxiety, implementing preoperative interventions to prepare parents for surgery is recommended.

Background: Patient education is taken into account as one of the key components of comprehensive care as well as one of the significant nursing functions in order to increase community health. In this respect, education materials and written texts can improve patient information up to 50% and consequently meet patient satisfaction. Readability is considered as an integral concept in patient education and an appropriate measure to determine how contents are perceived by readers. Aim: The present study was to measuring the readability level of patient education pamphlets in training hospitals in the city of Mashhad. Method: This study was a descriptive research conducted in 2016. In order to measure the readability level, the Simple Measure of Gobbledygook (SMOG) Readability Test was used. The study sample included 543 patient education pamphlets used by 11 training hospitals in the city of Mashhad along with pamphlets developed by the Office of Vice-Chancellor for Treatment Affairs that were collected through the census method. The SPSS16 software was also employed for data analysis. In terms of descriptive analysis, mean and standard deviation were used. In addition, Cronbach’s alpha correlation test was employed for inferential analysis. Results: The average readability level of patient education pamphlets was estimated equivalent to 11th grade (11.35±1.05). Moreover, the minimum and the maximum readability levels of the pamphlets were 9th grade and 15th grade, respectively. Implications for Practice: The results revealed that patient education pamphlets available in training hospitals in the city of Mashhad were endowed with a high level of readability. Thus, the given pamphlets were appropriate to patients with a level of literacy equal to senior university students and they could not be perceived by the public. Considering the importance of readability index in health promotion and increased patient self-care, it was recommended to improve the readability level of patient education materials.

Background: Hundreds of patient education materials i.e. pamphlets are annually published in healthcare systems following their design, correction, and revision. Aim: to design and evaluate patient education pamphlets based on readability indexes and their comparison with literacy level in society. Method: The average literacy level among 500 patients admitted to two training hospitals in Bojnurd (northeastern Iran) was determined in 2014-2015. Afterwards, all patient education pamphlets in both hospitals (n=69) were collected and their readability level was determined. After that, all the pamphlets were re-designed according to the given standards and in line with literacy level in society. The SPSS software (Version 20) was also used to analyze the data. Results: The average level of literacy among 500 patients in both hospitals in the present study was 6.72±4.34 which was placed in grades six and seven in terms of the guide to readability indexes. In line with McLaughlin’s SMOG Readability Formula, the bulk of pamphlets (91.3%) were at college level before corrections and revisions based on the given standards, but 23.2% were at a level lower than grade seven following corrections and revisions. Implications for Practice: Evaluation of patient education pamphlets plays an important role in promoting self-care among patients. Due to the novelty of the present study in Iran, the results of this study can contribute to patient education researchers in order to identify the strengths and weaknesses of patient education materials i.e. pamphlets based on scientific indices as well as their revisions and re-developments.

Background: As two of the most prominent cultural components, spirituality and religion give sense to our human values, conducts, and experiences. The spiritual dimension is one of the four significant aspects of holistic care. However, the diversity of views has resulted in different interpretations of the reality of spirituality and its origins and consequences. Aim: This study aimed to examine the available approaches and paradigms in the realm of spirituality. Method: In the present integrative review, the initial search was performed in national and international databases, including Science Direct, PubMed, Google Scholar, Scopus, Sage, Medline, Wiley, SID, MagIran, IranMedex, and IranDoc, using the keyword, "spirituality", without considering any time limits. Articles relevant to the objectives of the study were then fully reviewed. Results: Since ancient times, spirituality has been sporadically discussed in human intellectual and artistic artifacts. This concept was expanded as an independent, systematic, and conscious movement since the second half of the 19th century in Europe, USA, and Canada. The three prominent approaches to spirituality include religious, secular, and holistic health perspectives. Implications for Practice: Despite the growing interest in research on spirituality, it is difficult to reach a unanimous decision about this concept. However, it should be noted that spiritual concerns cannot be disregarded, considering the holistic perspective to humanity as the building block of holistic nursing care. Overall, every patient is a unique human being whose spiritual needs are affected by his/her cultural beliefs and values.

Introduction:Lack of coordination in clinical education of nursing, the method of health care after graduation, and the existence of many problems in fulfilling the aims of clinical teaching encouraged the researchers to conduct this research, aiming at investigating the quality and obstacles of clinical teaching in nursing.Method:This is a cross-sectional descriptive study on 90 individuals (clinical teachers, senior M.S. students of nursing and 30 nurses). 3 self-made questionnaires were used to collect the data.Results:The results showed that the quality of clinical teaching in viewpoint of the majority of students (73.3%) is weak and for the majority of clinical teachers (86.7%) it is moderate .The X2 statistical test revealed a significant difference between the viewpoints of these two groups. As to the problems and obstacles in achieving the aims of clinical teaching, 100% of the students stated the inadequacies concerning the clinical teachers. 96.6% of the clinical teachers indicated that the existing insufficiencies in the curriculum and environmental factors are the obstacles in this regard. 100% of the nursing staff emphasized lack of familiarization of the personnel with the aim of clinical teaching of nursing students which is the main problem.Conclusion:To improve the quality of clinical teaching in nursing, it is recommended that there should be a cooperation among clinical teachers, nurses, head nurses, educational supervisors, and nursing managers in preparing curriculum plans in nursing.

Introduction. Most factors which make infants susceptible to pneumonia arise from incorrect infant care in the family and also insufficient knowledge of mothers about correct infant care which makes this problem even worse. The present research was carried out to determine the effect of a Designed Care Plan on mothers' performance in caring for the infants with pneumonia in Children Medical Center in Tehran. Methods. In a quasi- Experimental study 66 mothers of hospitalized infants aged between 1-12 month and suffering from pneumonia, were selected by convenience sampling method and assigned randomly to two experimental and control groups. Data collection tools included questionnaire and observational-interviewing checklist. The designed Care Plan was presented both theoretically and practically to the experimental group at home with an eye to the strengths and weaknesses of mothers’ performance and their need, while the control group received only the current care program. The mothers’ performance in infant care was assessed during repeated measurements before and after the intervention. All study subjects were followed for 3 months after the intervention. Results. The mean score for mothers' performance in infant care during pneumonia showed a significant increase in the experimental group and a significant decrease in the control group, after the intervention. While, there was a significant difference between the mean score of mothers' performance in prevention of reinfection with pneumonia before and after the intervention in the experimental group. Moreover, there was a significant difference between the total score of experimental and control groups in infant care during the disease and also in prevention of reinfection with pneumonia, after the intervention. Conclusion. Using a Designed Care Plan is an effective approach for improving mothers’ performance in caring for infants suffering from pneumonia moreover, the results indicated that home-training is a good strategy in the betterment of mother’s caring behaviors.