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The study was conducted to review, categorize and organize early tele-homecare follow-up research in premature infants based on research type, the focus of tele-homecare, and measured outcomes. This narrative review was conducted in 2021 through international databases, including PubMed, Scopus, ProQuest, and Web of Science databases. Studies selected for this purpose included original articles on premature infants. We reviewed 16 out of 267 identified articles. These studies were analyzed according to general characteristics, elements, and characteristics of tele-homecare intervention. Based on the obtained data, most studies had been conducted in Nordic countries as the pioneer in tele homecare. Also, most of them were on the psychological status of premature infants’ parents. Phone calls, video consultation, and applications were considered dominant tele-homecare communication tools. Overall, the qualitative studies on parents’ and health providers’ views about tele homecare revealed its hidden aspects as a supportive tool. The tele-homecare studies were distributed across different fields and countries, resulting in positive outcomes for infants and parents. However, further studies in the long-term periods are recommended to follow up on premature infants.

Covid 19 has made a huge difference in all aspects of life, especially in care and treatment. Hospitalization is limited because of infected family members and fear of getting Covid 19 has limited. The purpose of this study is to analyze the existing conditions based on the SWOT analysis for the home care program for children in Coronavirus crisis. This study is a qualitative study with a conventional content analysis approach. Participants were 18 nurses, physicians, and faculty members, selected based on their willingness to participate in the study and through purposeful sampling. Two specialized panels and 10 presence and in-presence interview sessions were held to collect data. Then, the data were analyzed using SWOT analysis. Four main categories were emerged of the study including: (a) need for a legal protocol, (b) mutual fear of Covid-19, (c) self-responsibility in Corona, and (d) team working approach in the program development. In addition, solutions based on the SWOT analytical were suggested. The results of the study showed that it is necessary to develop a formal protocol, along with self-responsibility, and a program based on the needs of the community and the Covid crisis incorporating the team opinion.

Background: The Coronavirus Disease 2019 (COVID-19) pandemic and lockdown have had a profound impact on the emotions, anxiety, and mental health of communities and premature infants as one of the most vulnerable groups in society whose health depends on the health of the mother.Aim: This study aimed to determine the psychological impact of COVID-19 on mothers with premature infants admitted to the neonatal intensive care unit (NICU).Method: This cross-sectional study was conducted during the COVID-19 pandemic from December 2020 to March 2021 through convenience sampling on 190 mothers whose preterm infants were admitted to the NICUs of the selected hospitals in Isfahan, Iran. Corona Disease Anxiety Scale, a Multidimensional Scale of Perceived Social Support, and Maternal-Neonatal Demographic Characteristics were used for data collection. The obtained data were analyzed using t-test, ANOVA, Pearson correlation coefficient, and multiple regression.Results: The mean total score of COVID-19 anxiety (12.21±10.31) was reported at a mild level, and perceived social support (66.55±12.81) was at a high level. Based on the final results of the multiple regression model, COVID-19 anxiety, and the levels of mothers' income and education were significant predictors of perceived social support. No significant relationship was observed between COVID-19 anxiety and perceived social support.Implications for Practice: The results showed that the levels of psychological factors and their relationship with other factors can be varied in the COVID-19 pandemic condition. Therefore, a decrease or an increase in the perceived social support did not affect the level of COVID-19 anxiety in mothers with premature infants.

One of the most important goals of the health system in this pandemic was to provide a home care for the high-risk neonates. The aim of this study was to audit a high-risk neonate home care program during the COVID-19 pandemic. This descriptive-analytical study was conducted with the participation of 158 high-risk neonates discharged from neonatal intensive care units of hospitals. Data collection was performed through questionnaire and a researcher-made checklist. The researcher observed and evaluated 7 areas of healthcare. The study was first performed in person, but after the COVID-19 pandemic, the researcher evaluated these cares in absentia. The results of the study showed that the mean score of in-person “conduction” was 56.7 and in-absentia conduction was 52.5 and the mean score of in-person “education” was 63.6 and in-absentia conduction was 65.6. The results showed that there was no significant difference between the in-person and in-absentia methods. Moreover, while 53.2% of caregivers performed well, 33.5% of them performed poorly. According to the results, the implementation of home care program for high-risk neonates is relatively desirable. However, some regular evaluation and review need to be conducted on instructions and implementations. Regular education of caregivers and, finally, regular in-person and in-absentia monitoring is essential. In-absentia home care during the COVID-19 pandemic was not an obstacle to the implementation of the program and it was implemented through telephone and follow-up.

Background and Aim: Considering widespread use of vancomycin in childeren and the occurrence of phlebitis related peripheral intravenous catheters (PIVC); we decided to determine Predisposing factorsof phlebitis in the childeren receiving vancomycin. Methods and Materials: This cross-sectional descriptive-analytic study included 145 children older than 1 month who had been admitted to a medical education center in Isfahan and were under treatment with vancomycin. The sampling method was convenience and phlebitis measuring instruments were used 24, 48 and 72 hours, after the peripheral intravenous catheter insertion for every child. Chi-square test and multinomial logistic regression tests were used to analyze the data. Results: Chi-Square test showed a significant relationship between phlebitis and catheter place, catheter size and washing catheter with 0.09%NaCl (p

Background: Hospital discharge and transfer of a preterm infant from hospital to home are usually stressful for parents. Objectives: This study evaluated the effects of a neonatal critical care nurse companionship with parents during hospital–home transfer of preterm infants on mothers' mood status. Methods: This randomized clinical trial was conducted on 64 mothers of preterm infants discharged from the neonatal intensive care unit of a teaching hospital in Isfahan, Iran. Participants were randomly and equally allocated to an intervention and a control group. Each mother in the intervention group was accompanied by a nurse immediately from hospital discharge up to 3 h afterward. The nurse also supported the mother during the first 3–4 postdischarge days. Mothers' mood status was assessed using the 21-item Depression, Anxiety, and Stress Scale both groups 3–4 days before hospital discharge and 72 h after hospital discharge. Data were analyzed through the Chi-square, the paired-sample t, and the independent-sample t-tests. Results: The pretest mean scores of depression, anxiety, and stress, respectively, were 4.71 ± 4.43, 6.51 ± 4.04, and 9.17 ± 5.40 in the intervention group and 4.91 ± 2.59, 6.59 ± 2.92, and 8.77 ± 3.58 in the control group. The between-group differences respecting the mean scores of depression, anxiety, and stress were not statistically significant (P > 0.05). These mean scores significantly decreased in the intervention group after the intervention (P < 0.05) while did not significantly change in the control group (P > 0.05). Conclusion: Nurse companionship with parents during the transfer of preterm infants to home improves mothers' mood status.

Infant’s health care management at home was an important challenge for the families. Therefore, the policymakers provided a program as an extension to the care plan to implement at home and examine families’ attitudes toward the program. Examination of the parents’ attitude was a coincidence with COVID-19 pandemic in this study, a descriptive-analytical cross-sectional study that was conducted on 385 parents with infants less than 2 months old in the health centers of Isfahan—Iran. The samples were selected by stratified random sampling method. Data gathering was done through a researcher-made Likert questionnaire, which had 30 items and 3 domains including individual-cultural, educational-supportive, and environmental domains. The data were analyzed through the descriptive and analytical statistic. The results of the study revealed a mean score of 104.12 ± 11.69 on family attitude and their positive view toward the infant home-based care program. Also, the highest score was related to the individual-cultural domain 36.95 ± 4.44, educational-supportive 34.88 ± 5.04 and environmental domains 32.29 ± 3.98, respectively. In addition, a significant relationship was found between the mean score of the family attitude and age, the number of children, education, and place of care ( P

Introduction Learning methods and styles greatly affect both instruction method and perception of the learners. Due to the high rate of infant hospitalization and the need for technical procedures such as venipuncture, it is necessary to provide neonatal nurses with a correct and effective training for correct techniques. Objective To determine the learning rate of nurses about venipuncture insertion based on Kolb learning theory. Method A clinical trial was carried out in 2018, recruiting 60 nurses from selected hospitals, affiliated with Isfahan University of Medical Sciences. The participants were given a pretest and then were filmed while preforming venipuncture with the exception that those recruited to the intervention group were trained based on Kolb's theory after the pre-test. A post-test was conducted with the whole participants after one month. Then, data were analyzed by SPSS 21 software. Results The results showed that the average result in the intervention group was 58.83% before intervention and increased to 78.67% after the intervention. The paired t-test also showed a significant difference before and after the intervention (P Conclusion Using Kolb's learning theory, nurses could better learn infants' venipuncture.

Background: Many newborns are hospitalized in neonatal intensive care units (NICU) and undergo invasive procedures. Intravenous (IV) insertion is one of the most common painful invasive procedures performed on newborns. Thus, it is important to carry out this procedure according to the standards. The present study aimed to determine the effect of video feedback on nurses’ adherence to neonatal IV insertion standards in selected hospitals affiliated to Isfahan University of Medical Sciences, Isfahan, Iran. Methods: This study was conducted as a clinical trial on 60 nurses in selected hospitals affiliated to Isfahan University of Medical Sciences in 2018. In the control group, after filling out the pre-test checklist and recording the IV insertion processes, the procedures were implemented according to the NICU routines. After a month, the post-test checklist was filled out. In the intervention group, feedbacks were given to the nurses about the correct insertion of IV and their performance after filling out the pre-test checklist and recording the processes. After a month, the post-test checklist was filled out, and the data were analyzed by the independent t-tests, Fisher’s exact test, Chi-square test, covariance analysis, and paired sample t-test using SPSS software (version 22). Results: According to the findings, the mean score of adherence to neonatal IV insertion standards in the intervention group was about 59 before the intervention, but it increased to 78.7 after the intervention. The statistical test also indicated a significant difference in this practice before and after the intervention (PConclusion: Use of feedback method can be effective in nurses’ adherence to standards.

Background Hospitalization of an infant in the first days following birth is one of the most stressful events in the life of the parents of any parent. More than half of the infants suffer from neonatal jaundice, and are referred to health centers by their parents for treatment. In wake of this, the present study aims to examine the effect of home-based phototherapy on parental stress in mothers of infants with neonatal jaundice. Methods This is a clinical trial carried out on 64 infants with hyperbilirubinemia referred to health centers of Isfahan in 2017. The samples were randomly divided into two experimental (home-based phototherapy) and control (hospital-based phototherapy) groups. The instruments consisted of the training checklist, demographic characteristics of the mother and the parental stress scale, which was given to the parents at two stages, and the data were recorded on a daily basis and at the end of the intervention. Results The results of this study showed that the mean score of maternal stress before intervention was not significantly different between the two groups (P Conclusion According to the findings of this research, home-based phototherapy can be considered as a suitable strategy for treatment and prevention of infant admission by reducing parental stress.

Background Prematurity escalates the crisis of the infants a susceptible group of the society. Multiple delivery further intensifies the susceptibility of both family and health system. A comprehensive care is, thus, necessary to ensure the optimal growth and development of such multiple-births. Accompanied by trainings, challenges, and strategies, the present study was conducted based on a two-year report of comprehensive care management experience on two sets of multiple infants. Methods A qualitative case study approach was used to survey these two sets of premature infants (quadruplet and quintuplet) and their families. The data were collected through medical files, interviews, questionnaire, field presence, phone call and WhatsApp application, and continued follow-ups. Content analysis was performed based on survey and interventions during a period of two years in Isfahan, Iran (2018–2020). Results Case presentation and comprehensive care management are the main areas resulted from this study. The results of the study were categorized in eight challenging areas (categories) and strategies including sterility and infertility period, transition from the intrauterine to neonatal intensive care unit (NICU), discharge process, physical and developmental status, home visit and home care, development of care plan, socio-economic support, and coronavirus nightmare. Conclusion Based on challenges and strategies during these two years, the situation of the multiple-birth infants and their families’ needs should be identified as the first prerequisites in an inter-professional approach and in collaboration with the health providers. Isfahan University of Medical Sciences, Welfare Organization, and the charities were the parties involved with this process in our study. It was also found that developing a separate specific package of comprehensive care management plan for multiple-births is a necessity.

Background: Pediatric nurses, who take care of ill children and interact with their exhausted and anxious parents, face more challenges for which some strategies must be considered to reduce tensions and improve mental health. This study was conducted to examine the effect of Kobasa and Maddi hardiness model on hardiness and perceived stress among nurses in pediatric units of a hospital in Isfahan – Iran in 2018. Materials and Methods: Participants were 57 nurses selected from the staff of pediatric units. They were randomly assigned to intervention and control groups. Data collection was done by means of Kobasa Hardiness Inventory and perceived stress scale. The intervention group attended educational and exercise sessions for 3 months. Data were analyzed through descriptive (frequency, mean, and standard deviation) and analytical (Chi-square, Fisher exact test, Mann–Whitney, and t-tests) statistics. Results: Results of study revealed that before the intervention, the mean scores of hardiness and perceived stress of nurses were not significant. However, significant differences were observed after the intervention for hardiness and perceived stress (t 2,98 p < 0.004, t2,4 p < 0.02), respectively. The mean (SD) hardiness score in the intervention group increased from 65.06 (9.11) to 71.27 (7.44), whereas mean perceived stress score decreased from 26.54 (7.59) to 22.55 (8.39) after the intervention. Conclusions: The implementation of Hardiness Kobasa and Maddi Model increased hardiness and decreased perceived stress of the nurses. Thus, nursing managers may implement the Kobasa and Maddi hardiness model before initiating their job and during continuing education.

Background: Child Abuse and Neglect (CAN) is an important public health concern. Nurses play a key role in caring for the children and keeping them safe from abuse and neglect. The aim of this study was to determine the rate of perceived CAN in Hospitalized Children with Special Health Care Needs (CSHCN) as well as the relationship between the rate and some effective factors. Materials and Methods: This is a descriptive cross-sectional study on 199 CSHCN aged 6–18 years old, admitted to the pediatric wards in an educational hospital, in Isfahan, Iran, in 2018. Children were selected through convenience sampling method and assessed for CAN through a child abuse questionnaire. The Pearson correlation coefficient and Kruskal–Wallis and Mann–Whitney U tests were used to analyze the data. The p values smaller than 0.05 were regarded as significant. Results: According to the findings, 173 children (86.93%) had perceived CAN, the average total score of which was 9.36 contributing commonly to malnutrition 3.01 (2.36) followed by psycho-emotional abuse 2.71 (1.76), neglect 1.62 (1.23), and physical 1.52 (1.08) and sexual 0.54 (0.31) abuse based on mean (SD). Statistical analysis indicated a significant effect of child's age, economic situation of the family, mother's education and occupation, and parents' illness on the total score of perceived CAN (p < 0.05). Conclusions: Malnutrition was found to be the most common type of perceived CAN. Therefore, parents and the health system are advised to prioritize nutritional needs when planning their nutrition.

Home care service is considered as comprehensive care for children with chronic disease or COVID-19. This study aimed to investigate the factors affecting the implementation of a home care nursing program for such children in 2019-2020.A descriptive-analytical study was conducted with 198 nurses working in pediatric wards of selective hospitals of Isfahan University of Medical Sciences. The data were collected through an author-administered questionnaire with 44 questions. The questionnaire was designed in two parts. Part one involved gathering the demographic data of the participants. Facilitating and barrier factors of the implementation of the care were prioritized and examined in part two by using the Likert scale in both the individual and the organizational domains. The data were analyzed using the mean frequency and pairedThe mean (SD) score of individual and organizational facilitating factors were 65.65 (16.24) and 65.98 (11.29), respectively, and the mean (SD) score of the organizational barriers was 82.04 (14.36), which was significantly higher than the mean score (SD) of the individual barriers of 57.94 (14.82) (Organizational factors were the most significant barriers. Therefore, the findings of this study will help policymakers in the program implementation.

Background: Oral feeding problems are among the most common issues in preterm infants. Various methods and feeding support tools are used in this regard, such as cup feeding and feeding nozzle. The present study aimed to determine the preferred method between cup feeding and feeding nozzle to support oral feeding in premature neonates. Methods: This clinical trial was conducted on 70 preterm infants with the gestational age of 30-33 weeks in Isfahan, Iran. Infants were divided into two groups of cup feeding and feeding nozzle application. The studied variables were the duration needed to reach the time of full oral feeding, weight changes since birth until full oral feeding, and length of hospital stay. Results: Mean duration to start full oral feeding was 4.03 and 5.1 days in the cup feeding and feeding nozzle groups, respectively (P0.05). Mean length of hospital stay was 23.1 and 21.9 days in the cup feeding and feeding nozzle groups, respectively (P>0.05). Conclusion: According to the results, the time needed to reach full oral feeding was shorter in the cup feeding group compared to the feeding nozzle group. However, the mean length of hospital stay was two days shorter in the feeding nozzle group compared to the cup feeding group. Therefore, feeding nozzle could be utilized as a supportive method in the feeding of preterm infants.

Background: Medication management is a complex process with multiple stages that involves different health care teams. Based on the evidence, an electronic medication management system offers significant benefits, such as reduced medication errors, improved conformity, enhanced time and cost efficiency, and increased patient safety. This study aimed to design and implement an electronic medication management system and measure the nurse’s satisfaction regarding the application of this system. Methods: In this technical action research, the nurses' satisfaction with the use of the designed system was evaluated. The electronic medication system development and data collection were conducted in two phases. The first phase included the design and development of an electronic nursing medication management system to be used in the neonatal intensive care unit. The second phase involved the evaluation of the nurses’ satisfaction with the use of the electronic system by applying a five-point Likert scale questionnaire. Results: The findings were divided into two categories, including results related to the design of the electronic systems and those regarding the evaluation of nurses’ satisfaction with the use of the electronic systems. The design of the electronic system was successful as the nurse's satisfaction evaluation revealed a high level of satisfaction with the use of the system. Conclusion: Electronic medication management system has more practical advantages than other similar systems. This system helps the nurses to identify and prevent many medication errors and save time in drug care documentation. Therefore, this system is a big step towards satisfaction with nursing medication care.

Background: Prematurity could result in the long admission of the neonate to the Neonatal Intensive Care Unit (NICU) and development of some complications for both mother and newborn. The early discharge programs make the neonatal transference to home much easier and are beneficial to both parents and newborns. However,there are limited studies investigating the real needs of the preterm neonates discharged early. Therefore, the identification of the post-discharge needs of these newborns could help the nurses, as the most important health care members, to consider these needs and mitigate the complications affecting the neonates. This study aimed to describe the care needs of the preterm infants with early discharge from the NICU. Methods: The present study was conducted on 25 participants (i.e., 10 mothers, 3 physicians, and 12 nurses) selected by purposive sampling technique. Data collection was performed by Observer as participant and in-depth interviews by qualitative content analysis for analysis. Results: Data analysis led to the emergence of four categories, namely need to follow nasogastric tube feeding, need for oxygen level monitoring, need to obtain sufficient information about medication, and need to acquire skill for daily care delivery. Conclusion: The enhancement of the nurses' knowledge about the needs of the preterm neonates with early discharge would result in the improvement of their abilities in the relevant domain. Accordingly, these nurses could help the mothers to prevent the incidence of several complications in the neonates, such as readmissions to the NICU. More importantly, these measures could prevent from the consequences of failure to fulfil these needs emerging in the later stages of life.

Background: Opioids are used to relieve pain during labor and may affect the neurobehavioral conditions of infants. However, effects of using drugs, such as oxytocin, as a routine component of pre- and post-delivery care on the breastfeeding behaviors of newborns remain unclear. The present study aimed to investigate the association between the maternal use of oxytocin during labor and breastfeeding behaviors of neonates within two hours after birth.Methods: This descriptive-analytical study was conducted on 160 women selected via convenience sampling. The participants were assigned to two groups of oxytocin administration (n=70) and physiologic delivery (n=90). Data were collected using demographic questionnaires and infant breastfeeding assessment tool (IBFAT). IBFAT was completed by the researcher through observing the behaviors of infants during breastfeeding after birth. Data analysis was performed in SPSS version 20, using descriptive and analytical statistics, including independent t-test, correlation-coefficients, and analysis of variance.Results: Mean age of the mothers in the oxytocin administration and physiologic delivery groups was 26.9±5.9 and 27.8±5.5 years, respectively. Breastfeeding was significantly stronger in the infants whose mothers had physiologic delivery compared to the group administered with oxytocin during labor.Conclusion: According to the results, use of oxytocin during labor directly weakens the breastfeeding of neonates. Therefore, it seems necessary to inform and prepare women for physiologic delivery during pregnancy

Background: Mothers with premature infants face certain challenges such as uncertainty on how to deal with their infant's condition and care for it after discharge from neonatal intensive care unit (NICU).Methods: A qualitative design was used to explain mothers' challenges after their infant's discharge from NICUs in Isfahan, Iran, 2015. Purposive sampling was adopted to interview the mothers who could provide us information about the challenges after their infant's discharge. Data collection was performed by interviewing mothers. Data saturation was reached after conducting 23 in-depth, semi-structured interviews. All the data was analyzed by qualitative content analysis.Results: Four themes and nine categories were identified. The themes were incompetence in breastfeeding, dependence on hospital and nurses, feeding tube as a reason for stress, and constantly worried mothers.Conclusion: Mothers have difficulty in meeting their infants' basic needs after discharge. Supporting these mothers can enable them promote their infant's health.

We aimed to assess the viewpoints, experiences, and preferences within the clinical communication triangle (parent, adolescent, health care team) concerning the information-sharing process for adolescents with cancer. This is a qualitative descriptive-exploratory study. Overall, 33 participants were recruited (adolescents diagnosed with cancer aged 15–20 years, their parents, oncologists, and nurses). In-depth semi-structured interviews were conducted and data were analyzed using constant comparative analysis. Data analysis yielded three main themes. Disaffiliation of adolescents in information-sharing process with three subthemes: confusion and unanswered questions; and, seeking information from inferior sources. Barriers to information-sharing with three subthemes: parents as gatekeepers in the information-sharing process, cultural background creating strong barriers for information-sharing, and the negative attitude of the medical team towards information-sharing. The last theme is cornerstones in information-sharing process with three subthemes: trust and honesty to enhance communication between adolescents and the medical team, the necessity of paving the way for information-sharing, and the value of gradual information-sharing based on the adolescents need and mental readiness. Participants believed that information-sharing was insufficient and provided recommendations for facilitating this process. Information-sharing process needs to be gradual and based on the adolescent’s need and mental capacity. Future research needs to focus on devising a protocol for information-sharing with adolescents with cancer that accounts for familial and cultural factors, is carefully timed, and provides clearer and more efficacious communication between parents, adolescents, and the health care team.

Background: Infant's transition is a challenge for parents and the health system that requires ongoing assessment and management to improve each newborn`s growth and development. The purpose of this study was to explore the management of infant` transition from neonatal intensive care unit (NICU) to home.Materials and Methods: We used a grounded theory study to explore and describe the management of infants’ transition from the NICU to the home. Interviews were conducted with 31 professionals and 20 family members, and participant observations were made in hospitals, clinics, and one physician office. MAXQDA was utilized for coding and categorizing data.Results: The theory illustrated six phenomena: An unexpected separation; A crisis situation; Mother-infant rebonding; Protection of the infant’s health; Promotion of growth and development; and Inadequate management causing disability. Together, these formed a three-phase process consisting of: A threat to the infant's life, Efforts to save the infant's life, and Continuation of life. Conclusion: Development of the theory of infants transition provides a three phases process ( A threat to the infant’s life, Efforts to save the infant’s life, and Continuation of life), that can yield guidelines to manage the infant` transition in prevent mother–infant separation, support parents in their role as primary caregivers, and follow up with individual home visits by nurses.

Commentary on: Olsen AL, Ammitzboll J, Olsen EM, et al. Problems of feeding, sleeping and excessive crying in infancy: a general population study. Arch Dis Child 2019;104:1034–41. The most common problems among infants are excessive crying, and feeding and sleeping problems, which …

Background: Jaundice is one of the most common problems in the neonatal period. Phototherapy is one of the most commonly used treatments for jaundice that can be used as a simple, practical home-based treatment. Hospitalization during the first days of birth to conduct phototherapy may result in problems like nosocomial infections and mother separation from the baby. Objectives: The aim of this study was to evaluate the efficacy of home phototherapy in the duration of treatment, mean bilirubin level, and complications. Methods: This clinical trial was performed on newborns with jaundice in Isfahan health centers. The sample was randomly divided into two groups: Phototherapy at home (32 patients) and phototherapy at the hospital (32 patients). A demographic questionnaire and a researcher-made checklist were used to collect data on variables such as the duration of treatment, the frequency of treatment failure, mean bilirubin, and phototherapy complications. Results: The mean duration of phototherapy in both groups was two days, which showed no significant difference (P = 0.32). The most common complication in both groups was skin rashes and restlessness, which also showed no significant between two groups (P > 0.05). There was no significant difference in terms of treatment failure (P = 0.246). Statistical tests also revealed that bilirubin reduction was the same in both groups. Conclusions: Home phototherapy can be suggested as a safe treatment with no complication to the patients.

Background: Performance appraisal system can be an effective role to improve the infants’ health in the Neonatal Intensive Care Unit (NICU). The most important challenge of the nurses’ performance appraisal system is that the process is not conducted correctly. The aim of this study was therefore to determine the effect of the appraisal interview on the performance scores of the nurses in NICU. Materials and Methods: A randomized clinical trial study was conducted with 71 nurses in two selected hospitals of Isfahan University of Medical Sciences in 2018. The participants worked in the NICU and were selected through convenience sampling method, and then, were randomly assigned to the intervention and control groups. The intervention was an appraisal interview which was done by head nurses, who attended a training workshop to know how to conduct an appraisal process. Control group was appraised without an interview. The performance scores of both groups were collected through approved Nurse Appraisal Tool, developed by the Ministry of Health and Medical Education for nurses, and analyzed by SPSS Software before and after the intervention. Results: Independent t ‑test showed no significant differences in mean scores of nurses’ performance appraisal before the intervention between the two groups ( p = 0.91), but independent t ‑test showed that these scores were significantly higher in the intervention group compared to the control ( p = 0.007). Conclusions: According to the findings, nurses’ performance scores can be increased through an acceptable performance appraisal system with an interview process.

Background: One of the factors affecting the behavior and performance of nurses is mental workload. Training programs can improve the attitude, knowledge, and performance of nurses. However, the impact of these programs on mental workload is not clear. Therefore, the study aimed to evaluate and compare the effect of two conventional and self-designed education classes on the mental workload of neonatal intensive care unit (NICU) nurses. Materials and Methods: This study was conducted on 68 nurses, divided into two intervention and control groups. Subjects of the intervention group attended a social awareness reinforcement class, in which one of the dimensions of emotional intelligence was introduced and covered. Research tool was the mental workload questionnaire of National Aeronautics and Space Administration Task Load Index (NASA-TLX). Results: In this research, results of the paired t-test were indicative of a significant decrease in the mean score of mental workload immediately after the intervention (t = 1.48, p < 0.001) and one month later (t = 1.11, p = 0.007). Moreover, a significant difference was observed in the mean score of mental workload of the intervention group between before and after the conventional education class, and before and 1 month after the self-designed class using repeated-measures analysis of variance (F = 21.31, p < 0.001). Conclusions: According to the results of the study, the conventional education class had no impact on the mental workload, whereas the self-designed class significantly decreased mental workload. Therefore, it is suggested that education programs be conducted for NICU nurses to improve their emotional intelligence, which leads to decreased level of mental workload.

Objective: Children are damage-prone population whose illness is stressful for their parents. Family stress may endure long after discharge and proper remedies need to be employed. The present study was conducted to determine the level of mother’s stress whose children were discharged from pediatric surgical units and to assess the effects of a four-staged follow up care program on the level of this stress. Method: This is a quasi-experimental research, conducted in pre and post interventions on 64 mothers whose children were hospitalized in the surgical units of selective hospitals of the Isfahan university of medical sciences. Participants were randomly classified into 2 control and experimental groups. Demographic data questionnaire and stress measurement scale (SRI) were the data collection tools. The interventions were done by a four-staged follow up program. The data were analyzed using descriptive statistics, independent t test, and variant analysis with repeated observations. Results: The result of the study indicates that the maximum scores of stress were 115 and 103 in experimental and control groups respectively. Stress mean score of the experimental group was meaningfully less than that of control group straightaway, one week, and one month after the intervention (P

Introduction Preterm infants demonstrate problems with pharyngeal swallowing in addition to sucking problems. Oral motor intervention and nonnutritive sucking (NNS) were introduced for promoting oral feeding skills in preterm infants. NNS cannot cover all the components of oral feeding. In another hand, the swallowing exercise (SE) can accelerate the attainment of independent oral feeding in the preterm infants. The current study sought to examine if a combined program of NNS and SE compared with a program that only involves NNS would be more effective on oral feeding readiness of premature infants. Material and methods This randomized controlled trial was conducted in a neonatal intensive care unit (NICU). 45 preterm infants were recruited in three groups. In the group I, infants were provided with NNS twice a day. The group II received a program that involved 15 min of NNS and 15 min of SE, daily. Both interventions were provided 10 days during two consecutive weeks. The group III, control group, just received the routine NICU care. All infants were assessed by functional oral feeding outcome measures including postmenstrual age (PMA) at the start of oral feeding, PMA at full oral feeding, transition time (days from start to full oral feeding), PMA at discharge time and also the infant's dependency on tube-feeding at discharge time after interventions. Also, all infants were assessed via Preterm Oral Feeding Readiness Scale (POFRAS) before and after intervention. Results No significant differences were observed in the PMA mean at start of oral-feeding (P = 0.29), full oral-feeding (P = 0.13), discharge time (P = 0.45) and the mean of transition time (P = 0.14). Compared to the control group, more infants in the group II were discharged without tube-feeding (P = 0.01). The mean of POFRAS was significantly higher in both groups I and II compared to the group III (P = 0.02 and P = 0.01, respectively). This score was, however, not statistically different between the groups I and II (P = 0.98). Conclusions Both studied interventions were superior to routine NICU care in enhancing the oral feeding readiness of preterm infants based on the POFRAS score. The studied combined program of NNS and SE, and not NNS program, could significantly increase the number of discharged infants without tube-feeding compared to control group.

BACKGROUND: The mental health of the mothers of the children with cancer is strongly influenced by the child's illness and treatment process. This study aimed to investigate the effect of a self-help educational program with peer group on anxiety of the mothers of the children with cancer. MATERIALS AND METHODS: This clinical trial study was conducted on 44 mothers of the children with cancer in an educational Hospital of Isfahan University of Medical Sciences, Iran. Convenience sampling method was performed on the eligible mothers, and using random allocation, they were divided into two groups of the intervention (n = 22) and the control (n = 22). Both groups completed the Hamilton Anxiety Questionnaire before and after the intervention. The intervention of the study was a self-help educational program with peer group that was performed in collaboration with the mothers of the children with cancer, a psychiatrist, and cancer nurses in the hospital within 3 months. RESULTS: The results showed that 55% of the mothers of the intervention group had severe and very severe anxiety before the intervention, but the intensity of their anxiety was reported to be moderate after the intervention. The analysis of covariance with adjusted anxiety score in the two groups showed that the mean score of anxiety in the intervention group decreased from 22.3 to 12.3 after the intervention, showing a significant difference (P < 0.05). CONCLUSION: The program, designed to support the mothers and guide the specialists and psychiatrists to counsel the mothers, can enhance their self-help and reduce their anxiety level.

Background Home care is an acceptable strategy for the relationship between family and healthcare team and implementation of healthcare interventions, and infants’ nurses could play an important role in enhancing the capability of families and promoting child health in this area. This study examined challenges facing infants’ home care from nurses’ viewpoints in Iranian culture.Materials and MethodsA qualitative design was used to explain challenges facing infants’ home care from nurses’ viewpoints. Participants included 20 nurses’ working in the neonatal units of University hospitals in Isfahan, Iran in 2015. Data collection was done by interviewing nurses working in neonatal units of Shahid Beheshti and Alzahra hospitals. All the data were analyzed by qualitative content analysis.ResultsFour main categories of “The need to warn the community ", “culture",” need for security " and ” legal support" were extracted from the participants' explanations, indicating the dimensions of Challenges for Infants’ Home Care.Conclusion Nursing policy makers and managers are able to help to facilitate home care and improve the infants’ health through correcting the infrastructure and eliminating current obstacles.

Background: Kangaroo mother care (KMC) is the most implementation intervention in caring of the infants, as in this method, both the mothers and infants are cared. The World Health Organization recommends implementation of KMC for all infants. However, there are some barriers in the way of its application. The purpose of this study was evaluation of the practical application of KMC and nurses' perspective about its implantation barriers in the neonatal intensive care units (NICUs) in Iran. Materials and Methods: The descriptive study was conducted on 96 infants and 80 nurses working in the NICUs of two university hospitals in Isfahan, Iran. Data were collected by a two-section questionnaire and analyzed by t-test through SPSS 14. Results: Study findings indicated that mean weight and age of the infants with KMC were 1510 g and 32 weeks, respectively. KMC was implantation for 32 min in a day. From nurses' perspective, mother-related barriers were the main barriers in the implantation of KMC as mothers were not present by their infants. Another barrier was the mothers' fear of touching their infants. In the domain of organizational barriers, physician's order was found to be the most important barrier in application of KMC. Conclusions: Identifying barriers in implantation of KMC is essential to support the mothers. Regarding mother-related barriers, organizational barriers, and the need for a physician's order for implementation of KMC, policy makers must provide facilities and equipment for applying KMC practice for mothers and improve the protocol of KMC in the NICU.

This study examined mothers' experiences of the preparation of their infants for discharge in the Iranian neonatal intensive care unit (NICU) culture.Participants included 16 mothers who had preterm infants who were hospitalized in Iranian NICUs.A qualitative study was used to describe mothers' experiences of infant discharge from the NICU.Data collection was done by interviewing mothers who were in NICUs of Iranian University Hospitals. The qualitative data analysis package was used for coding and categorizing.Four themes were identified: learning from multiple sources, conditional discharge, enabled mother, and continued nightmares.This study highlighted several issues regarding mothers' experiences of infants' discharge plan. Nurses should be aware of these themes to support the mothers during preparation of their infants for discharge from NICUs.

Aim The aim of this investigation was to determine nurses' viewpoint about the impact of Kangaroo Mother Care on the attachment between mother and infant. Methods A descriptive study was carried out with the staff (23 nurses) of an NICU of a University Hospital in Iran. Data were collected through self-report method (Avant Maternal Attachment Behavior Scale) and analyzed by use of SPSS. Findings The majority of the participants had positive viewpoint on the subject of study. The affectionate behavioral subscale had the most effect on the mother–infant attachment, while the item " holding without skin contact " of proximity maintaining subscale was looked at as the most disagree and strongly disagree item (68.2%) of the attachment scale. Conclusion According to the nurses' viewpoints, mother–infant attachment behavior are strengthened by applying the Kangaroo Mother Care. Furthermore, the benefits of this type of care are mentioned.

BACKGROUND: Management pain in hospitalized children is challenging for the health-care professionals. Nurses have the most interactions with children who need to assess and manage for their pain. Therefore, the aim was to describe nurses’ experiences from pain management among hospitalized children from Iranian culture in this study. METHODS: A phenomenological study was conducted in which 23 nurses working in an educational hospital in Isfahan–Iran. The nurses participated in interviews based on a purposeful sampling method. RESULTS: Participants’ experiences were categorized into three major themes and twelve subthemes including the nurses’ ability of detection of the pain nature, reaction to pain management and belief in pain relief. CONCLUSIONS: The research showed that the nurses have valuable experiences in pain management in their workplaces. Their descriptions were based on the use of three domains that consist of knowledge, belief, and practice. Therefore, it is vital to focus on the subject of pain in nursing curriculum and guidelines in hospitals. A more extensive research is needed to demonstrate perceived barriers to pain management.

Namnabati M, Abazari P, Talakoub S. International Journal of Nursing Practice 2012; 18: 221–225 Identification of perceived barriers of pain management in Iranian children: A qualitative study Hospitalized children are often inadequately treated for their pain. Paediatric nurses experience these inadequacies more than other health-care team members. This research was an attempt in the form of a phenomenological study to reveal some major barriers in children pain management as the nurses had perceived. Sixteen nurses were interviewed in the medical, surgical and infectious paediatric wards of a hospital in Iran. Data analysis were based on Colaizzi method that surfaced three main themes in different areas namely: organizational barriers, limitations relating to child's characteristics and barriers relating to the nature of disease and its treatments. The study results have shown organizational limitations added to the lack of authority for administering some medical intervention, inadequate equipment and utilities and unavailability of opioids as the main pain controlling and restricting factors. Additional factors that relate to the child specifications like age, temperament, behaviour, expression and gender affect the assessment and treatment of pain. The results revealed identified barriers in real context. It seems that some guidelines are needed to achieve optimal pain management.

Background: All nursing cares require decision-making, and the ability to make the best decisions impact upon the quality of nursing care. Moreover, authenticity and accuracy of the best cares may be questioned if not recorded and reported properly and in a standard manner. We aimed to design and implement an electronic nursing managementsystem and then evaluate satisfaction of nurses with the designed electronic system.Methods: This technical action research was conducted in four phases of a) designing an electronic nursing process decision support system, b) designing an electronic nursing care documentation system, c) integrating these two systems and developing an electronic nursing information management system, and d) implementing the system and system satisfaction evaluation using quantitative methods (satisfaction questionnaire).Results: The results of this project led to design and development of an electronic nursing information management system for neonatal intensive care units, which enables nurses to carry out standard care and documentation with high level of nursing satisfaction.Conclusion: In order for an electronic system to support nurses in their care process, it must be accepted by nurses. If nurses are satisfied with the performance and nature of this system, they are much less likely to develop workaround solutions and much more likely to spend their efforts focusing on the professional aspects of nursing care.

Introduction: Child’s hospitalization for surgery is a source of anxiety for the child and the family that persists for a long time after discharge. Therefore, it is necessary to provide appropriate solutions in this regard. This study aimed to investigate the effect of implementation of continuous care model on anxiety in mothers of children discharged from pediatric units of educational hospitals of Isfahan University of Medical Sciences in 2016. Materials and Methods: In this quasi‑experimental study, 64 mothers of children hospitalized in surgical units were categorized in two groups (experimental and control). The intervention was a continuous care model including orientation, sensitization, follow up, and evaluation stages. We used Spielberg’s Anxiety Questionnaire to assess mothers’ anxiety before, 1 week, and 1 month after the intervention. Data were analyzed using descriptive statistics, ( t ‑test and analysis of variance) using the Statistical Package for the Social Sciences version 16. Results: The results of the study showed that the mean anxiety scores of the experimental group were 58.9, 36, and 31.4, respectively, before, 1 week, and 1 month after the intervention ( P < 0.001). These scores were 57.5, 55.8, and 49.7, respectively, for the control group. t‑test results showed that the mean anxiety scores of the experimental group were significantly less than that of the control group at 1 week and 1 month after the intervention. Conclusions: Based on the results, use of the continuous care model led to a decrease in mothers’ anxiety during their children’s discharge from the pediatric surgery units. Therefore, we suggest the implementation of this model in pediatric units.

Background: The infants, hospitalized in the neonatal intensive care unit (NICU), engage with problems from admission to discharge, exploring of which ensures their safe transition. The purpose of this study was to identify the factors that influence infant's transition from the NICU to home. Materials and Methods: A qualitative study was used for identifying the factors that affect infant's transition. Data were gathered by interviewing 16 nurses and physicians in NICUs of university hospitals in Iran; and were analyzed by qualitative content analysis method. MAXQDA, MAX Qualitative Data Analysis, is a software which has been developed in Berlin, Germany. software, the qualitative data analysis package, was used for coding and categorizing. Results: There are 10 categories that affect infant's transition, as revealed in data analysis. These categories were delineated into three themes: Cognition of infant's needs, effectiveness of trainings, and organizational context. Conclusion: The results of this study further disclosed the factors that facilitate or hinder infant's transition from the NICU to home. The aspects of correct cognition along with more effective trainings must be fully introduced to the staff to meet infant's needs. Also, authorities are better to make policies to decrease organizational barriers. Therefore, it is suggested that applying developmental care can ease infant's transition.

Background: Nurses' clinical competency plays an important role in the care of preterm infants. On the other hand, burnout is one of the most important factors in reducing the nurses' efficiency. With regard to the importance of the role of nurses, and the vulnerability of the infants, the purpose of this study was to investigate the relationship between nurses' burnout and clinical competency in NICUs. Materials and Methods: The descriptive cross-sectional study was conducted with the participation of 86 nurses working in the NICUs of hospitals in Isfahan, Iran. Census sampling method was used in the NICUs of educational hospitals in 2014. Data were collected by a questionnaire including demographic characteristics, Patricia clinical competency, and Maslach burnout scales. Data were analyzed by the statistical tests of independent t -test and Pearson correlations test with the significance level of α Results: Six dimensions of clinical competency and three dimensions of nurses' burnout were assessed at three levels (weak, moderate, and strong levels). Statistical tests showed that clinical competency was at a moderate level in all fields. Of the dimensions of nurses' burnout, emotional exhaustion was moderate, depersonalization was weak, and personal performance was strong. The results showed that nurses` burnout and clinical competency in the NICUs were at a moderate level and had a significant negative relationship ( r = −0.322, P = 0.003). Conclusions: Results showed that burnout had a negative relationship with competency. Therefore, managers are suggested to improve nurses' competency and diminish their job burnout through better and more applicable planning.

Background: Advancements in neonatal intensive care unit (NICU) science and technology have increased the survival rate of preterm infants. Despite these advances, they are still facing with neurobehavioral problems. Noise level in NICU is a potential source of stress for preterm infants. It should be decreased to the standard level as much as possible. The purpose of this study was to evaluate the effect of peer education on the performance of staff in noise management in the NICU. Materials and Methods: A pre‑post test quasi‑experimental design was used. Fifty‑eight staff members (nurses and physicians) participated in this study. Sound pressure levels were measured before and after the intervention. Peer education program formed the intervention. The staff performance in noise management was evaluated before and after the intervention by using a questionnaire. Data analysis was done by using t‑test. Results: The results of the study showed that the mean sound level in different environments significantly decreased after the intervention. It reached from 86.7 to 74.9 dB in the center of unit and from 68.2 to 48.50 dB in the infants’ bedside (P < 0.0001). The mean score of the staff performance in noise management significantly increased after the intervention, compared to the pre‑intervention score. It increased from 74.6 to 83.4 (P < 0.0001). Conclusions: Peer education was found to be successful in noise management because behavioral changes were done to avoid generating unnecessary noise by the staff.

Hospitalized children are often inadequately treated for their pain. Paediatric nurses experience these inadequacies more than other health-care team members. This research was an attempt in the form of a phenomenological study to reveal some major barriers in children pain management as the nurses had perceived. Sixteen nurses were interviewed in the medical, surgical and infectious paediatric wards of a hospital in Iran. Data analysis were based on Colaizzi method that surfaced three main themes in different areas namely: organizational barriers, limitations relating to child's characteristics and barriers relating to the nature of disease and its treatments. The study results have shown organizational limitations added to the lack of authority for administering some medical intervention, inadequate equipment and utilities and unavailability of opioids as the main pain controlling and restricting factors. Additional factors that relate to the child specifications like age, temperament, behaviour, expression and gender affect the assessment and treatment of pain. The results revealed identified barriers in real context. It seems that some guidelines are needed to achieve optimal pain management.