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Background: Consultation is one of the primary roles of nurses as a health professional discipline in the community. COVID-19 allowed the nurses to respond to public health needs, be accountable for their concerns, and advocate for vulnerable groups to alleviate COVID-19 challenges. Objectives: The study was aimed to explore the nurses’ experiences in the consultation role during the COVID-19 crisis. Methods: This qualitative study was conducted with Colizzi’s descriptive phenomenological approach. Data was collected through semi-structured interviews with fifty nurses in different positions. The participants were selected purposefully of the nurses with consultative performance through hotlines. Results: Qualitative data were classified into 5 main themes: "nurse consultation as a missing link in the health system", "COVID-19 threat as an opportunity to demonstrate the nurse`s role in the community", "formation of consultation role identity", "nurse`s competency in the role performance", and "calming the people". Conclusion: As a result of the COVID-19 pandemic, effective health communication strategies must be used to inform the public. Nursing consultation is essential to increase coping with unexpected events in the community. It reduces the pressure on the health system’s capacity to be potentially in crisis and provides the opportunity to extend nurses’ role in emergencies.

Background: Premature infants often encounter different challenges due to their underdeveloped systems at birth and require specialized care to survive. Telecare usage as a follow-up tool is a proper line to increase infants’ health by reinforcing parents’ competency to care effectively during the post-discharge period. However, there is controversy about telecare for post-discharge infant care. This study aimed to investigate and compare the experiences of nurses and physicians about post-discharge telecare usage in premature infants. Methods: This qualitative study employed conventional content analysis. Semi-structured interviews were conducted with 30 nurses and 25 physicians using purposive sampling. The participants were recruited from three neonatal intensive care units (NICU) affiliated with Isfahan University of Medical Sciences, Iran, from October 2022 to February 2023. All participants had at least two years of experience providing teleconsultation care for premature infants through a web-based national social media platform. The interviews aimed to explore participants’ experiences with teleconsultation. Data collection spanned five months, and the analysis was guided by Granheim and Lundman’s method to extract core concepts until data saturation was reached, meaning no new information emerged from further interviews.Results: The findings demonstrated two main components, including the challenges and benefits of telecare. Both nurses and physicians generally agreed on the usefulness of telecare, but they differed in opinions regarding infant safety and trust in parents’ understanding of telecare monitoring.Conclusion: The study highlighted safety concerns and parental internet literacy levels related to telecare follow-up, advocating for its integration alongside traditional care. Valuable insights were provided for policy-makers in managing post-discharge care for premature infants, emphasizing the need for further exploration into long-term impacts and parental adherence to telecare protocols.

Background: 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. Materials and Methods: 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 paired t test. Results: The 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) (t197 = 21.32, p < 0.05). The most important individual facilitating factor (53.82%) was “respectful communication with the family,” and the most important organizational facilitator (80.40%) was “Physicians' support of the nurses.” Conclusions: Organizational factors were the most significant barriers. Therefore, the findings of this study will help policymakers in the program implementation.

Introduction: Children are vulnerable to damage. Health problems in children, especially if necessitate hospitalization, can cause stress in their parents that may persist even long after discharge. This study aimed to investigate the effect of implementing follow-up care plans on stress in mothers of children discharged from pediatric surgical units. Methods: A quasi-experimental study was conducted on 64 mothers whose children were hospitalized in the surgical wards of two educational hospitals affiliated to Isfahan University of Medical Sciences, Iran. The participants were randomly assigned into two groups of control and experimental. The data collection tools included a demographic data questionnaire and stress response inventory (SRI). The interventions were performed using a four-stage follow-up care plan. The data were analyzed using SPSS software version 13 and descriptive statistics, independent t-test, repeated measures analysis of variance (ANOVA), and least significant difference (LSD) test. Results: The mean (SD) stress scores of the experimental group were 64.1 (28.8), 20.4 (12.4), and 11.6 (7.5) before, one week, and one month after the intervention, respectively. In the control group, these scores were 61.2 (29.2), 59.9 (25.5), and 46.7 (19.1), respectively. The results showed the mean score was significantly lower than that of the control group at one week and one month after the intervention in the experimental group. Conclusion: Our results demonstrated that a follow-up care plan can decrease the stress levels of mothers as a continuity of patient care even after discharge.

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.

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

Abstract 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 (t2,98 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.

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.

BACKGROUND: Infertility, a problematic issue to the newly married couples, should be treated as no couple should be deprived of having children. The treatment, however, poses new challenges to the multiples and subsequent preterm births, health system, and families. Therefore, the aim of this study is to investigate the effect of an education–support–follow-up program on the mothers' perceptions of their multiples' needs. MATERIALS AND METHODS: This research is a three-phase interventional study. The first phase develops an educational program through review of the literature and using the opinions of experts. In the second phase, the developed program will be implemented in the neonatal intensive care unit (NICU) for the mothers of multiples. In the third phase, based on the developed plan, the required support will be applied and followed up. The data collection tool is a researcher-made questionnaire which is completed by the mothers (N = 30) before and after the intervention. Convenience sampling method will be used, and the mothers will be allocated randomly. Data gathering started from September 2020 and would continue until the sample collection is completed. Data will be analyzed through the descriptive and analytical statistics with Statistical Package for the Social Sciences (SPSS) version 21. RESULTS: The present study can address the needs of the multiple infants based on the implementation of an education–support–follow-up program for mothers and their families. CONCLUSION: The mothers of multiple infants are required to specify unique physical and developmental needs of their infants, while their perceptions of these needs may be different based on the education–support–follow-up program. The researchers designed the program to help them define highly specialized needs of multiples and also examined their perceptions of these needs.

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: 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.

BACKGROUND: Today, the increasing process with the using internet is a kind of disease among adolescents, especially in the COVID-19 pandemic. The activities such as learning–educational process and online games will become one of the problems for families. This study aimed to determine the relationship between internet addiction and parent–child relationships in high school girls in Isfahan. MATERIALS AND METHODS: This descriptive-correlational study was conducted in girls' high school in Isfahan, Iran. One hundred and sixty students and one of their parents had participated through cluster sampling method. They filled out the Young Internet Addiction Questionnaire and the Fine et al.'s Child-Parent Questionnaire (PCRS). Data were analyzed using descriptive statistical tests and Pearson correlation test. The significance level of the data was considered 0.05. RESULTS: The mean score (standard deviation) of internet addiction was 52.15 (5.67). 62.5% of the participants were not addicted to the use of the nternet. The mean score of the parent–child relationship was 118.24 (85.35). The results of the Pearson correlation test show that there is a significant negative correlation between parent–child relationships and Internet addiction in adolescent girls (P < 0.01). CONCLUSIONS: Therefore, in the girl high school students who have a stronger parent–child relationship, the rate of Internet dependence is lower. Due to the current situation of the COVID-19 pandemic in terms of Internet addiction and the parent–child relationship, the present study can help nurses, teachers, and educational planners to provide a suitable information for appropriate intervention.

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.

Introduction: Nowadays, due to the increasing development of nursing science and demand for improving and enhancing the quality of nursing care, the necessity of integrating informatics with Nursing Science for proper management of nursing information flaunts more than ever. Therefore, the present study aimed to develop the electronic information system of nursing as a step towards the integration of informatics science with nursing science. Methods: The present study was conducted using technical action research approach. The main stages of the study were the development of a nursing electronic information system, its implementation, application and evaluation in a neonatal intensive care unit in 2016. Descriptive statistics was used for the analysis of quantitative data and qualitative data obtained from interviews were analysed using content analysis and coding. Results: The results of Satisfaction Scale Questionnaire showed satisfaction of nurses with the components and applications of the electronic system. Nurses' information about drugs and the process of nursing increased after using the system. Content analysis of qualitative findings also led to exploit the main categories of enhancing the quality of care, improving the documentation process, professional development, continuing education and learning, the integration of theory and practice in the application of the nursing process, human and equipment barriers. Conclusion: According to the obtained results, paying attention to the design of a native system based on the needs of nurses and the participation of the beneficiaries could take a small but successful step toward effective use of informatics science in nursing.

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

Introduction: Challenges of clinical education have been described and explored from the viewpoints of nursing students in numerous studies, but few studies have deeply explained these factors from the perspective of nursing faculty members and nursing managers of teaching hospitals. The aim of this study was to describe and explain the experiences of nursing faculty members and nursing managers about the factors that affect clinical education effectiveness. Methods: The study employed a conventional qualitative content analysis approach. Participants included 18 faculty members, clinical instructors and nursing managers of Isfahan University of Medical Sciences. Purposive sampling was conducted until data saturation. Data were collected through individual semi-structured interviews and field notes. All the interviews were recorded, transcribed and analyzed line by line. The data were analyzed using conventional content analysis. Results: Qualitative analysis of the data yielded two main categories of restrictive and facilitating factors of clinical education effectiveness. Restrictive factors included four subcategories: physical and psychological atmosphere of training units, student density, lack of teamwork approach in caring and training, and inappropriate role models. Facilitating factors consisted of two subcategories: experienced and tactful instructors and competent clinical nurses. Conclusion: The challenges of nursing clinical education effectiveness are the common concern of students, nurses, and nursing faculty members. Thus, considering the nature of the problems, cooperation of faculties of nursing and vice chancellors for treatment and education of medical universities is necessary to overcome these challenges.

ABSTRACTBackground: 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.

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 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: 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.

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 < 0.05. 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.

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.