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Background Although it has been reported that there is a relationship between empathetic behaviors and the reduction in cardiovascular events, some evidence revealed a lack of empathy among nurses. Accordingly, some interventions are required to be conducted for improving empathy among cardiac nurses. This study aimed to determine the effect of knowledge brokering on cardiac nurses' empathy with their patients. Methods This is a field randomized controlled trial conducted on a total of 100 cardiac nurses. Participants were assigned to two groups of control and intervention using stratified random allocation. In the intervention group, knowledge brokering was performed at seven stages, including personal assessment; horizon scanning; knowledge management; knowledge translation and exchange; network development, maintenance and facilitation; knowledge facilitation and skill development; and receiving the support of managers for individual changes. Data were collected using Empathy Construct Rating Scale (ECRS) and then analyzed using IBM SPSS Statistics for Windows, version 21 (IBM Corp., Armonk, N.Y., USA). The significance level was considered less than 0.05. The independent-samples t-test was utilized to compare the mean empathy scores before the intervention. The paired-samples t-test and the generalized linear model (with the identity link function) were respectively used to conduct the within- and between-group comparisons after the intervention. Results After the completion of the intervention, the mean changes of empathy score (± standard deviation) of empathy was shown to be 1.14 ± 27.73 in the control group (p = .773) and 11.02 ± 35.39 in the intervention group (p = .032). The difference in the mean changes of empathy score was significant between the two groups (p = .042). Conclusion Knowledge brokering can promote the level of empathy among cardiac nurses.

Background: One of the main concerns in critical care units is the development of humanistic approaches. In this regard, recognizing the factors affecting humanistic nursing can contribute to humanizing nursing care in these units. Objective: The objective was to recognize the influential factors of humanistic nursing in critical care units. Research design: This qualitative study was carried out using a phenomenology method. Thirty-nine in-depth unstructured interviews were performed. The data were analyzed using the phenomenological nursology approach. To guarantee trustworthiness, prolonged engagement, member check, triangulation of resources, and maximum variation sampling were used. Participants and research context: Purposeful sampling was employed to select 10 nurses, 8 patients, and 4 patient’s relatives from the intensive care unit and critical care unit departments. Ethical consideration: This study was approved by the ethics committee of Lorestan University of Medical Sciences with the code of LUMS.REC.1395.121. Finding: The participants’ experiences were reflected in the following three main concepts: (a) moral, educational, and existential nature of the two humans involved in the interaction; (b) maintenance of the nurses’ dignity; and (c) interactions in the cultural and social context. Discussion: The nurse and patient, organizational environment, and society give rise to a set of intertwined characteristics which influence the realization of humanistic nursing. By affecting the nurses’ educational background and maintaining their dignity, the atmosphere of the hospital and cultural readiness of the society pave the way for delivering the humanistic care.

ImportanceIntegrated care for children is rarely studied, especially in low- and middle-income countries, where generalists often provide mental health care.ObjectivesTo explore the effect of adding a child and youth component to an existing adult collaborative care program on mental health outcomes and receipt of care.Design, Setting, and ParticipantsThis cluster randomized trial was conducted within an adult collaborative care program in Tehran, Iran. General practitioners (GPs), their 5- to 15-year-old patients, and patients’ parents were included. Children and youths coming for routine medical visits who scored greater than the cutoff on the Strengths and Difficulties Questionnaire (SDQ) were followed up for 6 months. The study was conducted from May 2018 to October 2019, and analysis was conducted from March 2020 to August 2021.InterventionsGPs were randomized to either a 2.5-day training on managing common child mental health problems (intervention) or refresher training on identification and referral (control).Main Outcomes and MeasuresPrimary outcome was change in SDQ total problems score; secondary outcomes included discussion of psychosocial issues by the GPs and receipt of mental health care during the follow-up period.ResultsOverall, 49 GPs cared for 389 children who scored greater than the cutoff on the SDQ (216 children in intervention group, 173 in control group). Patients’ mean (SD) age was 8.9 (2.9) years (range, 5 to 15 years), and 182 (47%) were female patients. At 6 months, children in the intervention group had greater odds of receiving mental health care during the study (odds ratio [OR], 3.0; 95% CI, 1.1 to 7.7), parents were more likely to report that intervention GPs had discussed parent (OR, 2.1; 95% Cl, 1.1 to 3.8) and child (OR, 2.0; 95% Cl, 0.9 to 4.8) psychosocial issues, and intervention GPs were more likely to say they had provided counseling (OR, 1.8; 95% Cl, 1.02 to 3.3). However, there was no greater improvement in SDQ scores among children seen by intervention vs control GPs. Adjusted for clustering within GP, the variables used for balanced allocation (practice size, practice ownership, and study wave), and the other variables associated with change in SDQ scores over time, there was not a significant time-treatment interaction at either the 3- or 6-month follow-up points (linear combination of coefficients for intervention, 0.57 [95% CI, –1.07 to 2.22] and –0.08 [95%CI, –1.76 to 1.56], respectively). In a subgroup of GPs with practices composed of 50% or more children, children seen by intervention GPs improved to a significantly greater extent (–3.6 points; 95% CI, –6.7 to –0.46 points; effect size d = 0.66; 95% CI, 0.30 to 1.01) compared with those seen by control GPs.Conclusions and RelevanceIn this cluster randomized trial, GP training on managing common child mental health problems did not demonstrate greater improvement in child SDQ scores. Child mental health training for GPs in collaborative care can improve children’s access to mental health care, but prior experience working with children and their families may be required for GPs to use a brief training in a way that improves child outcomes.Trial RegistrationClinicalTrials.gov Identifier: NCT03144739

Background COVID19 pandemic has caused a variety of psychological problems including panic disorder, anxiety and depression. It is also associated with adverse psychological outcomes in pregnant women. The aim of this study was to compare the severity of postpartum depression in pregnant women with and without COVID-19 during the coronavirus epidemic. Methods This case-control study was performed on 102 pregnant women referred to the hospitals of (XXX). Using questionnaire, consisting of demographic and maternal data (age, number of pregnancies, type of delivery, history of any disease, history of drug use, breastfeeding experience, separation of mother from infant due to coronavirus) and score from Edinburgh postnatal depression scale (EPDS) score data from all the participants obtained and analyzed statistically using SPSSv23. Results The results showed that the mean EPDS score in COVID-positive mothers was 26.64 and in COVID-negative mothers was 24.76, which was statistically significant, p

Despite the importance and prominent role as a clinical, theoretical, and research approach in nursing practice, humanistic care nature and boundaries are not explicit and challenging for nurses to understand. This study was conducted to clarify the concept of humanistic care in nursing.Based on Rogers's evolutionary concept analysis, keywords such as "humanistic car *," "caring behave *," "humanistic nurs *," "humanistic model of care," were searched in PubMed, SCOPUS, Science Direct, Web of Science, WILEY, Springer, SAGE, ProQuest, SID, Iranmedex without time limit until November 2018. Sixty-five documents in nursing and ten documents in the medical discipline were finalized for thematic analysis.Nine attributes of the humanistic care, including "excellence in clinical literacy," "creating a healing environment," "a comprehensive and unique viewpoint," "contribution to clients' adaptation and flourishing of their talents," "unrequited love and affection," "preservation of human dignity," "real presence," "constructive dynamic interaction," and "nurse's self-care," were recognized. Assessing the historical and evolutionary course of the concept's semantic tendency revealed three periods: The focus in first, second, and third was on the nurse-patient relationship, quantitative tendency/measurement, and metaphysics/spiritual humanism, respectively. The comparison of interdisciplinary differences indicated greater semantic comprehensiveness and depth in the nursing discipline.Clear and practical definition and identification of humanistic care in nursing can be helpful in the further development of existing knowledge, instrumentation, designing guidelines, clinical interventions, knowledge translation, and correction of concept misuse. The identified antecedents and consequences can be in various aspects of clinical management.

BACKGROUND: Iran has well-established networks for primary care staffed by general practitioners who provide services to patients across the lifespan. Iran recently established collaborative care networks to build general practitioners’ capacity to provide adult mental health services. In an NIH-funded study, we are designing and evaluating a training program for general practitioners (GPs) to extend this collaboration to include services for children and adolescents. In the formative phase of this project, we conducted a qualitative study to obtain information relevant to the design of the training program. METHODS: We conducted semi-structured individual interviews with 28 stakeholders; including 15 GPs working in a collaborative care network, 6 parents and 4 adolescents who had received child mental health care from a GP, and 3 policymakers. We also held a focus group discussion with 8 school teachers and counselors. All interviews were transcribed during the interviews’ sessions and then were thematically analyzed. RESULTS: GPs reported seeing a range of child emotional and behavioral problems but felt the need for additional training in diagnosis and management, especially in skills for interviewing and communicating with children. GPs also expressed the need to understand legal issues involved in treating children, including cases of possible child abuse. School staff agreed that GPs could help with children’s educational and emotional problems but also believed GPs would need extra training. Parents indicated a preference for GPs over psychiatrists (as did adolescents) as a source of mental health care, and for psychological over pharmacological interventions. Adolescents expressed a preference not to speak about private issues in the presence of their parents, and expressed concern that the GPs did not respect their preference. They also desired a more active role during visits. CONCLUSIONS: Before expanding the scope of practice of Iranian GPs to provide management of common emotional and behavioral problems in children and adolescents, the concerns and specific needs of these practitioners need to be addressed. Parents and youth in the study expressed a preference for mental health care from a GP rather than a specialist. However, they also commented on the need for restructuring the current GP visits to facilitate youth participation. These findings provide directions for expanding the scope of practice of adult collaborative care networks to meet the mental health care needs of children and adolescents more expeditiously and effectively.

Introduction:The coronavirus disease 2019 (COVID-19), is profoundly affecting the mental health status. Although the burden of mental health problems has been reported in the general population and health care workers, little is known about the prevalence of mental health disorders among recovered COVID-19 patients and their associated factors.Methods:A cross-sectional telephonic-study of recovered COVID-19 patients with and without a history of hospitalization was conducted from April 20 to June 20, 2020, in Tehran, Iran. We assessed the anxiety symptoms, depression, and post-traumatic stress disorder (PTSD) among participants, using the Patient Health Questionnaire (PHQ-4) and PTSD checklist for DSM-5 (PCL-5). Logistic regression analyses were used to explore the risk factors associated with mental health problems.Results:A total of 602 individuals with a mean age of 53.2 years (SD: 14.7), completed the study. The rates of mental health symptoms among the respondents were 5.8% (95% CI: 4.2–7.8%) for anxiety, 5.0% (95% CI: 3.5–7.0%) for depression, and 3.8% (95% CI: 2.3–5.3%) for PTSD disorders. Moreover, being younger than 50 years and female gender was significantly associated with a higher probability of reporting anxiety (p< 0.01), and depression (p< 0.001 for being younger than 50 years,p< 0.02 for female gender).Conclusions:The current study indicated that patients with COVID-19 presented features of anxiety, depression, and PTSD. These results may help implement appropriate mental health intervention policies for those at risk and minimize the mental health consequences of the COVID-19.

Background: Nurses working in intensive care units do their main part of the job using medical equipment. Nursing scholars have raised concerns about the decline and lack of attention to humanistic care in nursing. One of the threatening factors can be the high attention of nurses to the use of technology, especially in intensive care. Up to now, there has been little investigation of the nurses' perceptions of this phenomenon. The aim of the study was, therefore, to explore the perceptions of nurses and attendants of humanistic care in the intensive care unit.Methods: The present study was a qualitative conventional content analysis (COREQ guidelines) conducted in. an intensive care unit in a hospital in Qazvin, Iran, in 2019. Data was collected using unstructured interviews and field notes and then analyzed using the Elo-Kyngäs method in 2008. Findings: Continuous and comparative analysis of the data led to the extraction of 4 main themes as follows: 1) Insufficient understanding of nurses and patients’ families of each other's roles, needs, and expectations; 2) The use of personal and situational reasoning rather than ethical principles; 3) Caring stagnation, and 4) Satisfaction with care.Conclusion: The findings of the study indicated that due to insufficient equipment, high workloads, and anxieties, nurses and attendants might not be able to understand each other’s roles and expectations. If it is not resolved properly, this situation will end in conflicts and stagnation in healthcare. Patients admitted to an intensive care unit are usually in critical health conditions. However, nurses feel satisfied with the outcome of their jobs when those patients are discharged from the hospital with a stable health condition. Shedding more light on the humanistic care status in intensive care units in Iran, the results of this research can be applied to health professionals and nursing managers.

Background: The strengths and difficulties questionnaire (SDQ) is one of the most common screening tools to detect children and adolescents who are at risk of mental health problems or have psychiatric disorders. The standard mode of SDQ completion is on paper; however, some studies used phone administration and argued that this is a feasible and valid method that can substitute in-person administration. However, few studies have investigated the validity and reliability of phone administration of the SDQ. Objectives: The current study aimed to compare the telephone versus paper-and-pencil administration of the SDQ among Iranian child and adolescent outpatients. Methods: Sixty six parents with children aged 3 to 15 years completed the SDQ questionnaire using paper-and-pencil and telephone interview techniques. The study was performed in 2016, and participants were from the city of Tehran (capital of Iran). Participants were first divided into two groups. Then, one of them first completed the questionnaire using the face-to-face interviews, and 3 to 4 days later, they again completed the questionnaire using the telephone interview. And the vice versa occurred for the other group. The Pearson correlation analysis was used to calculate the correlation between the two methods in each group separately. Intra-class correlation (ICC) analysis was used to investigate the association between the two administration methods. Results: A significant positive correlation was found between the two types of administration in both groups (P < 0.05). Intra-class correlation coefficients indicated a good correlation between the scores obtained from each method of administration (all P values were < 0.001). Conclusions: Telephone administration of SDQ is a reliable method for collecting data when studying emotional and behavioral symptoms in children and adolescents attending outpatient psychiatric centers.

Background: Community Mental Health centers (CMHCs) have been successful in the on-time diagnosis and treatment of psychiatric disorders worldwide. Objectives: The study aimed to evaluate the efficiency of the Community Mental Health Center (CMHC) affiliated with Shahid Beheshti University of Medical Sciences in the on-time diagnosis and treatment of psychiatric patients who go to the general physicians. Evidence suggests that such a diagnosis and treatment can help reduce the burden of disease on society. Methods: This descriptive cross-sectional study was conducted from January 2014 to September 2016. Fourteen general physicians and case managers in the catchment area of CMHC cooperated with the study. General physicians began to diagnose and treat psychiatric disorders based on therapeutic guides. The descriptive statistics were used for data analysis. Results: One thousand and four hundred and eighty seven patients were diagnosed by the general practitioners, 730 (49.09%) of whom suffered from depression, and 544 (36.58%) suffered from anxiety. As the physicians reported, 15/74% of the total number of visits was related to psychiatric disorders. Based on the telephone follow-ups, 94/34% of the patients reported improvement. Untreated patients were followed up or taken to a psychiatrist. Conclusions: This study demonstrates the importance of on-time diagnosis of psychiatric patients and the provision of specialized services that can decrease the load of prevalent psychiatric disorders if continued.

The purpose of this data article is to present the prevalence of Internet addiction in people with a history of substance abuse disorder in Kerman during 2016–2017. For this purpose, 223 people with the history of substance abuse disorder in three cities of Kerman province completed the demographic form and Young׳s Internet addiction questionnaire. Demographic characteristics of participants was analyzed and presented here. Young׳s Addiction Commitment Questionnaire contains 20 questions, each with a score of 1 to 5. The history of participants about the drug abuse was investigated. In addition, the prevalence of Internet addiction among the participants was evaluated. The internet addiction is more common in people with a history of drug abuse which may be a behavioral substitute for drug addiction. Keywords: Internet addiction, Drug use, Iran, Kerman

Background: Nurses have always been known as an advocate for the rights of patients. The recognition of what is perceived as the violation of patients’ rights can help nurses to understand patients’ concerns and priorities. Thus, it helps nurses play their supportive roles more effectively. Objective: The aim of this study was to explore different dimensions of the violation of patients’ rights. Research design: Data were collected utilizing unstructured interviews and field notes. Data analysis was conducted using the qualitative content analysis approach. Prolonged engagement, maximum variation sampling, and member check were among the factors which enriched the research. Participants and research context: The sample consisted of 18 patients and 11 members of their families. They were purposively selected from two hospitals in Tehran during 2009–2012. Ethical considerations: The research was approved by the Ethics Committee of the university and hospitals. Finding: The patients’ rights were violated in a variety of ways. There were three main dimensions to this issue: (a) care recession including deprivation of the caregiver’s presence and the delay/lack of needed responses; (b) receiving mechanical care including superficiality, lack of emotion, and failure to understand the situation; and (c) being disrespected including humility and aggression. Conclusion: The patients and their families consider any shortcomings in relation to the patient and the quality of care as the violation of the rights. The findings of the study imply sensitizing managers toward providing appropriate conditions as well as educating nurses to observe patients’ rights. It is suggested that the processes leading to the violation of patients’ rights be discovered and prevented in the future.

Background: Values are the basis of nursing practice, especially in making decisions about complicated ethical issues. Despite their key role in nursing, little information exists on the factors affecting their development and manifestation in nursing students. Objective: This study identifies and describes the facilitators and inhibitors of the development and manifestation of professional values based on the experiences of nursing students and instructors and nurses. Research design: Data were collected through 29 semi-structured interviews and two focus group interviews in 2013–2015 and were analyzed using the conventional content analysis method of Elo and Kyngäs. Participants and research context: In total, 18 nursing undergraduates, five nursing instructors, and five nurses from Shiraz University of Medical Sciences and one of the teaching hospitals in Shiraz were selected through purposive sampling. Ethical considerations: The research was approved by the Ethics Committee of Shiraz University of Medical Sciences and the teaching hospital examined. Findings: The findings consisted of two categories: personal and environmental factors. Personal factors consisted of the two subcategories of personal stimuli (work experience and past relationships, inner beliefs and acting on values, belief in God and a divine worldview) and personal inhibitors (the lack of professional motivation and enthusiasm, negative emotions). Environmental factors consisted of the two subcategories of environmental stimuli (cooperation, order and discipline) and environmental inhibitors (unfavorable work environment, society’s negative attitude toward nursing, the violation of rights). Discussion and conclusion: Given the impact of personal and environmental factors on the development and manifestation of professional values in nursing students, it is upon the education authorities to take account of them in their planning, and nursing managers are also recommended to further address these factors in their development of a proper work environment, provision of standard facilities and removal of barriers.

Objective: We aimed to investigate the efficacy of polyunsaturated fatty acids (PUFAs) as an adjuvant treatment in patients with ADHD receiving methylphenidate as well as its side effects. Method: This randomized clinical trial was conducted on 40 ADHD patients aged between 6 and 12 years. Both treatment and placebo groups received methylphenidate. Treatment arm also received omega-6 once daily. The Parent ADHD Rating Scale was used to evaluate disease improvement. Results: The Parent ADHD Rating Scale scores of the two groups were similar at baseline. Although total score and scores of three categories decreased significantly in both groups, total score and scores of inattention, hyperactivity, and impulsivity were not significantly different between the groups. Conclusion: The results did not support the efficacy of PUFA in the treatment of ADHD, and adding PUFAs to the therapeutic regimen of ADHD is not recommended at the moment.

Background: Stimulants are not very effective on attention deficit hyperactivity disorder (ADHD) children under 6 years old. The most common medication that is used in this range of age is Risperidone. Evaluating the safety and efficacy of Aripiprazole versus Risperidone for treating children under 6 years suffering from ADHD was the aim of this study. Methods: During this double-blind clinical trial, 34 children aged 3 - 6 years who were diagnosed with ADHD, received treatments with Aripiprazole or Risperidone randomly for 12 weeks. Follow-up measures comprised, CGAS, the ADHD-RS, CPRS and side effect checklist. Results: The findings revealed that 20 patients in Risperidone group (including 13 boys and 7 girls) and 20 patients in Aripiprazole group (including 13 boys and 7 girls) had at least one follow-up examination. After 12 weeks of the study, both medications showed distinct improvements in ADHD RS (P < 0.001), CPRS (P < 0.001) and CGAS (P < 0.001) scores. The statistic difference between them was not significantly different. The most common side effects in Risperidone group were reported to be panic (20%), nausea and vomiting (20%), while in Aripiprazole they were reported to be increased appetite (25%) and somnolence (15%). Conclusions: The findings revealed that both Risperidone and Aripiprazole are effective in treating ADHD children under 6 years old and there was no significant difference between the two drugs. Children can tolerate them well. Aripiprazole effect on children showed itself earlier compared to Risperidone.

Attention deficit-hyperactivity disorder (ADHD) is one of the most common psychiatric disorders among children. It is associated with adverse complications for the children, their families, and the society in both short and long runs; therefore, finding solutions to correctly and timely diagnose the disease brings about numerous benefits. In this regard, the present study was carried out in order to examine the mean scores of neurological soft signs as a tool for more accurate and faster diagnosis among children with ADHD and compare them with healthy children. The present study was a descriptive analytical cross-sectional investigation that was carried out in Child and Adolescent Psychiatry Clinic, Imam Hussein Hospital. Twenty-five children aging 7-12 with ADHD were examined using attention deficit-hyperactivity checklist of DSM-IV, Conners Test, and 28-item Neurological Evaluation Scale (NES) (to examine neurological soft signs). Afterwards, the results were compared with those of 25 children without the disorder. The children with ADHD were all treated with Ritalin. The total scores in NES in the experimental group and the control group were respectively 11.4±4.14 and 5.6±79.2, and this difference was completely significant (P>0.0001). The experimental group obtained higher scores in glabellar reflex, quick alternative movements, and right-left separation compared to the control group. Given the significant difference between the children with ADHD and the healthy ones, these signs can probably be used to early diagnose the disorder and take faster steps toward preventing and treating it.

Attention deficit-hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children, which is associated with a high level of comorbidity among siblings of individuals with ADHD. Given the strongly hereditary nature of ADHD, it may include a group of neurobehavioral defects that can be seen with a higher prevalence in the patients’ siblings due to shared genetic origins. The present study was aimed at examining the prevalence rate and mean scores of neurological soft signs in children with ADHD and their siblings and comparing them with a healthy population. Thirty-two children and adolescents with ADHD and an age range of 7 to 16 years old and 32 siblings of them with the same age range were studied using attention deficit-hyperactivity checklist of DSM-IV-TR and K-SADS Questionnaire, and their neurological soft signs were evaluated using NES questionnaire. Afterwards, the results were compared with those of 32 healthy children and adolescents. The total scores on the test of assessing neurological soft signs were 8.34±4.9, 4.6±3.34, and 3±3.25 in the group with ADHD, the siblings, and the control group, respectively. There was a significant difference between the two groups and the control group (p

Background: Due to the high incidence of atelectasis following coronary artery bypass surgery and the effects of different levels of positive end expiratory pressure (PEEP) in preventing this condition. Objectives: this study was designed aimed to investigate the effects of PEEP on the incidence of atelectasis after coronary artery bypass surgery. Material and methods: This study is a clinical trial with a control group conducted on 90 patients underwent coronary artery bypass surgery. After surgery and entering patients to the intensive care unit (ICU) the intervention group subjects were under PEEP = 10 cm / H2o and the control group subjects were under PEEP = 5 cm / H2o for 4 hours. For the final diagnosis of atelectasis, a chest radiograph was performed six hours after extubation and 5 days after surgery, saturation pulse oximetry was also examined. The systolic and diastolic blood pressure before and after the intervention were measured in order to evaluate hemodynamic status of patients. Chi-square and independent t-tests were used to statistical analysis. Results: The observed difference in the incidence of atelectasis between the two groups 6 hours after extubation were statistically significant (P=0/03). There was also no statistical significant difference between the two groups 5 days after surgery (P=0/3). The difference between the two groups in terms of the average of saturation pulse oximetry was statistically significant (P=0/025). There was no statistical significant difference between the two groups in terms of systolic (P = 0.25) and diastolic (P = 0.14) blood pressure before intervention. There also was no statistical significant difference between the two groups in terms of systolic (P = 0.62) and diastolic (P = 0.67) blood pressure after intervention. Conclusion: this study indicated that applying PEEP=10 cm/H2O after the Coronary Artery Bypass Surgery can lead to decrease the incidence rate of atelectasis following the surgery, and considering that applying of two levels of PEEP with 5 and 10 cm of water has no effect on the hemodynamic status of patients, so it is proposed that this technique be used at intensive care unit to reduce the incidence of atelectasis. Keywords: positive end expiratory pressure (PEEP), coronary artery bypass graft surgery (CABG), atelectasis

Dear Editor, One of the international challenges for nurses, especially in developing countries, is dissatisfaction with social status and not being seen as they deserve. The social image of nursing is one of the long-standing concerns of this profession, which has extensive effects on many other issues........

This mixed method retrospective pilot study empirically investigated the grief experience of mothers of small children who were bereaved during motherhood. Prolonged Grief Disorder (PGD), life satisfaction, and attachment styles were measured among a web-based sample of 37 mothers using quantitative measures, and essay questions were used to gather qualitative data. Results indicated that while none of the mothers met the complete criteria for PGD, 49% endorsed presently experiencing separation distress, 24% endorsed frequently experiencing psychological symptoms and 14% reported current impairment in daily living. Insecure attachment style was positively correlated with higher PGD scores. Qualitative findings also indicated that although challenging, motherhood offered a distraction from grief, and provided a sense of meaning and purpose in life. Motherhood seems to have helped them to be less susceptible to prolonged grief complications. This was also responsible for their low scores on the PG-1...

Modern psychoanalytic developmental theory suggests that a child's inability to make sense of her own mind and those of others (i.e. mentalization) leaves her vulnerable to communicate through action instead of words, which can include somatization in the form of an eating disorder (ED). This pilot study tested the correlation between ED risk and insecure attachment among 76 preadolescent girls and compared the mentalization capacities of girls with high and low vulnerability to EDs. Girls in fourth through sixth grades were given tests measuring their ED risk and attachment styles. Thirty subjects with the highest and lowest scores on measures of ED were then administered a mentalization picture task to measure their capacity to mentalize. The analysis of the data indicated a significant negative correlation between ED risk and attachment style as well as ED risk and mentalization capacity, i.e. girls in the high-risk group for ED had significantly lower scores on attachment and mentalization. Implicatio...

Background: Humanistic nursing practice which is dominated by technological advancement, outcome measurement, reduced resources, and staff shortages is challenging in the present work environment. Objective: To examine the main concern in humanistic nursing area and how the way it is solved and resolved by Iranian nurses in acute care setting. Research design: Data were collected from interviews and observations in 2009–2011 and analyzed using classic grounded theory. Memos were written during the analysis, and they were sorted once theoretical saturation occurred. Participants and research context: In total, 22 nurses, 18 patients, and 12 families from two teaching hospitals in Tehran were selected by purposeful and theoretical sampling. Ethical considerations: The research was approved by the Ethics Committee of the university and hospitals. Results: The main concern for the nurses is the violation of their rights. They overcome this concern when there is a synergy of situation–education/learning, that is, a positive interaction between education and learning of values and sensitivity of the situation or existence of care promotion elements. They turn to professional values and seeking and meeting others’ needs, resulting in “success and accomplishment” of nurse/nursing manager and patient/family. Conclusion: This theory shows that professional values, elements of care promotion, and sensitivity of the situation have a key role in activation of humanistic approach in nursing. Violation of the nurses’ professional rights often leads to a decrease in care, but these factors make the nurses practice in an unsparing response approach. It is necessary to focus on development of professional values and provide essential elements of care promotion as changeable factors for realization of humanistic nursing although there is a context in which the nurses’ rights are violated.

Dignity is a human right and a base for human health. This right must be observed in work environments as a moral obligation. This qualitative study aimed to understand nurses’ experiences of violation of their dignity at work and to explore its dimensions. The participants were 15 nurses working in two hospitals in Tehran. The data were collected through 26 unstructured interviews and analyzed using content analysis. The dimensions of violation were ‘irreverence’, including experiences of abuse and violence, humiliation, and being ignored; ‘coercion and violation of autonomy’, consisting of the control of relationships, lack of privacy, rigidness, and imposition; ‘ignoring professional and scientific ability’, indicating impossibilities in applying nurses’ knowledge; and ‘denying the value of nurse/care’, being the theme that verified the dominance of treatment/cure and lack of recognition of care value. Health systems should take the promotion of the nurses’ dignity into account through providing a dignified work environment.

Background: Attention Deficit Hyperactivity Disorder (ADHD) can lead to drastic problems for the patient and its worldwide prevalence is 5%-12%. It also has many comorbidities with other disorders, and the genetic contribution seems the most significant cause. Objectives: The current study was conducted to investigate the association between norepinephrine transporter-3081 (A/T) polymorphisms and ADHD in Iranian population. Patients and Methods: Participants were chosen from children and adolescents diagnosed with ADHD referred to Imam Hoseyn Hospital. A child and adolescent psychiatrist confirmed the diagnosis using the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL) semi-structural interview. The control group was from pupils of schools in Tehran (capital city of Iran) who had no history or presence of psychiatric and medical complications. Also, a child and adolescent psychiatrist confirmed their health using the K-SADS-PL semi-structural interview. Genetic examinations were DNA distraction, Polymerase Chain Reaction (PCR), and Restricted Fragment Length Polymorphism (RFLP), which were conducted according to standard protocols. The statistical analysis was performed using chi-square and Fisher's exact test in SPSS version 21. Results: The percentages of ADHD subtypes for combined, inattentive, and hyperactive/impulsive were 72.2%, 17.2%, and 11.9%, respectively. There was no significant association between norepinephrine transporter polymorphism and ADHD (P = 0.81). Moreover, no significant relationship was found between gender [male (P = 0.92) and female (P = 0.63)] and polymorphism. No significant association was found between subtypes of ADHD [combined (P = 0.46), inattentive (P = 0.41), hyperactive/impulsive (P = 0.32)] and polymorphism SCL6A2. This lack of association can also be seen in gender in every subtype. Conclusions: The results of the study show no significant association between norepinephrine transporter polymorphism SCL6A2 and ADHD.

The aim of the present study was to compare the parenting styles in parents with and without adult attention deficit hyperactivity disorder (ADHD) who had children with ADHD. It was a case-control study with convenience sampling strategy. Participants were recruited from the parents of previously diagnosed children with ADHD referred to Imam Hossein Hospital, Tehran/ Iran. Ninety parents with adult ADHD and 120 normal parents were chosen by Conner's Adult ADHD Screening Scale (CAARS) and psychiatrist interview. Using Baumrind Parenting Styles Questionnaire and Arnold Parenting Scale, parenting styles were assessed in both the groups. Results from independent samples t-test indicated that Authoritarian parenting style (F = 0.576, p 0.022) and Over reacting style (F = 7.976, p 0.045) were significantly higher in cases. On the other hand, controls were using Permissive style (F = 0.131, p 0.044) more than cases. The results are consistent with prior studies; these findings can improve the content of parent training for children with ADHD, who have adult ADHD themselves.

Background: Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in which impairment of executive functions plays an important role. Objectives: The main objective of this study was to assess the validity of the Behavior Rating Inventory of Executive Function (BRIEF) in children with ADHD. Patients and Methods: Thirty children, aged 7-12 years, attending the child and adolescent clinic of Roozbeh hospital and diagnosed with ADHD according to interview with a child and adolescent psychiatrist, formed our ADHD group. In contrast, thirty participants of the control group were selected from 7 to 12 year-old students according to Conners’ Teacher/Parent Rating Scale and did not have ADHD. The kiddie schedule for affective disorders and schizophrenia-present and lifetime version-Persian version was also completed for all children to rule out other psychiatric disorders. After oral consent, parents of 60 children (ADHD = 30, control = 30), completed three questionnaires of ADHD-Rating Scale-IV, Conners’ Parent Rating Scale-Revised: Short Version and BRIEF. Results: Children in ADHD group got higher scores than those in the control group in all subscales and indices of BRIEF (P < 0.001). There were also good correlations between subscales and indices of BRIEF and the two other rating scales (P < 0.001). Conclusion: BRIEF could be used as a valid tool to assess behavioral aspects of executive functions, especially to discriminate children with ADHD and normal ones.