Moral Injury and its Correlates among Iranian Nurses in the Second Year of the COVID-19 Pandemic: A Multicenter Cross-Sectional Study

The COVID-19 pandemic has been associated with various health-related issues among nurses, including mental health problems such as moral injury. This study aimed to evaluate the relationship between moral injury, general health, post-traumatic stress disorder (PTSD), and type of hospital among Iranian nurses working in different clinical settings during the COVID-19 outbreak. This cross-sectional study employed convenience sampling to recruit 334 nurses working in various clinical settings, including teaching and referral hospitals, in Kerman, Southeastern Iran from October 2021 to February 2022. The study used three measures, including the General Health Questionnaire (GHQ-12), the Impact of Event Scale-Revised (IES-R), and The Moral Injury Symptom Scale-Healthcare Professionals version (MISS-HP). Data analysis was conducted using SPSS25. The results indicated that moral injury was highly prevalent among Iranian nurses, with 47% of the participants reporting experiencing it. A total, 26.9% of the participants reported experiencing mental health disorders and 57.2% of the participants reported experiencing this disorder. Significant correlations were found between moral injury, general health, and PTSD. Specifically, moral injury levels were higher among female nurses with a history of mental disorders and those designated to treat all kinds of cases, compared to other participants. The results suggest that Iranian nurses are at a high risk of experiencing moral injury during the COVID-19 pandemic. Policymakers and health authorities should establish related health educational programs, provide counseling services to promote general health, and pay particular attention to moral injury and PTSD. Additionally, nurse educators should integrate materials related to moral injury into the nursing curriculum.

Muscle strength/intensive care unit acquired weakness in COVID-19 and non-COVID-19 patients

BACKGROUND

Intensive care unit acquired weakness (ICU-AW) affects both coronavirus disease 19 (COVID-19) and non-COVID-19 patients. ICU-AW can result in a variety of consequences, including increased patient mortality.

AIMS

The current study aimed to compare muscle strength and ICU-AW in COVID-19 and non-COVID-19 patients.

STUDY DESIGN

This was a cross-sectional, descriptive-analytical pilot study.

METHODS

Fifteen conscious COVID-19 patients and 15 conscious non-COVID-19 patients admitted to the ICUs of a public hospital were selected by convenience sampling. Muscle strength in arms and legs was assessed by a hand-held dynamometer (HHD), and ICU-AW was measured with the medical research council sum score (MRC-SS) scale on the first, fourth, and seventh days of admission to ICUs.

RESULTS

The results showed that muscle strength in the arms and legs of the COVID-19 patients assessed by a HHD and MRC was significantly lower than that of non-COVID-19 patients. On the fourth day of ICU admission, 80% of the COVID-19 patients and 40% of the non-COVID-19 patients had ICU-AW. All COVID-19 patients and 86.8% of the non-COVID-19 patients had ICU-AW on the seventh day of ICU admission.

CONCLUSIONS

Decreased muscle strength and ICU-AW are more likely in COVID-19 patients who must stay in the ICU compared with non-COVID-19 patients.

RELEVANCE TO CLINICAL PRACTICE

Health systems should plan to provide rehabilitation facilities for COVID-19 patients and prevent prolonged complications of COVID-19.

A randomized controlled trial on the effects of different music genres on physiologic parameters and emotion

BACKGROUND

Listening to music has psychophysiological effects on individuals' body and emotions, and it is known as one of the most influential stimuli to create emotions. The aim of this study was to explore the effect of different music genres on some physiological parameters and emotion.

METHODS

This was a randomized controlled trial. For 5 days, forty-six healthy undergraduate students were randomly assigned to several types of music (pop, rock, western classical, and Persian traditional), as well as silence. Physiologic parameters were checked five times (before, during, immediately, 15, and 30 min after the interventions). Before and after the interventions, the Self-Assessment Manikin questionnaire was completed.

RESULTS

There was no statistically significant difference in heart rate, diastolic blood pressure, temperature, silence, or other approaches between the groups. Silence and other ways did not reduce systolic blood pressure as much as listening to the pop. Peripheral oxygen saturation increased significantly only when listening to Persian traditional music, and when there was silence however, the differences were not statistically significant. In terms of valence, arousal, and dominance, none of the five treatments were shown to be more effective.

CONCLUSION

The results of the present study showed that statistically and clinically, there was no difference between silent music and other types of music, including pop, rock, western classical, and Persian traditional, in reducing physiological parameters. Different genres of music had no additional impact on emotion when compared to silence.

Development and Validation of the Nurses' Spiritual Sensitivity Scale in Southeastern Iran

Spiritual sensitivity refers to awareness and perception of the attitudes and feelings of others and helps nurses to recognize and take responsibility for the spiritual values and needs of patients. The dimensions of spiritual sensitivity remain unknown as there is no comprehensive and standardized scale for assessing nurses' spiritual sensitivity; therefore, the current research aimed to design and validate the nurses' spiritual sensitivity scale. We conducted this exploratory sequential study using eight stages suggested by DeVellis (2016) when developing the scale. We conducted this study among Iranian nurses from March 2021 to October 2022. Results suggested a 20-item scale with two components (nurses' professional spiritual sensitivity and nurses' internal spiritual sensitivity) that explained 57.62% of the total variance extracted. We were able to confirm convergent validity based on an acceptable correlation between the nurses' spiritual sensitivity scale and the King's spiritual intelligence scale (r = 0.66), which showed good stability (cronbach's alpha coefficient = 0.927, omega coefficient = 0.923, and icc = 0.937). Spiritual sensitivity in nurses is difficult to evaluate. Considering the acceptability of the psychometric properties of the "Nurses' spiritual sensitivity" scale, this scale can be used in clinical environments to evaluate nurses' spiritual sensitivity. Therefore, it is suggested that managers and policy makers should consider developing related guidelines to help nurses to become more spiritually sensitive and also to meet the spiritual needs of patients. We suggest further studies to confirm the study results in the nursing community.

Postmenopausal women's usage of complementary and alternative medicine and its relationship to sexual function: A cross-sectional study in southeastern Iran

Background and Aims

Sexual dysfunction is one of the most common problems in postmenopausal women that affect their lives. Due to the widespread disadvantages and age limit of drug and hormone therapy, the demand for complementary and alternative medicine (CAM) methods has increased.

Methods

This was a descriptive-analytical study. A total of 297 postmenopausal women who were referred to health centers in Kerman, southeastern Iran, were selected during the years 2020-2021. The use of CAM and sexual function were examined by Complementary and Alternative Medicine Questionnaire and the Female Sexual Function Index, respectively. Data were collected through a combination of face-to-face and online forms.

Results

More than half of the participants used at least one type of CAM in the preceding year for any general reason. The mean satisfaction score for CAM use was 21.7 ± 5.84; Most reasons of use were for improving quality of life, improving physical function, reducing sleep disorders, improving mood status, reducing vasomotor symptom, and improving sexual function, respectively. Most reasons of use were related to sexual dysfunction. Specifically, the mean score for sexual function was 17.96 ± 7.50 which was lower than the scale's midpoint of 28. According to different subscales of sexual function, 52.9% of participants had good desire, 49.5% good arousal, 34.7% good lubrication, 56.9% good orgasm, and 2% had no pain, and 52.5% were satisfied with their sexual function. There were no significant differences between CAM users and nonusers about sexual functions and all its subscales.

Conclusion

There were no significant differences between CAM users and nonusers about sexual functions and all its domains. Further research in different communities with different health systems is recommended to investigate the relationship between CAM and sexual function among postmenopausal women.

Hospital challenges and managerial approaches to combat COVID-19 outbreak: a qualitative study in southeastern Iran

BACKGROUND

During the covid-19 pandemic, hospitals have faced several challenges, so they need to identify and address effective management strategies to cope with these challenges that enhance their current knowledge to deal with similar challenges in the future. This study aimed to identify managerial strategies for dealing with Covid-19 pandemic challenges at a hospital in southeastern Iran.

METHODS

This qualitative content analysis study used purposive sampling to select eight managers, three nurses, and one worker from Shahid Bahonar Hospital. In this study, semi-structured interviews were used to collect data and Lundman and Graneheim's approach was used to analyze them.

RESULTS

Three hundred fifty codes remained after constant comparison, compression, and merging. The results demonstrated one theme "Managerial reengineering in the healthcare system during the Covid-19 crisis", two main categories, seven subcategories and, 19 sub- subcategories. The first main category was "The difficulty of managing challenges," including "Insufficient resources and physical space", "Socio-organizational challenges" and, "Incompetence and unpreparedness of managers." The second main category was "Reforming the management duties." This category included "Planning and decision-making," "Organization," "Leadership and motivation," and "Monitoring and control."

CONCLUSIONS

Hospitals and managers were less prepared to cope with the Covid-19 crisis challenges due to health system organizations' less attention to biological crises. Healthcare organizations can carefully evaluate these challenges, and the strategies managers adopt to deal with these problems. They also can identify the strategies' strengths and weaknesses and propose more effective strategies. As a result, healthcare organizations will be better prepared for similar crises.

Psychometric Evaluation of Chronic Patients Using the Persian Version of Patient Activation Measure (PAM)

The Patient Activation Measure (PAM) is a 13-item questionnaire that assesses patients' knowledge, skills, and confidence in self-management. The current study aimed to translate the American version of the PAM-13 into Persian and test the psychometric properties of the Persian version among chronic patients. This cross-sectional study was conducted on 438 chronically ill patients in Rafsanjan, Iran from May to November 2019. The American version of the PAM-13 was translated into Persian using a standardized forward-backward translation method. Internal consistency, test-retest reliability, face and content validity, as well as construct validity (structural and convergent validity) were all assessed. The content validity index of the Patient Activation Measure-13 Persian (PAM-13-P) was 0.91. Exploratory and confirmatory factor analyses showed that the PAM-13-P had a meaningful structural validity. The PAM-13-P scores were negatively correlated with the Partner in Health Measure (PIH) (r = -0.29, p < 0.001). In addition, the PAM13-P scores were positively correlated with the Satisfaction with Life Scale (SWLS) (r = 0.31, p < 0.001). The internal consistency was 0.88, and the repeatability was excellent [Intraclass Correlation Coefficient (ICC):0.96 and confidence interval (CI): 0.94-0.98]. This study demonstrates that the PAM-13-P is a reliable and valid measure for assessing activation among chronically ill patients. The PAM-13-P scale assesses the level of self-management of chronic patients and identifies appropriate care strategies to meet their needs.

Nurses' clinical competency and its correlates: before and during the COVID-19 outbreak

BACKGROUND

Clinical competency is the ability to integrate knowledge, skills, attitudes and values into a clinical situation and it is very important in nursing education, clinical settings, nursing management, and crises. This study aimed to investigate nurses' professional competence and its correlates before and during the COVID-19 pandemic.

METHODS

We conducted this cross-sectional study before and during the COVID-19 outbreak and recruited all nurses working in hospitals affiliated to Rafsanjan University of Medical Sciences, southern Iran, so we included 260 and 246 nurses in the study before and during the COVID-19 epidemic, respectively. Competency Inventory for Registered Nurses (CIRN) was used to collect data. After inputting the data into SPSS24, we analysed them using descriptive statistics, chi-square and multivariate logistic tests. A significant level of 0.05 was considered.

RESULTS

The mean clinical competency scores of nurses were 156.97 ± 31.40 and 161.97 ± 31.36 before and during the COVID-19 epidemic, respectively. The total clinical competency score before the COVID-19 epidemic was not significantly different from that during the COVID-19 epidemic. Interpersonal relationships (p = 0.03) and desire for research/critical thinking (p = 0.01) were significantly lower before the COVID-19 outbreak than during the COVID-19 outbreak. Only shift type had an association with clinical competency before the COVID-19 outbreak, while work experience had an association with clinical competency during the COVID-19 epidemic.

CONCLUSION

The clinical competency among nurses was moderate before and during the COVID-19 epidemic. Paying attention to the clinical competence of nurses can improve the care conditions of patients, and nursing managers should improve the clinical competence of nurses in different situations and crises. Therefore, we suggest further studies identifying factors improving the professional competency among nurses.

The relationship between nurses' psychological resilience and job satisfaction during the COVID-19 pandemic: a descriptive-analytical cross-sectional study in Iran

BACKGROUND

Job satisfaction and factors affecting them are among the most important social issues. Resilience has a moderating role in the relationship between stress and diseases, so it can affect a person's job satisfaction because it enables a person to deal with adverse conditions. This study aimed to investigate the relationship between nurses' psychological resilience and job satisfaction during the COVID-19 outbreak.

METHODS

This descriptive-analytical cross-sectional study (2022) used convenience sampling to select 300 nurses. The Connor and Davidson Resilience Scale and Minnesota Satisfaction Questionnaire were used to collect data. The data were then analyzed with SPSS 22 and statistical methods (Independent t-test, Analysis of Variance, Pearson correlation coefficient, and Multiple linear regression).

RESULTS

The study results showed a positive and poor relationship between resilience, some of its dimensions (trust in individual instincts, tolerance of negative affect (p = 0.006), positive acceptance of change and secure relationships (p = 0.01), spiritual influences (p = 0.04)) and job satisfaction (p < 0.001). In other words, nurses' high level of resilience increased their job satisfaction and vice versa.

CONCLUSIONS

Enhancing the resilience of frontline nurses during the COVID-19 pandemic improved their job satisfaction and affected care provided by them. Nurse managers can control nurses' resilience and offer interventions that would strengthen it, especially at crises.

The effect of mindfulness-based stress reduction on rejection sensitivity and resilience in patients with thalassemia: a randomized controlled trial

BACKGROUND

Thalassemia is a genetic and chronic congenital disorder composed of physical problems that severely impair patients' cognitive, psychological and social processes. The rehabilitation of patients is particularly important because they have a high rejection sensitivity and low resilience. The present study aimed to determine the effects of mindfulness-based stress reduction counseling on rejection sensitivity and resilience in patients with thalassemia referring to a dedicated disease center in Kerman, Iran.

MATERIALS AND METHODS

We conducted this randomized controlled trial study on 66 patients with thalassemia referring to the Kerman Thalassemia Center in Kerman, Iran in 2022. Using convenience sampling and the stratified block randomization method, we divided the samples into two intervention (N = 33) and control (N = 33) groups. Patients in the intervention group received eight 60-min online mindfulness-based stress reduction counseling sessions (one session per week) and completed the Rejection Sensitivity Questionnaire, Adult Version (A-RSQ) and the Conner-Davidson Resilience Scale before and after the intervention. We collected data using the SPSS 25 trial and descriptive statistics (frequency, percentage, mean and standard deviation), Chi-Square test, Independent-samples t-test, Fisher's exact test, and Analysis of covariance. A significance level of 0.05 was considered.

RESULTS

We found no significant difference in the mean scores of rejection sensitivity between the intervention (8.75 ± 4.86) and control groups (9.87 ± 5.16) before the intervention. Mean scores for rejection sensitivity were 10.23 ± 4.94 in the control group and 7.11 ± 4.13 in the intervention group after the intervention, the results of analysis of covariance showed that, there was a significant difference between two groups after the intervention (F = 7.52, p = 0.008). The mean resilience score in the control group was 63.69 ± 19.43, while it was 67.72 ± 17.98 in the intervention group before the intervention and there is no significant difference between them, but the mean resilience scores in the control and intervention groups were 58.06 ± 22.81 and 74.18 ± 17.46 after the intervention, respectively. the results of analysis of covariance showed that, there was a significant difference between two groups after the intervention (F = 9.28, p = 0.004).

CONCLUSION

Our results showed that in addition to other physical treatments, mindfulness-based stress reduction counseling was effective in reducing the patient's rejection sensitivity and increasing the resilience of patients with thalassemia.

The relationship between beliefs in substance craving and quality of life among narcotics anonymous: a cross-sectional study in southeastern Iran

BACKGROUND

Addiction is a chronic and relapsing disorder characterized by compulsive drug seeking and lasting changes in the brain. Low quality of life may influence the substance craving, which leads to relapsing. Therefore, the present study aimed to investigate the relationship between beliefs in substance craving and quality of life among narcotics anonymous.

METHODS

This cross-sectional study was performed on 202 narcotics anonymous in Kerman, southeastern Iran. Convenience sampling was used to select anonymous patients in the Narcotics Anonymous (NA) association in Kerman city. Narcotics anonymous completed the demographic questionnaire, the Craving Beliefs Questionnaire (CBQ), and the World Health Organization Quality of Life-BREF (WHOQOL-BREF). Multiple linear regression model was used to determine the predictors of craving beliefs. The data were then analyzed using SPSS 22.

RESULTS

The mean age of the participants was 38.48 ± 11.32 years. The majority of the samples were male (86.1%), married (65.4%), educated (93.6%) and urban (86.1%). The mean scores of craving beliefs and overall Quality of Life (QOL) were 77.58 ± 20.70 and 64.42 ± 23.13, respectively. Forty-two-point 1% had high level of craving beliefs. We found a significant negative and weak correlation between beliefs in substance craving, physical health domain (r = -0.16, p = 0.02), and overall quality of life (r = -0.15, p = 0.03). History of crack use, job, and physical health domain of QOL were predictors of beliefs in substance craving among the NAs.

CONCLUSION

Based on the study results, the participants had a high level of substance craving, and some aspects of the quality of life had an impact on the beliefs of addiction. However, it is necessary to conduct more studies in this field; psychological interventions and programs to increase the quality of life may reduce the substance craving.

The design and psychometric evaluation of the Supportive-Care Needs Scale (ZOKH-SCNS29) in patients living with cancer

BACKGROUND

Understanding the needs of cancer patients and planning to meet these needs is a major concern of the health system.

AIM

The present study aimed to design and conduct a psychometric evaluation of supportive-care needs scale in patients with cancer.

METHODS

This study was conducted in both qualitative and quantitative stages. In the qualitative phase, the questionnaire items were generated by analysing the data from 16 interviews, after which, face, content and construct validity were tested. To construct the validity, the questionnaire was completed by 229 cancer patients. The reliability of the questionnaire was assessed by internal consistency. Data were analysed using SPSS (version 18).

FINDINGS

In this study, 4 factors were extracted from 29 items through exploratory factor analysis: 'Need to be understood by the spouse and family' (10 items), 'Need to manage existential and psychological challenges' (7 items), 'Need to manage lack of knowledge about the disease' (7 items), 'Need organisational-therapeutic support '(5 items). These factors accounted for 50.1%. of the total variance. Internal consistency was 0.88, and also the Cronbach's alpha coefficient was also 0.89 after construct validity for the scale items'. The Cronbach's alpha was 0.91 after the construct validity.

CONCLUSION

The findings of the present study showed that this supportive care needs scale is a valid and reliable scale for identifying the supportive care needs of patients with cancer.

The Effect of Acupressure and Cryotherapy on the Pain of Patients on Hemodialysis During Arteriovenous Fistula Cannulation: A Randomized Crossover Clinical Trial

Various pharmacological and non-pharmacological measures are used to reduce pain of patients on hemodialysis during an arteriovenous fistula (AVF) cannulation. In this randomized, crossover clinical trial, 39 patients randomly received acupressure and cryotherapy. In cryotherapy, an ice cube was used to massage the Hegu point in the hand without the fistula for 10 minutes before AVF cannulation. In acupressure, a moderate pressure with the thumb was applied. The pain score was mild after cryotherapy and acupressure, with no significant difference between the two methods. In addition, acupressure significantly reduced pain compared with routine care, but cryotherapy did not significantly reduce pain compared with routine care. Pain intensity was mild after acupressure and cryotherapy, and neither of these two methods was preferred over the other to reduce the pain during AVF cannulation.

Effect of Massage and Dry Cupping on Hemodynamic Parameters of Cardiac Patients: A Randomized Controlled Trial

Objective

The aim of this study was to compare the effects of massage versus dry cupping in addition to routine care on hemodynamic parameters of cardiac patients in critical care units.

Methods

The present study was a parallel randomized controlled clinical trial that was conducted in the critical care units of Shafa Hospital in Kerman, Iran, from 2019 to 2020. Ninety eligible patients)aged 18-75 years, no cardiac arrest in the past 72 hours, no severe dyspnea, no fever, and no cardiac pacemaker) were divided into massage (n = 30), dry cupping (n = 30), and control (n = 30) groups using the stratified block randomization method. The massage group received routine care and a head and face massage for 3 consecutive nights from the second day of admission. The dry cupping group received routine care and dry cupping between the third cervical vertebra and the fourth thoracic vertebra for 3 consecutive nights. The control group received only routine care, which included daily visits by the attending physician, nursing care, and medication. Each intervention session was performed for 15 minutes. The data collection tools included the sociodemographic and clinical characteristics questionnaire and the hemodynamic parameters form (systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and saturation of peripheral oxygen). The hemodynamic parameters were measured each night before and after the intervention.

Results

The mean systolic blood pressure, heart rate, respiratory rate, and oxygen saturation level showed no significant difference among the 3 groups. The mean diastolic blood pressure of the 3 groups varied significantly over time. The mean diastolic blood pressure of the massage group decreased significantly on the third day of intervention, while it did not change significantly in the 2 groups of dry cupping or control (P < .05).

Conclusion

According to the results of this study, dry cupping had no effect on regulating hemodynamic parameters, while only diastolic blood pressure was reduced significantly after massage on the third day of intervention. Therefore, our study did not show effects of massage and dry cupping on regulating hemodynamic parameters.

Creative Art Therapy for Improving Depression, Anxiety, and Stress in Patients with Stroke: A Quasi-Interventional Study

Introduction

Creative art therapy is a psychotherapeutic approach used to enhance the mental health status of patients.

Objectives

This study aimed to evaluate the effect of creative art therapy on the levels of depression, anxiety, and stress in Jordanian patients following stroke.

Methods

One-group pretest-posttest design was used; it included four sessions of creative art therapy which were conducted as two sessions for two weeks. This study recruited 85 participants who were within three months poststroke diagnosis. The Depression, Anxiety, and Stress Scale was used to assess the levels of psychological reactions pre and post creative art therapy intervention.

Results

The data showed that there was a statistically significant improvement in the levels of depression (t = 37.98; p < .001), anxiety (t = 20.59, p < .001), and stress (t = 35.52, p < .001) post-intervention. There was a statistically significant improvement in the study-related psychological aspects following creative art therapy.

Conclusion

The findings of this study suggest that creative art therapy is a valuable method to complement other types of treatments among patients with stroke, resulting in positive patient mental health outcomes. Creative art therapy could be used as a psychotherapeutic approach to manage mental health complexities among patients with stroke. Health policymakers are invited to use the findings of this study to establish tailored counselor services using this new psychotherapeutic approach.

The relationship between use of complementary and alternative medicine and health literacy in chronically ill outpatient cases: a cross-sectional study in southeastern Iran

Background

Chronically ill outpatient cases use a variety of complementary and alternative medicines due to their diseases and therapeutic complications. Chronic condition, quality of life, and health literacy all affect the use of complementary medicine among chronically ill outpatient cases. Health literacy helps patients make fully informed decisions about the use of complementary and alternative medicine. This study aimed to investigate the relationship between complementary and alternative medicine and health literacy in chronically ill outpatient cases.

Method

This cross-sectional analytical-descriptive study was conducted on 400 chronically ill outpatient cases referred to medical centers affiliated to Kerman University of Medical Sciences. Convenience sampling was used. Research tools included the complementary and alternative medicine questionnaire and the health literacy questionnaire. SPSS25 was used to analyze data.

Results

The mean use of complementary and alternative medicine in a recent year was 16.75 ± 7.89, which was lower than the mid-point of the questionnaire (84). Prayer, medicinal plants, vitamin supplements, music therapy, and art therapy were the mostly used complementary and alternative medicine methods. The most common reasons for using complementary medicine were to reduce physical complications and improve anxiety and stress. The mean satisfaction with the use of complementary and alternative medicine was 34.96 ± 6.69. The mean health literacy score was 67.13 ± 19.90. Decision-making and the use of health information had the highest mean score among the dimensions of health literacy, whereas reading skills received the lowest mean score. We found a significant and direct relationship between the use of complementary and alternative medicine, health literacy, and all its dimensions.

Conclusion

The study results showed that health literacy predicted the use of complementary and alternative medicine. Health education and promotion programs may be useful for improvement of health literacy in the community.

Teacher violence from the perspectives of teachers and students and related factors: A survey in Southern Iran

INTRODUCTION

Teacher violence is defined as the intentional use of power by teachers against students in a variety of ways, including physical, verbal, psychological, and sexual assault. Victims of school violence are more anxious and insecure than other students. An in-depth and comprehensive study on the prevention of violence in schools is urgent and necessary. We conducted this study to determine teacher violence from the perspectives of schoolteachers and students and related factors.

METHODS

We conducted this descriptive-analytical study on 313 teachers and 400 students in Ardestan, southern Iran, in 2019. We selected teachers and students using a census method and stratified random sampling, respectively. The research instrument was the school violence questionnaire.

RESULTS

From the perspective of teachers, the mean score of teacher violence (5.7) was significantly lower than that of students (18.3). Male, young, single teachers with diploma and less work experience had significantly higher violence scores than other teachers (P < 0.001). We witnessed this trend in public boys' schools as well (p < 0.001). The total mean score for teacher violence was not significantly different between male and female students. From the perspective of students, the mean score of teacher violence was significantly different (P < 0.001).

CONCLUSION

Our results suggest that education authorities and school principals should supervise public school teachers with less education, younger students, and boys' schools and provide practical training to improve the communication and emotional skills among these teachers.

The Relationship Between Perception of Good Death With Clinical Competence of End-Of-Life Care in Critical Care Nurses

Providing a good death can be one of the most important goals of end-of-life care. This study aimed to investigate the relationship between the concept of good death with clinical end-of-life care competence among intensive care nurses. The participants were 279 nurses in southeast Iran. The data were collected using the Nurses' Concept of Good Death Questionnaire and the Clinical Competency of End-of-Life Care Questionnaire. There was a positive, moderate, and significant correlation between nurses' concept of good death and their clinical competence in end-of-life care. Nurses who got higher scores on the concept of good death showed higher levels of clinical competence in end-of-life care. It is possible to take steps to improve nurses' concepts and knowledge through specialized educational interventions.

Muslim nurse's spiritual sensitivity as a higher perception and reflection toward spiritual care: a qualitative study in southeast Iran

BACKGROUND

Spiritually sensitive nurses perceive the spiritual attitudes and feelings of others. They play a positive role in providing spiritual care to patients. Spiritually sensitive nurses deal appropriately with suffering, frustration, and spiritual dysfunction. Therefore, the present study aimed to explain Iranian nurses' experiences of spiritual sensitivity.

METHODS

This qualitative descriptive explorative study used conventional content analysis and purposeful sampling to explain the experiences of Iranian nurses (n = 19). This study used in-depth semi-structured interviews with 19 nurses, as well as maximum variation sampling to gather rich information (age, sex, religion, work experience, level of education, marital status, type of hospital and ward) from March 2021 to January 2022. The current study also employed Guba & Lincoln criteria to increase data trustworthiness and Graneheim and Lundman approach to analyze the content.

RESULTS

The research data showed 497 codes, 1 theme, 3 categories, and 6 subcategories. The theme of "Nurse's spiritual sensitivity as a higher perception and reflection toward spiritual care" included three categories of the spiritual and professional character of the nurse, perception of the spiritual needs of patients and their families, and the nurse's reflection on the religious beliefs of patients and their families.

CONCLUSION

Spiritual sensitivity helps a nurse to provide holistic care for patients and their families. Therefore, managers and policymakers should create guidelines to help nurses become more spiritually sensitive as well as to meet spiritual needs of patients. Further quantitative and qualitative research should confirm these results in other social and cultural contexts.

Effectiveness of cognitive-behavioral therapy on perceived stress among patients undergoing percutaneous coronary intervention: A randomized controlled trial

PURPOSE

This study aimed to determine the effectiveness of cognitive-behavioral therapy on perceived stress of patients undergoing percutaneous coronary intervention (PCI).

DESIGN AND METHODS

This was a randomized clinical trial in which the patients under coronary intervention were allocated to two groups, intervention and control by using block randomization. The experiment group received eight sessions of cognitive-behavioral therapy. The patients' perceived stress was measured before, immediately, and 1-month post ntervention.

FINDINGS

The results showed the perceived stress scores changed significantly in the intervention group compared with the control group immediately and 1 month after the intervention. Therefore, the perceived stress level significantly reduced in the patients of the intervention group (p < 0.001).

PRACTICE IMPLICATIONS

Cognitive-behavioral therapy significantly reduced perceived stress in patients undergoing PCI.

Intensive care unit registered nurses' perceived barriers towards ventilated associated pneumonia prevention in southeast Iran: a cross-sectional descriptive - an analytical study

OBJECTIVES

Ventilated associated pneumonia (VAP) is one of the most common nosocomial infection and complication occurring in intensive care units (ICUs) worldwide. This study aimed to assess the ICU registered nurses' perceived barriers towards VAP prevention in southeast Iran.

SETTING

This was a cross-sectional descriptive-an analytical study to examine the registered nurses' perceived barriers towards VAP prevention in southeast Iran.

PARTICIPANTS

The study population consisted of 242 nurses working in ICU and emergency departments.

PRIMARY AND SECONDARY OUTCOME MEASURES

The data was collected using demographic characteristics' questionnaire and a researcher-made ventilator-associated pneumonia barriers prevention questionnaire.

RESULTS

The mean score of nurses' perceived barriers towards VAP prevention was 2.82±0.46. The highest mean score of perceived barriers were related to items of 'lack of staff', 'lack of a team-based approach to care and interventions', and 'lack of support from management'.

CONCLUSIONS

This study indicates most of the barriers are related to organisational factors and lack of teamwork. Further studies are needed to obtain more accurate results.

TRIAL REGISTRATION NUMBER

The study protocol was approved by the Ethics Committee of Kerman University of Medical Sciences (IR.KMU.REC.1395.908).

Postpartum depression and its correlates: a cross-sectional study in southeast Iran

Background

Postpartum depression has a negative impact on both infants and women. This study aimed to determine the correlates of postpartum depression in women in southern Iran.

Methods

This cross-sectional study was performed on 186 mothers who had recently given birth to a baby. Data were collected using the demographic form, Quality of Prenatal Care Questionnaire, Edinburgh Postnatal Depression Scale (EPDS), Depression, Anxiety and Stress Scale—21 items (DASS-21) 3 days after delivery and EPDS and DASS-21 6 months after childbirth.

Results

Postpartum depression (PPD) was 24.2% and 3.2% 3 days and 6 months after delivery, respectively. Anxiety, Prenatal Care Quality and educational level predicted 34.0% of the variance of PPD 3 days after delivery (R² = 34.0%). Anxiety, type of delivery, and stress predicted 24% of the variance of PPD 6 months after delivery (R² = 24.0%).

Conclusions

With an increase in stress and anxiety and a reduction in the quality of prenatal care, the risk of postpartum depression increases. Therefore, attention to the quality of prenatal care and postpartum stress and anxiety should be carefully evaluated to prevent PPD. Psychological support and interventions are recommended to promote the mental health of women before and after childbirth.

Bitter silence allows sexual harassment to continue in workplace: A qualitative study in Iranian nurses

Background

Sexual harassment in the workplace is continuing. However, the rate of sexual harassment disclosure is low, which causes many problems. Non-disclosure of sexual harassment can cause nurses' psychological distress and physical harm, and affect their productivity and quality of care. Therefore, the present study aimed to investigate the reasons why Iranian nurses stayed silent and did not disclose sexual harassment in their workplace.

Method

This qualitative descriptive-explorative study was conducted to investigate the reasons why Iranian nurses (n = 18) stayed silent on sexual harassment. Conventional content analysis and purposeful sampling method were used in this study. Data was collected through in-depth semi-structured interviews. Maximum variance in terms of age, sex, work experience, education level, marital status, and type of hospital and ward was considered in order to obtain rich information. Guba and Lincoln criteria were used to increase the study's trustworthiness, while the Graneheim and Lundman approach was used to analyze the content.

Results

The research data indicated 112 codes, a major category, 4 subcategories, and 9 primary categories. The major category, "The missing link is bitter silence; sexual harassment is still going on," includes four subcategories: fear of social stigmas, organizational and legal barriers, family barriers, and personal barriers.

Conclusions

Nurses cannot break their silence on sexual harassment because they are afraid that disclosure of sexual harassment has negative consequences for their personal and professional lives. Policies and strategies should be developed to encourage nurses to disclose sexual harassment. This issue must be studied socially, culturally, and politically.

Menopause symptoms in women and its relation with using complementary and alternative medicines: A survey in southeast Iran

Background

Postmenopausal women are interested in using complementary and alternative medicine because of their menopausal symptoms and the side effects of chemical medications and hormone therapy. Therefore, this study aimed to investigate the relationship between the use of complementary medicine (CAM) and menopausal symptoms among postmenopausal women.

Methods

This cross-sectional study was conducted among 288 postmenopausal women who were referred to health centers in Kerman, southeastern Iran, from 2020 to 2021. Data were collected using a demographic questionnaire, the CAM questionnaire, and the Menopause Rating Scale (MRS).

Results

The mean score for the menopausal symptoms of the participants was 8.73 ± 6.11. Only 28.8% of the participants had no/little symptoms. About 65.3% of the participants used at least one type of CAM in the previous year. The most commonly used types of CAM were nutritional supplements, prayer, and medicinal herbs. A significant association was found between the use of medicinal herbs, dry cupping, relaxation and meditation, prayer, and menopausal symptoms. Women experiencing menopausal symptoms used more CAM methods than those without menopausal symptoms (Odds ratio = 2.25, 95% confidence interval = 1.33-3.80).

Conclusion

The study results indicated that the severity of menopausal symptoms and scores in somatic-vegetative and urogenital domains were higher in CAM users compared to non-CAM users. But there was no significant difference in the psychological domain between CAM and non-CAM users. Based on the results, it is suggested that more research be done in different communities with different healthcare systems to find out how complementary and alternative medicine affects menopausal symptoms in women.

Strategies to prevent workplace sexual harassment among Iranian nurses: A qualitative study

Background

Sexual harassment in the workplace has many negative consequences for nurses and the delivery of patient care. Appropriate policies and strategies can help to create a safe work environment for nurses. Therefore, the present study aimed to investigate Iranian nurses’ strategies for preventing sexual harassment in the workplace.

Materials and methods

This qualitative descriptive-explorative study used conventional content analysis to investigate how Iranian nurses cope with sexual harassment (n = 22). Participants were selected using a purposeful sampling method. Data was collected through in-depth, semi-structured interviews from September 2020 to April 2021. In order to obtain rich information, maximum variation was considered (age, sex, work experience, level of education, marital status, and type of hospital and ward). The Guba and Lincoln criteria were used to increase the study’s trustworthiness, while the Graneheim and Lundman approach was used to analyze the content.

Results

One hundred and twelve codes, one main category, four categories, and 12 subcategories were extracted. The main category, strategies to prevent sexual harassment among nurses in the workplace, includes four categories: behavioral response, working conditions adjustment, informing, and performance of hospital security guards. The most common strategy used by nurses was behavioral response.

Conclusion

Basic measures are required to prevent sexual misconduct against nurses, which is an obvious part of the professional organizational culture. Managers and policymakers should develop workplace ethics, legal accountability, and safety. They should also develop training programs and prevention strategies to help nurses improve their coping skills. Further quantitative and qualitative research in other healthcare groups is required to confirm the findings of this study.

Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study

Background

The practice of hand washing is an effective way to prevent contamination and disease transmission. Following the COVID-19 pandemic, hand washing has become increasingly important. Therefore, this qualitative study aimed to understand barriers to hand hygiene compliance among healthcare workers during the COVID-19 pandemic.

Materials and methods

Twenty-five healthcare workers from intensive care units were sampled using purposive sampling in a qualitative content analysis study. Data were collected through a semi-structured interview and field notes. Based on the Lundman and Graneheim approach, the data were analyzed. COREQ checklist was used to report the research.

Results

According to the findings, there are three main categories of barriers to hand hygiene practice: barriers related to individuals (including two subcategories of lack of knowledge of healthcare workers and healthcare workers' improper attitude), barriers related to management (including two subcategories of wrong behavioral patterns and unsuitable training and planning), and barriers related to organizations (including four subcategories of heavy workloads, improperly designed wards, a lack of equipment, and lack of quality equipment).

Conclusions

This research indicates that hand washing practice increased during the COVID-19 pandemic. Nevertheless, some barriers persist, resulting in a decline in hand washing compliance among health care workers. This finding can help managers and policymakers remove barriers to hand washing compliance and improve healthcare workers' adherence to hand washing.

Iranian nurses' knowledge and attitude toward complementary and alternative medicines: Is there any relation with quality of nursing care?

Background

Nurses play an important role in advising and guiding patients on effective treatments, and in this situation, it is better to be aware of complementary and alternative medicine (CAM) as well as the effects and side effects of different procedures. In addition, the quality of nursing care is directly related to the nurse's knowledge of the different treatments and preventions of different diseases and conditions. The present study aimed to investigate Iranian nurses' knowledge and attitude toward complementary and alternative medicines (CAMs) as well as their correlation with the quality of patient care.

Materials and methods

This cross-sectional study included 267 clinical nurses from three hospitals in southern Iran. The participants were recruited using convenience sampling methods in 2020-2021. A demographic questionnaire, knowledge and attitude toward CAM questionnaires, and the Quality Patient Care Scale were used to collect data.

Results

The mean score of CAM knowledge was 26.51, which was less than the questionnaire midpoint of 39. The mean score of attitudes toward CAM was 63.84, which was more than the questionnaire midpoint of 57. The mean score of the quality of patient care was 197.80, which was more than the questionnaire midpoint of 130. There was no significant correlation between knowledge about CAM, quality of patient care, and its dimensions. In addition, there was no significant correlation between attitudes toward CAM, quality of patient care, and its dimensions (P > 0.05).

Conclusion

The results of the present study showed that nurses' attitudes toward the use of CAM are positive and can be a sign of their readiness to use and further integrate clinically approved CAM in patient nursing care. Due to the role of nurses in patient care and treatment, there is a need to increase nurses' knowledge of CAM, and its training should be included in the nursing curriculum. More studies are needed to identify nurses' knowledge and attitudes toward CAM and its impact on the quality of nursing care.

The psychometric properties of the Persian version of the moral injury symptoms scale-health care professionals version

Background

Health care professionals face a number of problems during crises, such as the COVID-19. Studies addressed the prevalence of moral injury among healthcare professionals during the COVID-19 outbreak. Lack of a valid standard of moral injury among health care professionals is one of the factors that has made it difficult to identify and treat this complication. This study aimed to evaluate the psychometric properties of the Moral Injury Symptoms Scale-Health Care Professionals (MISS-HP) among health care professionals in Iran.

Methods

This study was conducted to evaluate the validity and reliability of the MISS-HP. The sample included 455 healthcare professionals working in four teaching hospitals in Kerman, who were in direct contact with patients. In this study, face validity, content validity, construct validity (structural and convergent), and internal reliability of the MISS-HP were evaluated. Demographic information questionnaire, the Moral Injury Symptoms Scale-HealthCare Professionals (MISS-HP), General Health Questionnaire (GHQ), and Impact of Event Scale (IES) were administered to study participants.

Results

The MISS-HP was evaluated using translation-back translation technique. The content validity index of the items (I-CVI) and the scale (S-CVI) were 0.9 and 0.99, respectively. Exploratory factor analysis showed a three-factor structure in the MISS-HP that explained 57.49% of the variance. Confirmatory factor analysis indices were acceptable. The cut-off point of the questionnaire was 36.5. There was a positive and moderate correlation between the Persian version of MISS-HP, GHQ (r = 0.34), and IES-R (r = 0.40). The Cronbach’s alpha coefficient of the Persian version of MISS-HP was 0.70.

Conclusion

This study found that the MISS-HP is a concise, comprehensive, valid and reliable scale for assessing moral injury among health care professionals in clinical or research settings. This scale will be helpful for managers and researchers to identify and plan health policies and improve the psychological state of health care professionals.

COVID-19 cases, hospitalizations and deaths after vaccination: a cohort event monitoring study, Islamic Republic of Iran

Objective

To investigate the incidence of coronavirus disease 2019 (COVID-19) cases, hospitalizations and deaths in Iranians vaccinated with either AZD1222 Vaxzevria, CovIran® vaccine, SARS-CoV-2 Vaccine (Vero Cell), Inactivated (lnCoV) or Sputnik V.

Methods

We enrolled individuals 18 years or older receiving their first COVID-19 vaccine dose between April 2021 and January 2022 in seven Iranian cities. Participants completed weekly follow-up surveys for 17 weeks (25 weeks for AZD1222) to report their COVID-19 status and hospitalization. We used Cox regression models to assess risk factors for contracting COVID-19, hospitalization and death.

Findings

Of 89 783 participants enrolled, incidence rates per 1 000 000 person-days were: 528.2 (95% confidence interval, CI: 514.0-542.7) for contracting COVID-19; 55.8 (95% CI: 51.4-60.5) for hospitalization; and 4.1 (95% CI: 3.0-5.5) for death. Compared with SARS-CoV-2 Vaccine (Vero Cell), hazard ratios (HR) for contracting COVID-19 were: 0.70 (95% CI: 0.61-0.80) with AZD1222; 0.73 (95% CI: 0.62-0.86) with Sputnik V; and 0.73 (95% CI: 0.63-0.86) with CovIran®. For hospitalization and death, all vaccines provided similar protection 14 days after the second dose. History of COVID-19 protected against contracting COVID-19 again (HR: 0.76; 95% CI: 0.69-0.84). Diabetes and respiratory, cardiac and renal disease were associated with higher risks of contracting COVID-19 after vaccination.

Conclusion

The rates of contracting COVID-19 after vaccination were relatively high. SARS-CoV-2 Vaccine (Vero Cell) provided lower protection against COVID-19 than other vaccines. People with comorbidities had higher risks of contracting COVID-19 and hospitalization and should be prioritized for preventive interventions.

Quality of life in terminally ill cancer patients: what is the role of using complementary and alternative medicines?

BACKGROUND AND PURPOSE

Cancer is the world's second greatest cause of mortality and a leading cause of death in both developed and developing countries. Patients employ a number of complementary and alternative medicine (CAM) methods to deal with the problems and difficulties of cancer, which can have an impact on their quality of life (QOL). The aim of the present study was to assess the correlation between QOL and the use of different CAM methods in terminally ill cancer patients.

METHODS

This was a cross-sectional study. In southern Iran, 238 individuals with advanced cancer were studied in oncology centers and doctors' offices. During the months of January to August 2021, patients were selected using convenience sampling. A demographic information questionnaire, the EORTC core quality of life questionnaire, and the CAM questionnaire were used to collect data.

RESULTS

The results showed that terminally ill cancer patients had a good quality of life. Last year, 85.7% of participants used at least one kind of CAM. Furthermore, 45.4% of participants used only one form of CAM, 30.3% used two types of CAM, 6.7% used three types of CAM, and 3.4% used four to five types of CAM. When all CAM users were compared to non-CAM users, CAM users had significantly higher social QOL and overall quality of life. Two subscales of QOL symptoms and function were correlated with cancer history, income, and use of CAMs, and the scores of QOL symptoms and function were greater in CAM users compared to non-CAM users. Among all the study variables, only the usage of CAM was correlated to overall QOL among terminally ill cancer patients.

CONCLUSION

The current study found that using CAM could affect different aspects of QOL in terminally ill cancer patients. As a result, it is feasible that using CAM could help these people enhance their health and QOL.

The Relationship Between Nurse’s Professional Quality of Life, Mindfulness, and Hardiness: A Cross-Sectional Study During the COVID-19 Outbreak

Background

In the pandemic of Coronavirus Disease 2019 (COVID-19) disease, various factors, such as workplace factors, and psychological variables, can affect the occupational status of nurses. This study aimed to assess the relationship between nurses’ professional quality of life, mindfulness, and hardiness during the outbreak of COVID-19.

Methods

This cross-sectional study included 239 nurses from two medical centers in Rafsanjan, Iran. Quota sampling was performed from August to November 2020. A demographic form, the Professional Quality of Life Scale (ProQOL), the Freiburg Mindfulness Questionnaire-Short Form (FMI-SF), and the Occupational Hardiness Questionnaire (OHQ) were used to collect data.

Results

The mean age of the participants was 33.20 ± 6.85 years. The majority of the participants were female, married, and employed. Compassion Satisfaction (CS), Secondary Traumatic Stress (STS), and Burnout (BO) were all moderate among nurses. Hardiness was the best predictor of compassion satisfaction. Mindfulness was the best predictor of both secondary traumatic stress and burnout. Psychological hardiness and mindfulness had the greatest impact on nurses’ quality of professional life during the COVID-19 pandemic.

Conclusion

Caring for COVID-19 patients may lead to BO, CF, and STS; identifying predictors of these can inform the development of interventions to mitigate or minimize BO, CF, and STS in nurses caring for these patients. Furthermore, in order to improve nurses’ quality of professional life, psychological hardiness, and mindfulness, necessary psychological programs and interventions should be designed and implemented.

PCycDB: a comprehensive and accurate database for fast analysis of phosphorus cycling genes

BACKGROUND

Phosphorus (P) is one of the most essential macronutrients on the planet, and microorganisms (including bacteria and archaea) play a key role in P cycling in all living things and ecosystems. However, our comprehensive understanding of key P cycling genes (PCGs) and microorganisms (PCMs) as well as their ecological functions remains elusive even with the rapid advancement of metagenome sequencing technologies. One of major challenges is a lack of a comprehensive and accurately annotated P cycling functional gene database.

RESULTS

In this study, we constructed a well-curated P cycling database (PCycDB) covering 139 gene families and 10 P metabolic processes, including several previously ignored PCGs such as pafA encoding phosphate-insensitive phosphatase, ptxABCD (phosphite-related genes), and novel aepXVWPS genes for 2-aminoethylphosphonate transporters. We achieved an annotation accuracy, positive predictive value (PPV), sensitivity, specificity, and negative predictive value (NPV) of 99.8%, 96.1%, 99.9%, 99.8%, and 99.9%, respectively, for simulated gene datasets. Compared to other orthology databases, PCycDB is more accurate, more comprehensive, and faster to profile the PCGs. We used PCycDB to analyze P cycling microbial communities from representative natural and engineered environments and showed that PCycDB could apply to different environments.

CONCLUSIONS

We demonstrate that PCycDB is a powerful tool for advancing our understanding of microbially driven P cycling in the environment with high coverage, high accuracy, and rapid analysis of metagenome sequencing data. The PCycDB is available at https://github.com/ZengJiaxiong/Phosphorus-cycling-database . Video Abstract.

Patients' knowledge and concerns about using the implantable cardioverter defibrillator for the primary prevention of sudden cardiac death and its correlates: A cross‐sectional study

Background and Aims

Methods

Results

Conclusion

Comparison of the Effect of Reflexology and Swedish Massage on Restless Legs Syndrome and Sleep Quality in Patients Undergoing Hemodialysis: a Randomized Clinical Trial

Background

Patients undergoing hemodialysis experience painful complications such as restless leg syndrome and poor sleep quality, which negatively affect their quality of life.

Purpose

This study aimed to compare the effect of reflexology and Swedish massage on restless leg syndrome and sleep quality in patients undergoing hemodialysis.

Method

This is a randomized clinical trial conducted on 90 patients undergoing hemodialysis. The two intervention groups received either foot reflexology (n = 30) or Swedish massage (n = 30) for four weeks. In the sham group (n = 30), a simple touch of the knee down was performed with the same conditions as the intervention groups. Each sample completed the International Restless Leg Syndrome and Pittsburgh Sleep Quality Index Questionnaires before, immediately after, and one month after the intervention.

Result

The results showed that immediately after the intervention, restless leg syndrome and sleep quality were significantly better in the foot reflexology massage group than the Swedish massage and sham groups (P_RLS < 0.001, P_PSQI < 0.001); also, changes in restless leg syndrome and sleep quality, respectively, before and one-month follow-up after the intervention were not significant in all three groups (P_RLS = 0.47, P_PSQI = 0.95), (P_RLS = 0.91, P_PSQI = 0.87).

Conclusion

Reflexology and Swedish massage, as complementary methods, can improve the restless leg syndrome and sleep quality of patients undergoing hemodialysis. However, foot reflexology massage had been more effective.

A randomized controlled clinical trial of the effects of range of motion exercises and massage on muscle strength in critically ill patients

Background

Atrophy and muscle weakness is a common problem in critically ill patients admitted to the intensive care unit (ICU). Muscle weakness in severe cases can lead to tetraplegia, reduced or lost tendon reflexes, delayed weaning from mechanical ventilation, physical disability, and increased mortality. The aim of this study was to compare the effects of range of motion exercises (ROM) and massage on muscle strength of the patients admitted to ICUs.

Methods

This study was a single-blinded randomized controlled trial conducted in ICUs of Afzalipour hospital in Kerman, southeastern Iran. Ninety conscious ICU patients were randomly divided into three groups (massage, ROM exercises and control). The researcher/co-researcher massaged or did ROM exercises on the patients’ extremities once a day for seven consecutive days. Using a hand-held dynamometer, the co-researcher, rated the muscle strength before, on the fourth and seventh days of intervention at 8 p.m.

Results

The mean muscles strength of the right arm in the ROM exercise and massage groups increased by 0.63 kg, and 0.29 kg, respectively after the intervention compared with before the intervention. The muscle strength of the right arm in the control group reduced by 0.55 kg. The mean muscles strength of the left arm in the ROM exercise and massage groups increased by 0.61 kg and 0.28 kg after the intervention, respectively while it reduced by 0.56 kg in the control group. The mean muscles strength of the right leg in the ROM exercise and massage groups increased by 0.53 kg and 0.27 kg after the intervention compared with before the intervention while it reduced by 0.70 kg in the control group. The mean muscles strength of the left leg in the ROM exercise and massage groups increased by 0.54 kg and 0.26 kg after the intervention compared with before the intervention while it reduced by 0.71 kg in the control group.

Conclusion

The results of the present study showed that ROM exercises and massage were effective interventions in increasing muscle strength of the critically ill patients admitted to intensive care units.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13102-022-00489-z.

Fear of Cancer Recurrence and COVID-19 Anxiety among cancer survivors: a cross-sectional study in southeast Iran

Cancer survivors face numerous therapeutic and health challenges during the COVID-19 epidemic. These patients experience high levels of anxiety and stress due to illness, external stresses, and crises, such as the COVID-19 epidemic. The present study showed a positive relationship between FCR and COVID-19 anxiety as well as moderate levels of FCR (according to the midpoint score of the questionnaire) and COVID-19 anxiety among cancer survivors. Factors affecting the mental condition of cancer survivors can play an important role in completing treatment and preventing disease exacerbation.

The effect of cognitive behavior therapy on attitude of infertile individuals toward child adoption

Background

Infertility is one of the most important life-threatening crises that will cause serious psychological problems and serious stressful experiences for couples. Granting the parenting of neglected children can benefit both infertile couples and those children.

Purpose

The study aimed to investigate the effect of Cognitive-Behavioral Counseling (CBT) on the attitude of infertile individuals towards child adoption.

Methods

It is a clinical trial study. Forty samples were determined in each case and control group. Five 90-minute cognitive-behavioral counseling sessions were held for the intervention group. Control group participants were on the waiting list. Data were reported based on frequency distribution, central distribution, dispersion, Wilcoxon, and paired T-test. The level of significance was set at p < 0.05.

Findings

Participants in this study had a mean age of 32.5 years old, the mean years without children was 6.29 years, most of them had higher education. The majority of individuals in the control and intervention groups referred more than once to treat infertility. Based on the current study results, the attitude score of the intervention group before the consultation was 100.74, and it was 112.46 after counseling (p = 0.046). Moreover, the score of attitudes toward adoption after counseling in the control group was 97.10 and 112.46 in the intervention group (p < 0.001).

Conclusions

CBT has been influential on the attitude of infertile people towards adoption.

A Comparison Between the Relaxation/Meditation/Mindfulness Tracker t Inventory and the Freiburg Mindfulness Inventory for Predicting General Health, Anxiety, and Anger in Adult General Population

Introduction

An individual’s level of mindfulness can predict his/her level of general health, anxiety, and anger. If we have a valuable tool for measuring mindfulness, we can predict such factors more concisely. Therefore, the aim of this study was to compare a narrowband and a broadband mindfulness scale in predicting the level of general health, anxiety, and anger in a general population.

Materials and Methods

This was a cross-sectional study on an Iranian general population (all citizens living in Kerman) from September 22, 2020 to April 14, 2021. The convenience sampling method was used. Data were collated via electronic and paper forms of the Relaxation/Meditation/Mindfulness Tracker t-Persian version (RMMt-P), the Freiburg Mindfulness Inventory- Short-Form-Persian version (FMI-P), the General Health Questionnaire, the trait anxiety section of the State–Trait Anxiety Inventory, and the trait anger section of the State–Trait Anger Expression Inventory-2.

Results

The FMI-P predicted 0.05% of GHQ variance while the first and third levels of RMMt-P predicted 0.145%. The FMI-P predicted 0.19% of anxiety variance, while the first and third levels of RMMt-P predicted 0.195%. The FMI-P predicted 0.0% of anger variance, while the first, second, and third levels of RMMt-P predicted 0.08%. RMMt-P Level 1 was a better predictor of general health, anger, and anxiety.

Conclusion

The current study found that the RMMt-P was a better predictor of general health and anger than the FMI-P. These findings suggest that the type of questionnaire used in the study of mindfulness is important, but more research is needed to determine the extent of these relationships.

Lonely, harassed and abandoned in society: the lived experiences of Iranian homeless youth

Introduction

Homelessness is increasing among young adults in large cities. According to the United Nations, there are more than one billion absolute or relative homeless people in the world. This study was conducted to explain the lived experiences of homeless youth in southeastern Iran.

Materials and methods

In this qualitative study, we recruited 13 participants in a big city, southeast Iran, in 2020. The participant was young homeless adults aged 18–29 years who were using homeless shelters provided by the municipality, sleeping in parks or on streets. Data were collected through in-depth and semi-structured interviews and three focus group discussions. Data were analyzed by conventional qualitative content analysis.

Results

The main category of “lonely, annoyed, and abandoned in society” and three subcategories of avoidance of/by society, comprehensive harassment, and lack of comprehensive support were extracted. The experiences of young homeless adults showed that they escaped from the community due to addiction, feeling like a burden to others, and social isolation, and not only have they been left without support in society, but they have also suffered from all kinds of physical and psychological harassments.

Conclusion

The lived experiences of homeless people show that in addition to appropriate facilities and living conditions, they require respect, reduced social stigma, discrimination, and favorable conditions for a return to life. Therefore, authorities should identify and settle their problems and needs.

Factors associated with disordered feeding among high school students in Kerman City, Iran

BACKGROUND

Mental health problems and disordered eating, are more common in adolescents. This study investigated relationship between mental health and disordered eating in high school girls in southeast Iran.

METHODS

This cross-sectional descriptive correlational study accomplished in high school girls of Kerman at the southeast of Iran in 2019. Using three parts demographic, Standard General Health Questionnaire (GHQ-28) and Eating Attitudes questionnaire, (Eat-26) with three subscales: eating habits, desire to eat and oral control. We investigated high school girl's mental health and relationship with disordered eating with cluster sampling method (600 high school girl). Multivariate logistic regression was used to determine the association between significant variables and the risk of General Health (Yes/No) and Eating attitude (Yes/No). Spearman correlation test, Mann-Witheny U test and Kruskal-Wallis test were used, and Significant level was considered at P < 0.05.

RESULTS

A direct and significant relationship between mental health and disordered eating (r = 0/19, P < 0.001). In other words, the higher the mental health disorder score, the higher the disordered eating score, and the higher disordered eating score, the higher mental problems. There was a direct and significant relationship between mental health and all aspects of disordered eating including eating habits (r = 0/12, P < 0.05), desire to eat (r = 0/1, P < 0.05) and oral control (r = 0/14, P < 0.001).

CONCLUSIONS

It seems that the disordered eating and mental health have a determinant role in relationship with each other. Therefore, prevention and health promotion programs should be implemented to improve female adolescent mental health and reduce disordered eating.

Comparison of Death Anxiety, Death Obsession, and Humor in Nurses and Medical Emergency Personnel in COVID-19 Pandemic

Introduction

COVID-19 has created numerous challenges for the health system. Nurses and medical emergency personnel are at the forefront of fighting COVID-19 and exposed to psychological disorders such as death anxiety and death obsession. Humor is a defense and coping mechanism against the anxiety and obsession associated with death. This study aimed to compare death anxiety, death obsession, and humor among nurses and medical emergency personnel during the COVID-19 pandemic.

Methods

This descriptive cross-sectional study was conducted with 230 nurses and medical emergency personnel. To collect data, the Templer death anxiety scale, death obsession scale, and humor styles questionnaire were used. SPSS 19 was used for data analysis. The significance level was considered at P < .05.

Results

Mean and standard deviation of death anxiety in the nurses and medical emergency personnel were 6.86 (4.04) and 5.68 (3.57), respectively; these values for death obsession were 29.82 (12.30) and 25.30 (12.66) and for humor 116.75 (30.87) and 118.48 (24.66), respectively. The nurses had significantly higher death anxiety (t = 2.33, P = .02) and death obsession (t = −2.68, P = .008) than the medical emergency personnel; moreover, there was no significant relationship among humor, death anxiety (r = .11, P = .10), and death obsession (r = .07, P = .31) in nurses and emergency personnel.

Discussion

The results of this study showed that the levels of death anxiety and death obsession were higher in the nurses than the medical emergency personnel. There was no significant difference between the hospital nurses and medical emergency personnel in terms of humor.

Compassion Satisfaction, Compassion Fatigue and Hardiness Among Nurses: A Comparison Before and During the COVID-19 Outbreak

BACKGROUND

Nurses provide the majority of health-care services and face numerous health challenges during an epidemic. During the COVID-19 epidemic, nurses are subjected to physical, mental, and social disorders that impair their quality of life and hardiness. Therefore, it is important to be aware of the situation of nurses. The current study aimed to compare the compassion satisfaction, compassion fatigue and hardiness among nurses before and during the COVID-19 outbreak.

MATERIALS AND METHODS

This cross-sectional study included 508 clinical nurses from one public hospital in southern Iran. The subjects were recruited using census sampling methods in 2019-2020. Sampling was performed before (n = 266) and during the COVID-19 (n = 242) with a 1-year interval. Although, the study setting was the same before and during the COVID-19, questionnaires were completed by different nurses before and during the COVID-19. Demographic questionnaire, professional quality of life (ProQOL) questionnaire and Occupational Hardiness Questionnaire were used to collect data.

RESULTS

The scores of compassion satisfaction, compassion fatigue and hardiness did not differ significantly during the COVID-19 compared with before the COVID-19 (p > 0.05). Before COVID-19, hardiness and work experience predicted 11% of the variance of compassion satisfaction, whereas during COVID-19, hardiness and gender predicted 26% of the variance of compassion satisfaction. Before COVID-19, hardiness and work experience predicted 3% of the variance of compassion fatigue, whereas during COVID-19, hardiness, type of employment and gender predicted 6% of the variance of compassion fatigue.

CONCLUSION

The current study found that compassion satisfaction, compassion fatigue and hardiness did not change during the COVID-19 outbreak compared with before the COVID-19 outbreak. However, during the COVID-19, the hardiness was a significant predictor of compassion satisfaction and compassion fatigue. The study results showed that it was possible to increase the compassion satisfaction and reduce the compassion fatigue by strengthening the hardiness of nurses. However, these results need to be considered in future studies, especially in crises such as COVID-19 disease.

The relationship between sleep quality and physical activity among patients with heart failure: a cross-sectional study

BACKGROUND

Sleep disorders are one of the most common and annoying problems among patients with heart failure, which decrease their quality of life. Participation in physical activity is one of the most effective methods to reduce sleep disorders; however, few patients participate. This study was conducted to examine the relationship between physical activities and sleep quality among heart failure patients.

METHODS

A convenience sample of 100 patients with heart failure referred to rehabilitation centers in southeastern Iran was used in this descriptive cross-sectional study. The Pittsburgh Sleep Quality Index and the Rapid Assessment of Physical Activity (RAPA) were used to collect data. The Spearman correlation coefficient and regression were used to analyze the data. The significance level was < 0.05.

RESULTS

The results revealed that the mean score of sleep quality was 8.74 ± 2.83, with the majority of them (84.47%) having poor sleep quality. The mean score of physical activity was 2.59 ± 1.33, and the majority of them (95.15%) had sub-optimal physical activity. There was a significant and inverse relationship between the total scores of sleep quality and physical activity, and patients' sleep quality improved while physical activity increased. Physical activity, sex, history of heart surgery, and the stage of illness were found to account for 31% of the variances in patients' sleep quality.

CONCLUSION

The results of this study showed better sleep quality among patients who were more physically active. Given that the majority of patients with heart failure suffer from sleep disorders, patients' knowledge of physical activity should be increased to improve their quality of sleep and quality of life.

Iranian Nurses' Experiences with Sexual Harassment in Workplace: a Qualitative Study

Background

Sexual harassment has become a worldwide issue in recent years. Nursing, like other professions, is vulnerable to this type of harm. Sexual harassment impairs nurses' ability to provide comprehensive care, resulting in psychological discomfort, diminished work commitment, absenteeism, and job termination. The current study was carried out to investigate Iranian nurses' experiences with sexual harassment in the workplace.

Materials and Methods

This qualitative study used conventional content analysis with a descriptive exploratory approach to investigate the experiences of Iranian nurses. Between September 2020 and April 2021, we conducted semi-structured and in-depth interviews with 22 employed nurses, recruited via a purposeful method. Age, sex, work experience, degree of education, marital status, and hospital and ward type were observed to acquire rich information.

Results

The study's data produced 354 codes, 1 main category, 5 s categories, and 23 sub categories. The main category of nurses' sexual harassment in the workplace is divided into five categories: verbal, physical, visual, seduction, and cybersexual harassment. The most and least common types of harassment were verbal and cybersexual harassment, respectively. Nurse harassment was perpetrated by patients and their families, physicians, colleagues, and other hospital personnel.

Conclusion

According to the findings of this study, the majority of nurses have been subjected to sexual harassment in the workplace in various forms. Given the negative consequences of workplace harassment, managers and policymakers should develop guidelines in the areas of workplace ethics, legal accountability, and workplace safety. There is also a need to develop training programs for nurses to improve their coping skills. More quantitative and qualitative research in other healthcare groups is needed to confirm the findings of this study.

The Psychometric Properties of the Relaxation/Meditation/Mindfulness (RMM) Tracker t Inventory in an Iranian Population

Background

A growing body of research has examined the psychometric properties of popular mindfulness inventories for different population. The present study is aimed at exploring the psychometric properties and factor structure of the Relaxation/Meditation/Mindfulness (RMM) Tracker t Inventory in Iran.

Method

This was a cross-sectional and methodological study that conducted in Kerman, southeast Iran. Fifty, 300, and 163 Iranian adult participants were participated in the pilot, exploratory, and confirmatory phase, respectively. Face, content, and structural validities, Cronbach's alpha, and Omega coefficient were used to validate the Persian scale.

Results

The results showed that the “Persian version of RMM t” had acceptable content and face validities. The Principal Axis Factoring (PAF) with Promax Rotation showed that the P-RMM t has 3 scales of “Mindful Love, Thankfulness, and Transcendence,” “Relaxation,” and “Mindful Deepening” which further confirmed with confirmatory factor analysis. The internal consistency of all three scales was acceptable (Cronbach's alpha coefficients > 80).

Conclusion

The Persian version of RMM Tracker t seems to be a valid and reliable questionnaire to assess the levels of mindfulness in the Iranian general population.

Depression and Self-Efficacy Among Iranian Children During the Prevalence of COVID-19 Disease

The coronavirus disease 2019 (COVID-19) outbreak has quickly endangered the physical and mental health of people in the community, particularly vulnerable people such as children. This study was carried out to investigate the depression and self-efficacy of Iranian children during the COVID-19 outbreak. This cross-sectional research was conducted on 321 students aged 8 to 17 in southeast Iran. A social media-based online questionnaire was used to collect data. The information was gathered using demographic and COVID-related items, the Children's Depression Inventory (CDI), and the Self-Efficacy Questionnaire for Children (SEQ-C). No significant correlation was observed between depression and self-efficacy of children (P = 0.23). However, in subscale of CDI, negative mood, ineffectiveness and negative self-esteem had a significant correlation with self-efficacy (<0.001). Depression had a significant correlation with family income (p = 0.017), being at risk of coronavirus infection (p = 0.036), effectiveness of preventive measures (p = 0.015) and how information about the coronavirus disease was obtained (p = 0.018). According to the results, the mean score of depression was higher than the midpoint of the questionnaire in Iranian children, therefore, it is needed to take the necessary measures and treatment plans to reduce the rate of depression in children. Further research is needed to assess and prevent childhood depression.

Fear and anxiety in girls aged 7 to 11 years old and related factors during the coronavirus pandemic

Children are one of the most vulnerable groups in crises. The psychological consequences of COVID-19 in children must be considered. This study aimed to assess the fear and anxiety of COVID-19 in primary school girls. It is a descriptive correlational study to investigate schoolgirls' fear and anxiety of covid-19 in southeastern Iran. Data were collected using the fear of coronavirus questionnaire and the Corona Disease Anxiety Scale. The mean score of fear and anxiety of corona disease was 11.49 ± 6.59 and 17.67 ± 10.87, respectively. The bivariate analysis showed a significant association between fear and anxiety of corona disease, a single child (p = .025 and p = .006), and a mother's level of education (p = .01). In other words, girls who were single child had a significantly higher level of fear and anxiety than other girls and the girls whose mothers had diploma had a higher level of fear and anxiety than girls whose mothers had Ph.D. Since fear and anxiety can be affected by factors such as culture, education level, and birth rate, it is recommended that this study be performed in other communities as well.

Psychosomatic Symptoms in Terminally Ill Cancer Patients and Its Relation With Using Complementary and Alternative Medicines: A Cross-Sectional Study in Southeast Iran

BACKGROUND

Cancer patients face various problems and complications, which they address through various complementary and alternative medicines (CAM). The aim of this study was to investigate the relationship between CAM and psychosomatic symptoms in terminally ill cancer patients.

METHODS

This cross-sectional study was performed on 221 terminally ill cancer patients (based on metastatic stage and according to the physicin diagnosis) in southeastern Iran. Convenience sampling was used to select terminally ill cancer patients. Using questionnaires like the demographic and clinical information questionnaire, Edmonton Symptom Assessment Scale (ESAS), Hospital Anxiety and Depression Scale (HADS), CAM questionnaire and satisfaction with the use of CAM, the researcher was able to compile a comprehensive picture of the population.

RESULTS

The mean age of the participants was 51.66 ± 13.34 years. The majority of the samples were female, married, educated, and unemployed. The mean score for the physical symptoms of the participants according to ESAS was 22.25 ± 17.57 which was less than the midpoint of the scale (the possible score of ESAS was 0-100). Only 2.7% (n = 6) and 0.9% (n = 2) of the participants had mild and moderate anxiety, respectively, and the other participants' anxiety levels were normal. Only 7.7% (n = 17) and 4.1% (n = 9) of the participants had mild and moderate depression, respectively, and the other participants' depression levels were normal. Last year, 87.3% of the participants used at least one type of CAM. Aside from prayer, 42.1% of the participants used at least one type of CAM in the last year. Prayer was used by 83.7% of the participants, medicinal plants by 35.8%, massage by 9.5%, dietary supplements by 3.6%, wet cupping by 3.2%, relaxation and meditation by 2.7%, dry cupping by 2.4%, and acupuncture by 0.5%. The common reason for using CAM was to reduce the stress and anxiety caused by cancer and to treat it. There were no significant differences in physical and psychological symptoms between the CAM-users and non-CAM users.

CONCLUSION

Patients with cancer have a relatively low level of psychosomatic symptoms, and the primary reason for using CAM was to relieve stress and anxiety associated with cancer and treat it. However, psychosomatic symptoms were the same for CAM and non-CAM users. Because so many people with cancer use CAM, future studies should look into why and how CAM is used.