Background: Environmental lighting can potentially affect weight gain and the length of stay in Neonatal Intensive Care Unit (NICU) among premature neonates. Yet, there are controversies about the best way of lighting in these units. Objectives: The aim of this study was to compare the effects of cycled lighting (CL) and constant lighting on weight gain and the length of stay in NICU among premature neonates. Methods: This two-group randomized controlled trial was conducted on 78 premature neonates hospitalized in NICU of Mofid Children's Hospital, Tehran, Iran. Neonates in the intervention group were treated, for 15 days, with CL. Neonates in the control group were exposed to constant lighting of the unit. Neonates in both groups were weighed every morning at 07:30 and their length of stay in the unit was recorded in days. Data analysis was done through Chi-square test, independent-samples t-test, and Mann–Whitney U-test and the two-way analysis of variance. The random-effects spline model was employed to compare the groups in terms of the trend of weight variations over time. Results: Neonates' weight in both groups decreased during the first 7 days of hospitalization and then started to increase from the 8^th day. The groups did not significantly differ from each other respecting neonates' weight in the first 8^th days (P = 0.857), while weight mean in days 9–15 in the intervention group was significantly greater than the control group by at least 25.25 g in the 9^th day and 159.95 g in the 15^th day (P < 0.001). Statistically significant differences were observed between the two groups in terms of daily weight gain (14.63 ± 5.64, 29.17 ± 7.32) with gender being unadjusted (P = 0.005) and adjusted (P = 0.001). However, no significant between-group differences were observed in terms of the length of stay (18.18 ± 10.21, 18.29 ± 12 days) in NICU with gender being unadjusted (P = 0.939) and adjusted (P = 0.990). Conclusions: CL is effective in improving premature neonates' weight gain but ineffective in shortening their stay in NICU.

Background: In each hemodialysis session, hemodialysis patients undergo two vascular punctures with large-diameter needles, which are associated with great pain. The reduction of puncture pain helps these patients accept hemodialysis and enhances their quality of life. Objective: The present study was conducted to assess the effects of Arnigol cream on the pain associated with arteriovenous fistula puncture. Methods: As a double-blind single-group randomized clinical trial, the present study was made on 71 hemodialysis patients. Each patient received an arterial and a venous fistula puncture. One puncture site was randomly allocated to the experiment and the other one to the placebo. Before needle insertion, the experiment and the placebo sites were treated for 10 min with 5 ml of Arnigol cream or Vitamin A and D ointment, respectively. After needle insertion, pain intensity at puncture sites was assessed using a visual analog scale. The data were analyzed using the paired-sample t-test. Results: Participants were 71 hemodialysis patients, 49.3% were female. The mean of participants' age was 56.86 ± 15.10 years, with a range of 22–82. The length of receiving hemodialysis ranged from 4 to 96 months with a mean of 40.36 ± 22.79. Diabetes mellitus was the major cause of renal failure among participants (56.3%). The intensity of pain at the experiment site was significantly lower than the placebo site (2.83 ± 1.60 vs. 3.46 ± 1.57; P = 0.006). Conclusions: This study showed the effectiveness of Arnigol cream in reducing the pain associated with arteriovenous fistula puncture among patients receiving hemodialysis. Thus, nurses are recommended to use this simple, safe, and inexpensive modality to reduce fistula puncture pain.

Background: Coronary artery bypass graft (CABG) surgery is associated with different postoperative problems such as lengthy rehabilitation period and decreased quality of life (QOL). Objective: This study aimed to investigate the effects of discharge training and postdischarge counseling on QOL after CABG. Methods: This quasi-experimental study was carried out on a convenience sample of 100 patients who underwent CABG surgery in Seyedoshohad Heart Hospital, Urmia, Iran. Using a nonrandom assignment technique, patients were allocated to a control and an intervention group. Patients in the intervention group were provided with an educational booklet as well as discharge training and postdischarge counseling. Training and counseling services continued up to 6 weeks after hospital discharge. Patients in the control group only received routine discharge and postoperative services. The 36-item Short Form Survey was used to measure QOL both in the admission day and 6 weeks after hospital discharge. A home follow-up form was also completed for all patients 2 and 10 days and 6 weeks after hospital discharge. The data were analyzed via the paired-sample t, independent-sample t, Chi-square, Fisher's exact, Mann–Whitney U and Wilcoxon signed ranks tests. Results: The baseline mean scores of QOL in the control and the intervention groups were respectively 46.89 ± 11.91 and 46.53 ± 15.04, with no between-group difference (P = 0.90). Six weeks after hospital discharge, the mean score of QOL in the intervention group was significantly greater than the control group (93.19 ± 4.45 vs. 47.00 ± 13.43; P < 0.001). Conclusions: Discharge training and postdischarge counseling are effective in improving postoperative QOL among patients who undergo CABG surgery.

Background: Water immersion during labor is increasingly being used in different medical facilities worldwide. Objective: This study aimed to determine the effects of water immersion during the first stage of labor on labor outcomes. Methods: This randomized controlled clinical trial was carried out from January to October 2015, in the labor and delivery ward of Khaleej-e Fars Hospital, Bandar Abbas, Iran. In total, 180 women were randomly allocated to a control group to receive routine care services and to an experimental group to receive water immersion during labor along with routine care services. The midwifery staff of the study setting regularly assessed uterine contractions, performed vaginal examinations, and monitored fetal heart rate. The length of the active phase of labor was measured in minutes as primary outcome. The independent-sample t and Chi-square tests were performed for data analysis. Results: The length of the active phase of labor in the experimental group was significantly greater than the control group (232.95 ± 20.76 vs. 165.81 ± 22.76 min; P < 0.001). Moreover, satisfaction with birth experience was significantly higher among women in the experimental group. However, no statistically significant between-group differences were observed in terms of the length of the second stage of labor, mode of delivery, the rate of hospitalization in neonatal intensive care unit, and 1- and 5-min Apgar scores (P > 0.05). Conclusions: Water immersion during labor significantly prolongs the first stage of labor and significantly improves parturient women's satisfaction with the birth experience.

Background: Caring for brain-dead patients is one of the hardest duties for nurses, particularly in Intensive Care Units (ICUs). Objective: This study aimed to explore the nursing challenges of caring for patients diagnosed with brain death. Methods: The present study was conducted as a qualitative conventional content analysis, and data collection was carried out by field notes and 15 semi-structured and in-depth interviews with nurses working in the ICUs. Data analysis co-occurred simultaneously with data collection. Results: Seven themes were extracted from the data: uncertainties and conflicts between physicians and nurses, tensions in breaking the news of patient's brain death to families, stressful experience of caring for the first time, nurses' physical and psychological afflictions due to complex care tensions, stress of being blamed by patients' family, difficulty in tackling the emotions of patients' family, and finally, a sense of lack of support and protection in care. Finally, the main theme of turbulent confrontation with successive chains of tension in caring brain-dead patients was abstracted. Conclusions: Since nurses confront chain of tensions while caring for a brain-dead patient, this can affect the quality of this vital role to keep the transplantable organs viable; furthermore, authorities should implement special support programs for nurses.

Background: Low fertility rate is currently a serious health problem both in developed and developing countries. Objective: The objective of this study was to assess the women's reproductive practices based on their marriage duration. Methods: This cross-sectional study was completed in urban and in rural healthcare centers in Babol, Iran. A sample of 880 married women aged 15–49 was recruited through the cluster sampling. Data on participants' reproductive practices were collected and analyzed through the one-way analysis of variance and the Chi-squared tests. Results: Women with different marriage durations significantly differed from each other respecting their age at the first pregnancy, the time interval between their marriage and their first pregnancy, the number of their children, the interval between their first and second pregnancies, their contraceptive use before the first pregnancy, a history of abortion, and a history of unwanted pregnancy (P < 0.01). The most commonly used contraceptive method was the withdrawal method. Conclusions: While the rate of fertility and the duration of reproductive life have decreased among women, the rates of unwanted pregnancy, induced abortion, and unreliable contraceptive method use are still high among them. Health-care providers, particularly midwives, are recommended to provide women with educations about the best contraceptive methods, the best marriage-pregnancy interval, and ideal spacing between pregnancies to reduce the rates of unwanted pregnancy and induced abortion.

Background: Breast density is routinely reported on mammograms, while breast nodularity is seldom reported on clinical examination, and there is no standard system for its classification. Objectives: The aim of this study was to evaluate the agreement of mammographic density with nodularity on clinical breast examination (CBE). In addition, the relationship of mammographic density with age, menopausal status, and number of parities were assessed. Methods: This cross-sectional study was conducted from September 2013 to February 2014, on 30–70-year-old women who referred for screening or diagnostic mammography to Shahid Beheshti Hospital, Kashan, Iran. Nodule size, nodule consistency, and mammographic density were assessed, and Cohen's kappa coefficient was calculated. The Chi-square test was also used to assess the relationship of mammographic density with age, menopausal status, and a number of parities. Results: In this study, 320 women with an age mean value of 46.01 ± 7.73 underwent mammography and CBE. Mammographic density showed a statistically significant weak agreement with nodule size (Kappa coefficient = 0.275; P < 0.001) and nodule consistency (Kappa coefficient = 0.256; P < 0.001). Moreover, mammographic density was inversely related to age, menopausal status, and number of parities (P < 0.001). Conclusions: Breast nodularity on clinical examination has only a weak agreement with mammographic density. Further studies are needed to develop more comprehensive instruments for assessing not only nodule size and consistency but also nodules distribution in all breast quadrants.

Background: Job security is a critical factor behind quality care delivery. However, it is still unclear whether job security is related to turnover intention among Iranian nurses. Objectives: This study aimed to determine job security and turnover intention and also factors behind turnover intention among hospital nurses who worked in Tehran, Iran. Methods: This cross-sectional study was conducted from April to November 2015 in three public and three private tertiary hospitals in Tehran, Iran. A quota sample of hospital nurses was recruited and a researcher-made questionnaire was used for data collection. The data were analyzed through the Chi-square and the independent-sample t-tests, the one-way analysis of variance, Pearson correlation analysis, and multivariate logistic regression analysis. Results: The mean score of job security was 3.10 ± 0.38 (from a possible range of 1–5). Around 22.6% of nurses reported low job security. Job security among nurses in private hospitals was significantly greater than those in public hospitals (P = 0.001). Moreover, 32.7% of nurses reported that they will leave their profession if they find another job opportunity. Factors behind nurses' turnover intention were work experience (odds ratio [OR] = 1.30; confidence interval [CI]: 1.117–2.742), organizational justice (OR = 0.516; CI: 0.522–0.785), job prospect and stability (OR = 0.533; CI: 0.299–0.948), relationships with managers and colleagues (OR = 0.401; CI: 0.409–0.927), and work environment (OR = 0.414; CI: 0.227–0.856). Conclusions: Hospital managers need to develop and adopt effective policies to promote nurses' job security and reduce their turnover intention through improving their job satisfaction and working conditions, providing fair compensations, enhancing supportive nursing management, promoting job prospect and stability, and facilitating competence-based career advancement.

There are many nursing theories about nurse–patient relationship, one of the most important of which is Imogene King's Theory of Goal Attainment. However, it is unknown why this theory is not used in everyday nursing practice. The aim of this study was to assess the use of King's theory in nurse–patient relationship.