Background: Hemorrhage is a leading cause of maternal death in the perinatal period. New teaching methods have been recommended for promoting midwives’ competence in maternal care delivery. Objectives: This study was conducted to determine the effects of a competency-based education (CBE) program on midwifery students’ knowledge, skills, and self-confidence for postpartum hemorrhage (PPH) management. Methods: This experimental study was conducted in 2018 on 86 third-, fourth-, and fifth-semester midwifery students recruited from the Faculty of Nursing and Midwifery of Iran University of Medical Sciences, Tehran, Iran. They were randomly allocated to either a control (n = 43) or an intervention group (n = 43). Participants in the control group received routine formal midwifery education, while their counterparts in the intervention group received CBE in addition to routine formal midwifery education. Participants’ knowledge, skills, and self-confidence for PPH management were assessed at three time points, namely before, immediately after, and six weeks after the study intervention. Data were analyzed through performing the Chi-square and the independent-samples t-tests and the repeated measures analysis of variance. Results: There were no significant differences between the intervention and the control groups regarding the pretest mean scores of knowledge (4.87 ± 1.58 vs. 5.05 ± 2.07), skills (80.12 ± 5.72 vs. 82.30 ± 6.89), and self-confidence (7.05 ± 1.19 vs. 6.62 ± 1.47) (P > 0.05). In the intervention group, the mean scores of knowledge, skills, and self-confidence were significantly greater than the control group both at the first posttest (10.17 ± 1.31 vs. 5.20 ± 1.55, 301.15 ± 19.30 vs. 80.50 ± 5.12, and 9.47 ± 1.19 vs. 6.80 ± 0.91, respectively) and the second posttest (9.37 ± 2.21 vs. 5.32 ± 1.50, 299.67 ± 17.58 vs. 81.07 ± 5.69, and 9.72 ± 1.28 vs. 6.52 ± 1.44, respectively) (P < 0.05). Conclusion: CBE is effective in significantly improving midwifery students’ knowledge, skills, and self-confidence for PPH management, and hence, it is recommended for promoting their competence.

Background: In most ophthalmic surgeries, patients are conscious or semi-conscious, and hence, they may experience varying levels of anxiety during surgery. Objectives: The aim of this study was to evaluate the effects of an interdisciplinary supportive educational program on anxiety among patients undergoing cataract surgery (CS). Methods: This quasi-experimental study was carried out in February–August 2019 using a two-group pretest–posttest design. Participants were 64 patients with cataract who were referred to Feiz Hospital, Isfahan, Iran, for undergoing CS. They were consecutively recruited and randomly assigned to either a control or an intervention group. Data were collected using a demographic questionnaire and Spielberger State-Trait Anxiety Inventory. Participants in the intervention group received an interdisciplinary supportive educational intervention, while their counterparts in the control group received routine care services. State anxiety and trait anxiety were assessed both on the sampling day and after regaining full postoperative consciousness. Data analysis was done via the independent and the paired samples t-, the Mann–Whitney U-, and the Chi-square tests. Results: There were no statistically significant differences between the intervention and the control groups respecting the pretest mean scores of state anxiety (35.25 ± 8.51 vs. 35.72 ± 9.43; P = 0.83) and trait anxiety (38.25 ± 7.002 vs. 39.16 ± 8.58; P = 0.64). However, there were statistically significant differences between the groups regarding the posttest mean scores of state anxiety (28.66 ± 10.39 vs. 34.84 ± 9.36; P = 0.02) and trait anxiety (31.76 ± 8.51 vs. 38.13 ± 10.29; P = 0.01). Conclusion: As a simple and inexpensive intervention, an interdisciplinary supportive and educational program through both face-to-face communication and telecommunication methods is effective in significantly reducing anxiety among patients undergoing CS.

Background: Nurses should be empowered for ethical care delivery (ECD) to patients with decreased level of consciousness (LOC) in the intensive care unit (ICU). However, there are limited data about the effects of ethical empowerment programs on nurses’ ECD ability. Objectives: The aim of this study was to evaluate the effects of an ethical empowerment program on nurses’ ability of ECD to patients with decreased LOC in ICU. Methods: This quazi‐experimental study was conducted in 2019 in Al‐Zahra University Hospital, Isfahan, Iran. Seventy‐two nurses were randomly recruited from the ICUs and randomly allocated to an intervention and a control group. Participants in the intervention group were provided with an ethical empowerment program. A researcher‐made questionnaire was used to measure participants’ ability of ECD to patients with decreased LOC at three time points, namely before, immediately after, and 1 month after the workshop. Data were analyzed through the Chi‐square test, the independent‐samples t‐test, and the repeated‐measures analysis of variance. Results: The difference between the intervention and the control groups respecting the pretest mean score of ECD ability was not statistically significant (124 ± 5.88 vs. 126.17 ± 9.07; P = 0.10). However, the mean score of ECD ability in the intervention group was significantly greater than the control group both immediately after the workshop (142.58 ± 7.22 vs. 127.14 ± 8.13; P < 0.001) and 1 month after the workshop (147.57 ± 5.45 vs. 128.51 ± 9.52; P < 0.001). Conclusion: Ethical empowerment is effective in significantly improving nurses’ ability of ECD to patients with decreased LOC in ICU. This program is recommended for improving nurses’ ECD ability.

Background: Hand hygiene is the first step in nosocomial infection control. However, most people have limited knowledge about proper hand hygiene. Objectives: This study aimed at comparing the effects of face-to-face education (FTFE) and video-based education (VBE) on hand hygiene knowledge and performance among mothers in neonatal intensive care unit (NICU). Methods: Using a three-group design, this randomized controlled trial was conducted in March–December 2019 in Al-Zahra University Hospital, Tabriz, Iran. In total, 132 mothers of neonates in NICU were recruited to the study through convenient sampling and were randomly allocated to either an FTFE group, a VBE group, or a control group. Data were collected before and 3 days after the intervention using a Maternal Hand Hygiene Knowledge Questionnaire and a Maternal Hand Hygiene Performance checklist. Data analysis was performed using the Chi-square test, paired-samples t-test, one-way analysis of variance, and analysis of covariance. Results: The mean scores of hand hygiene knowledge and performance significantly increased in both the intervention groups (P < 0.05) but did not significantly change in the control group (P > 0.05). There were no significant differences among the groups regarding the pretest mean scores of hand hygiene knowledge (P = 0.24) and performance (P = 0.26), while the posttest mean scores of hand hygiene knowledge and performance in both the intervention groups were significantly greater than the control group (P < 0.05). Conclusion: Both FTFE and VBE are effective in significantly improving hand hygiene knowledge and performance among the mothers of neonates in NICU.

Background: Overweight and obese pregnant women are more than twice at the risk of developing gestational diabetes mellitus in comparison to nonobese women. Objective: The objective of the study was to examine the effect of daily walking program on glucose level among overweight pregnant women. Methods: A quasi-experimental study was conducted in 2019 at Kasr El Aini, Cairo University Maternity Hospitals, at the antenatal outpatient clinic. A purposive sample of 100 primigravida, singleton, overweight, had an uncomplicated pregnancy, at 14 weeks of gestation were recruited in the study. A structured interview scheduled questionnaire, an anthropometric measurement scale, the pregnancy physical activity questionnaire, and a pedometer/step counter were used for data collection. The walking program was an 8-week program with six interviews and emphasized practice walking. The walking program started after the third interview and continued for 8 weeks. All women in the study group were instructed to practice daily walking for 8 weeks. They instructed to walk 30 min (brisk steps) on daily base, started by 15 min and gradually increase the timing of walking up to 30 min for at least 5 days weekly. The hypothesis was tested through student’s t-test and Chi-square test. Results: The intervention group had lower fasting plasma glucose mg/dl levels with mean of 110.80 ± 5.86 versus 114.80 ± 8.07 in the control group and HbA1c with mean of 6.38 ± 0.62 versus 6.60 ± 0.52 in the control group (P ≤ 0.05). Conclusion: Prediabetic, overweight pregnant women who have completed an average of 6,000 steps walking or more per day early in the second trimester may have lower levels of insulin resistance and lower frequency of exposure to gestational diabetes.

Background: The emergency department (ED) is a multidisciplinary department and seriously needs interprofessional collaboration (IPC). Objectives: The purpose of this study was to examine the emergency nurses’ attitudes toward IPC and teamwork and their affecting factors. Methods: A cross-sectional study was conducted on 138 emergency nurses working in teaching hospitals affiliated to Tabriz University of Medical Sciences, Tabriz, Iran, from January to April 2019. Data were collected using a three-part questionnaire including a demographic data sheet, the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration, and the Testing Team Attitude Questionnaire. The data were analyzed using descriptive statistics, Pearson’s correlation coefficient, analysis of variance, and multivariate regression analysis. Results: The majority of the study participants were female (68.1%), in the age range of 30–40 years old (44.2%), and had a working experience of 1–5 years in the ED (63.8%). The mean scores of nurses’ attitudes toward IPC and teamwork were 48.68 ± 5.14 and 96.15 ± 8.97, respectively. A direct and strong correlation was found between nurses’ attitudes toward IPC and teamwork (r = 0.594, P = 0.001). Regression analysis showed that, among all variables, only the participants’ employment status (compulsory governmental services, P < 0.031 and B = 2.356), overall work experience between 1 and 5 years (P < 0.001 and B = -3.769), and the attitude toward teamwork (P < 0.001 and B = 0.350) could significantly predict nurses’ attitude toward IPC. Conclusion: The attitudes of emergency nurses toward IPC and teamwork were at an optimal level. Nurses’ belief in IPC and especially belief in nurse–physician collaboration plays an important role in providing quality care and keeping patient safety in ED. Joint in-service workshops on the philosophy and principles of IPC and teamwork for nurses and physicians working in EDs can further strengthen the IPC.

Background: The coronavirus disease 2019 (COVID-19) pandemic has affected people around the world. Therefore, this situation has caused stress and burnout among the people and public health staff in Thailand. Objective: This study aimed to compare the stress and burnout levels among public health personnel during the lockdown and un-lockdown periods of the COVID-19 pandemic in Thailand. The secondary objective was to identify the factors associated with stress and burnout. Methods: This research was a cross-sectional survey study with online self-rated questionnaires. The sample size was 158 participants. Using convenience sampling, participants who worked in 12th health region, Southern Thailand took the questionnaire twice. The first time was during May–June 2020, which was the lockdown period from the COVID-19 outbreak in Thailand, and the participants completed the questionnaires again during July–August in the same year, which was the un-lockdown period. The non-parametric sign test, Spearman’s correlation, and logistic regression analyses were performed for testing the hypotheses. Results: The average total scores for stress during the lockdown and un-lockdown periods were 4.139 ± 3.534 and 3.398 ± 3.344, respectively. Moreover, the average total scores for burnout during the lockdown and un-lockdown periods were 1.573 ± 0.777 and 1.519 ± 0.702, respectively. The stress scores during the lockdown period were significantly higher than those during the un-lockdown period (sign test, P = 0.02). The stress correlated with the burnout by using Spearman’s correlation (P < 0.001). Binary logistic regression showed that the stress score (odds ratio 1.75; 95% confidence interval 1.41–2.91) was a risk factor for burnout. Conclusion: During the outbreak, the stress and burnout were high; the health organizations should have interventions or activities to reduce stress and burnout.

Background: The coronavirus disease 2019 (COVID-19) can significantly affect mental health among healthcare providers, particularly nurses in the frontline (FL) and the second line (SL) of care delivery to afflicted patients. Objective: This study aimed at evaluating the prevalence of depression, anxiety, and stress among FL and SL nurses during the COVID-19 pandemic. Methods: This cross-sectional descriptive-analytical study was conducted in June–September 2020. Participants were 146 FL nurses and 206 SL nurses who were in direct contact with COVID-19 patients in two hospitals in Sirjan, Iran. They were recruited to the study through a census. Data were collected using a demographic questionnaire and the 21-item Depression Anxiety Stress Scale. Data analysis was done through the Shapiro-Wilk, Chi-square, Mann-Whitney U, and independent-sample t tests. Results: The mean scores of depression, anxiety, and stress were, respectively, 15.87 ± 4.32, 8.35 ± 4.74, and 13.4 ± 4.39 among FL nurses and 9.91 ± 5.96, 6.91 ± 5.48, and 7.38 ± 3.95 among SL nurses. The between-group differences regarding these mean scores were statistically significant (P < 0.001). Conclusion: Depression, anxiety, and stress are highly prevalent among both FL and SL nurses who provide care to patients with COVID-19. Psychological support and education about stress management strategies for nurses can help them manage their depression, anxiety, and stress.

Background: Spiritual health (SH) has received great attention from nurses and other health-care providers in recent years. The existing instruments for SH measurement measure either some aspects of SH or SH-related concepts, and there is no specific SH measurement instrument, particularly for Muslim adults in Iran. Objective: This study aimed at the development and psychometric evaluation of the Spiritual Health Questionnaire (SHQ). Methods: This exploratory sequential mixed methods study was conducted in a qualitative and a quantitative phase in 2014–2016. In the qualitative phase, a concept analysis was conducted using the hybrid model and its results were used to develop the primary SHQ. In the quantitative phase, the face, content, and construct validity and reliability of SHQ were assessed. Exploratory factor analysis and concurrent validity assessment were performed for construct validity assessment. Test–retest stability and internal consistency were also assessed for reliability assessment. Results: The qualitative phase of the study showed that the concept of SH had six main components. In the quantitative phase, the number of primary SHQ items was reduced from 88 to 59 after face and content validity assessments. In construct validity assessment, 12 more items were excluded and the remaining 47 items were loaded on six factors which explained 45.2% of the total variance. The Cronbach’s alpha values of the questionnaire and its six dimensions were 0.778 and 0.752–0.788, respectively. Convergent validity assessment showed that the mean scores of SHQ and the Spiritual Well-Being Index had a significant correlation with each other (r = 0.35; P = 0.032). Conclusion: The 47-item SHQ is a specific instrument for SH assessment with acceptable validity and reliability.

Background: Breast cancer is the most common cancer and the 5^th leading cause of death in Iranian women. Many of these women are at the age of fertility and have dependent children. Objectives: This study aimed to explore the experiences of mothers with breast cancer of the support they receive for playing and rebalancing their mothering role. Methods: This qualitative content analysis study was conducted from 2018 to 2019. Participants were 22 mothers with breast cancer purposively recruited from Shahid Ghazi Tabatabaee Hospital in Tabriz, Iran. Data were collected through semi-structured interviews and analyzed through a conventional content analysis method. Results: Participants’ experiences were categorized into three main categories, namely, perceived difficulties, being with and for mother, and rebalancing family functions. The four subcategories of the first category were the physical limitations in performing the mothering role, the psychological burden of the disease, role strain in playing the mothering role, and children’s social difficulties. The second category included five subcategories, namely, assistance with the mothering role, emotional attachment to the mother, provision of family expenses and medical costs, normalization of appearance following cancer-induced changes, and social support resources. Finally, the third category included two subcategories, namely, the stability of the mother’s roles and promoting a health-oriented perspective in the family. Conclusion: Mothers with breast cancer face difficulties in performing their role as mothers. Identifying and providing supportive interventions for them by the health-care providers not only can be effective in achieving role stability for the mother but also in rebalancing family functions.