Background: Improving the quality of maternal care is considered a key strategy for improving maternal and neonatal outcomes. However, available definitions do not clearly define this concept. Objective: The aim of this study was to clarify the concept of maternal care quality (MCQ) for women with low-risk pregnancy in the maternity ward and to determine its attributes. Methods: This integrative review was conducted using Whitmore and Knafl's method. An online literature search was done in Medline, Embase, Web of Sciences, Scopus, SID, Magiran, and IranMedex databases as well as the websites of health-care and midwifery organizations and associations. Data were analyzed in the four steps of data reduction, data display, data comparison, and conclusion drawing and verification. Results: The two main attributes of MCQ are effective communication and interaction and professional care. Effective communication and interaction between the care provider and pregnant women in the maternity ward is the most important attribute of MCQ. The first category included three subcategories, namely informational interaction, human interaction, and participatory interaction. The two subcategories of the second category were adherence to standards during care delivery and delivering accessible care. Conclusion: MCQ in maternity ward is defined as “the process of delivering safe, fair, accessible, and standard professional care to women during childbirth through human, informational, and participatory interactions.”

Backgrounds: Relaxation techniques can help reduce stress. However, few studies are available on the effects of jaw relaxation on stress and physiological indicators of patients with acute coronary syndrome (ACS). Objectives: This study aimed to examine the effect of jaw relaxation on stress and physiological indicators of patients with ACS. Methods: A randomized controlled trial was conducted on 64 patients with ACS hospitalized in two hospitals affiliated with Isfahan University of Medical Sciences, Iran. The patients were selected using consecutive sampling and were randomly assigned to an intervention (n = 32) and a control (n = 32) group. Jaw relaxation was performed for the subjects in the intervention group twice a day and for 3 days. The subjects in the control group received their routine care. The data were collected using Cohen's Perceived Stress Scale and a checklist for recording physiological indicators. Data analysis was performed using descriptive statistics, the chi-square, and the independent samples t test. Results: The mean stress score in the intervention group decreased from 26.03 ± 15.97 to 11.45 ± 14.75 (P < 0.001). However, the difference was not significant in the control group. The mean diastolic blood pressure, systolic blood pressure, heart rate, respiratory rate, and arterial oxygen saturation were not significantly different between the two groups before the intervention (P > 0.05). However, after interaction, the mean of these variables was significantly different between the two groups (P < 0.05). Conclusion: The use of jaw relaxation together with medical treatments has a positive effect on the recovery of patients with ACS and helps them manage their stress.

Background: Handover from the operating room (OR) to the intensive care unit (ICU) is a complicated process that may endanger patients' lives. Objectives: The present study determined the effect of a standard patient handover protocol on the quality of transfer from the cardiac OR to the cardiac ICU. Methods: A quasi-experimental study was conducted in 2020 at an adult cardiac surgery center in Ahvaz city, Iran. Sixty-two handover cases were assessed before (n = 31) and after (n = 31) a training intervention on the nursing staff in the OR and ICU. The training intervention covered the process of standard handover. A checklist was used to evaluate the quality of care through the process of handover. The checklist consisted of three subscales. The independent samples t, Fisher's exact or chi-square tests were used to analyze the data. Results: The mean score of the technical errors was 10.61 ± 1.20 before the intervention and changed to 12.61 ± 0.80 after the intervention (P < 0.001). The mean score of ignoring information was 10.21 ± 1.78 before the intervention and changed to 14.00 ± 1.92 following the intervention (P < 0.001). Conclusion: Implementation of a standard handover protocol for post-cardiac surgery patients can decrease the intermission and improve the quality of care during patient handover.

Background: Fatigue and decreased activities of daily living (ADL) are important problems in patients with systemic lupus erythematosus (SLE) and reduce their quality of life. Objectives: This study was conducted to examine the effect of fatigue and activity management education (FAME) program on fatigue severity and ADL in patients with SLE. Methods: A quasi-experimental study was conducted on 40 patients with SLE. The patients were selected consecutively and randomly allocated into an intervention (n = 20) and a control group (n = 20). The control group was treated as usual. However, in addition to the usual treatment, the intervention group received the FAME program. Data collection was done before and 8 weeks after the intervention using the Swedish Occupational Fatigue Inventory-20 (SOFI-20) questionnaire, the daily physical activity questionnaire, and a demographic characteristics form. Descriptive statistics, independent- and paired-samples t tests, and analysis of covariance were used to analyze the data. Results: The two groups were homogenous in terms of demographic characteristics (P > 0.05) unless their job (P = 0.002). The mean baseline fatigue and ADL scores were significantly different between the two groups (P < 0.0001). Hence, analysis of covariance was used to control the confounding effect of the aforementioned variable. Then, significant differences were found between the two groups respecting the mean fatigue (P < 0.0001) and mean ADL (P = 0.009) after the intervention. Conclusion: Considering the effectiveness of the FAME program in reducing fatigue and increasing ADL in patients with SLE, nurses are recommended to use similar programs in the care for these patients and help them improve their own fatigue and ADL.

Background: Self-efficacy and the health locus of control (HLC) are the most important determinants of compliance with self-care behaviors in patients with heart failure (HF). However, there is still a lack of studies in this area. Objective: This study aimed at investigating the relationship between HLC and self-efficacy in patients with HF. Methods: This cross-sectional study was conducted on 170 patients with HF in 2019 in Urmia, Iran. The participants were enrolled by using a consecutive sampling method. Data collection was conducted by using a demographic questionnaire, the questionnaire for assessing the Strategies Used by People to Promote Health (SUPPH), and the Multidimensional Health Locus of Control (MHLC) Scale. Descriptive statistics, the Pearson correlation coefficient, and stepwise linear regression analysis were used to analyze the data. Results: The mean age of the participaants was 67.47 ± 11.27 years. The majority of participants were male (59.8%) and married (76.8%). Among the components of the MHLC, the internal and powerful others obtained the highest mean scores (28.52 ± 5.97 vs. 26.6 ± 4.01). On average, the patients possessed about half of the self-efficacy scores. The internal HLC (IHLC) only had a direct correlation with the overall score of self-efficacy (r=0.24, P = 0.03), and the powerful others HLC (PHLC) was directly correlated with a positive attitude (r=0.39, P = 0.001) and the overall score of self-efficacy (r=0.32, P = 0.004). In regression analysis, only the scores of IHLC and PHLC were associated with the self-efficacy scores. Conclusion: Patients' self-efficacy improves as the mean scores of the IHLC and PHLC increase.

Background: Family caregivers of patients with cancer experience high levels of anxiety and mental health problems. Relaxation methods have seldom been used in these caregivers. Objectives: This study tested the effect of Benson's relaxation method (BRM) on state anxiety in family caregivers of patients with cancer. Methods: A randomized controlled trial was conducted on 50 primary family caregivers of patients with cancer. Family caregivers were randomly assigned to a control group and an experimental group, each group consisted of 25 people. In the experimental group, the subjects were trained to practice the BRM at home, once a day for 6 weeks. Family caregivers' anxiety was measured at the start of the study and at the end of the 6th and 10th weeks by using Spielberger's State Anxiety Inventory (i.e., form y–1). The data were analyzed using descriptive and inferential statistics such as the Fisher's exact, independent samples t, and Mann–Whitney U tests as well as the repeated-measures analyses of variance. Results: No significant difference was found between the mean baseline state anxiety of the control and experimental groups (P = 0.329). However, during the study, the mean anxiety was decreased in the experimental group, whereas it did not significantly change in the control group. The repeated-measures analysis showed that BRM could significantly reduce the mean state anxiety (P <0.001) over time. Conclusion: Regular use of BRM for 6 weeks could decrease the mean scores of state anxiety in family caregivers of patients with cancer. Nurses and other healthcare providers are suggested to teach BRM to the family caregivers of cancer patients and advise them to use this method regularly for the reduction of their own anxiety.

Background: The global health crisis caused by the COVID-19 pandemic has led many institutions and universities around the world to bring about a sudden shift to virtual education to continue their educational activities. Objectives: This study aimed to explain the challenges of the sudden shift to asynchronous virtual education in nursing education throughout the COVID-19 pandemic. Methods: A qualitative study was conducted during 2020, on nursing faculty members and undergraduate nursing students in the Urmia School of Nursing and Midwifery, Iran. A total of 12 faculty members and 8 students were enrolled in the study using purposive sampling. Data were collected using semi-structured face-to-face interviews and then analyzed through the content analysis method. Results: Participants identified “inappropriate groundwork” and “low inclination to virtual education” as the main challenges of the sudden shift to asynchronous e-learning in nursing education during the COVID-19 pandemic. Conclusion: The authorities of nursing schools should provide the appropriate groundwork for virtual education by the provision and upgrading of the required hardware and software, teaching how to use the facilities, and developing standard protocols for virtual education.

Background: Safe care requires acquiring special competencies. Suitable instruments are needed to evaluate such competencies. Objectives: This study aimed to assess the psychometric properties of the Persian version of the Health Professionals Education in Patient Safety Survey (H-PEPSS). Methods: A methodological study was conducted in 2020, on the students who were spending their last year of study in nursing, medicine, pharmacy, midwifery, surgical technology, and anesthesia, in the Isfahan University of Medical Sciences. The H-PEPSS was translated into Persian based on the Brislin translation model. Face validity, content validity index (CVI), and content validity ratio (CVR) were examined. The construct validity of the scale was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA). Cronbach's alpha coefficient and interclass correlation coefficient were also calculated as reliability criteria. Results: The face validity of the Persian translation of H-PEPSS was confirmed by a panel of experts, and the items' impact scores were greater than 1.5. Three items were modified, and the CVI of the scale was calculated at 0.91. Besides, the items' CVR ranged from 0.64 to 1.00. In EFA, six factors were extracted, which shows the competencies the students possessed both in the classroom and clinical setting, which then were confirmed through the CFA. All items had a factor loading value greater than 0.4. Goodness-of-fit indices were obtained: Root Mean Square Error of Approximation (RMSEA) = 0.064, Tucker-Lewis Index (TLI) = 0.922, and Comparative Fit Index (CFI) = 0.931 for the classroom and RMSEA = 0.076, TLI = 0.912, and CFI = 0.923 for clinical setting. The Cronbach's alpha of the scale was 0.936 for the classroom and 0.949 for the clinical setting. Conclusions: The Persian version of H-PEPSS includes six factors with 23 items. This scale is a valid and reliable instrument for assessing patient safety education in the classroom and clinical setting.

Background: Dedication is one of the components of professional nursing. However, no clear consensus exists on the definition of dedication in nursing, and it is difficult to understand and operationalize this concept in clinical settings. Objectives: This study aimed to analyze the concept of dedication in nursing. Methods: This concept analysis was done using the hybrid model from February to June 2021. In the theoretical phase, the existing literature on dedication in nursing was reviewed in international databases of PubMed, Science Direct, ProQuest, Ovid, and Scopus. The keywords were “dedication” and “nursing”. After excluding duplicate and irrelevant records, 34 documents were reviewed. In the field phase, semistructured interviews were conducted with six nurses to gather new qualitative data on their experiences of dedication. In the integration phase, the findings of the earlier phases combined to provide a comprehensive definition of the concept. Content analysis was used to analyze the data. Results: Dedication in nursing was defined as a feeling and state of mind and heart, like an untiring commitment that is the art and essence of nursing. It is caring from one's heart with all human beings and technical resources available, doing beyond regular work hours and organizational and legal duty. This act usually happens without expectation for any reward or incentives in such a way that may lead to neglecting one's own needs. Conclusion: This concept analysis can be a good guide for nurses, teachers, and managers to know the meaning of dedication and recognize how to breed the spirit of dedication in nursing and prevent its negative consequences.

Background: Some health care providers feel uncomfortable to lead cost communication. They spend most of their time providing psychological and physiological care, while the willingness to discuss costs with their patients is uncertain. Objective: We aimed to explore Jordanian nurses' and physicians' attitudes toward cost communication with patient and explore potential predictors of this action. Methods: Descriptive correlational survey design was conducted in 2019. A questionnaire was used to measure attitudes regarding the cost communication. A total of 122 Jordanian nurses and physician from a governmental hospital were participated in this study. Pearson's r coefficient correlation and multiple regression were used to analyze the data. Results: Jordanian health care providers demonstrated a positive attitude toward communicating cost issues with their patients. Most of them (68%), preferred to explain the cost that patients have to pay. The years of experience significantly predicted health care provider's positive attitude in cost discussion (β = 0.214, P < 0.05). Conclusion: Findings support the importance of discussing treatment-associated costs with patients. Jordanian healthcare providers are comfortable with and desire to discuss treatment-associated costs. Furthermore, the present findings emphasize to develop educational programs for health care provides to improve their financial and communication management skills.