Background: Nausea and vomiting of pregnancy (NVP) is common complaints in pregnant women. Objectives: This study aimed to compare the effects of Citrus aurantium (orange blossom [OB]) and lavender essential oils on the severity of NVP in nulliparous pregnant women. Methods: A single-blinded clinical trial was conducted in 165 nulliparous women with NVP. A demographic and pregnancy-related information form and the Rhodes index of nausea, vomiting, and retching (RINVR) were used to collect data. Participants were assigned into three groups of 55 to receive lavender oil, OB oil, or a placebo. The oils were inhaled by the participants for 4 days when they felt nauseous. The severity of NVP was measured at baseline and at the end of the study. Data analysis was performed using the Chi-square, paired t-test, analysis of variance, and Bonferroni post hoc test. Results: Mean RINVR scores (i.e., mean total vomiting, nausea, and retching scores) did not significantly differ in the three groups at baseline (P = 0.477). However, mean posttest RINVR scores decreased significantly in the OB and lavender aromatherapy groups (P < 0.001), whereas it did not change significantly in the placebo group (P = 0.989). Conclusion: Lavender and OB essential oils were effective in reducing NVP. Nurses and midwives may therefore recommend pregnant women to use either OB or lavender oil to alleviate their NVP.

Background: Childbirth self-efficacy is one of the most important factors affecting pregnant women's decision about the type of delivery. Low childbirth self-efficacy can lead to unnecessary cesarean sections (CS). Objective: This study aimed to examine the effectiveness of motivational interviewing (MI) on self-efficacy and the decision about the type of delivery in primigravid women requesting elective CS. Methods: A randomized controlled trial was conducted on 120 primigravid women at 28–31 weeks of gestation. The participants were selected through multistage sampling and randomly assigned into an intervention and a control group, each 60. The intervention group received four 90-min sessions of MI, whereas the control group received routine prenatal care. The Childbirth Self-Efficacy Inventory, and the Decision-Making Checklist were used to collect data before and 4 weeks after the intervention. Chi-square, independent-samples t-test, and paired t-test were used for data analysis. Results: The mean baseline childbirth self-efficacy score was 63.68 ± 18.91 in the intervention group and 71.58 ± 25.66 in the control group (P = 0.57). The mean score increased significantly in the intervention group at the end of the study (P = 0.001), whereas it decreased significantly in the control group (P = 0.003). Although all women preferred CS at baseline, 91.7% of the intervention group and 28.3% of the control group applied for normal delivery at the end of the study (P < 0.001). Conclusions: MI can increase childbirth self-efficacy and can be used by midwives and other health-care providers to encourage pregnant women to choose normal delivery.

Background: Assessment of mothers' breastfeeding empowerment (BE) needs valid and reliable instruments. Objectives: The aim of this study was to develop and psychometrically evaluate the Mothers' BE Scale (MBES). Methods: This mixed methods study was conducted in 2018 in Isfahan, Iran. Initially, a literature review and a qualitative study were conducted and their results were used to develop MBES. The qualitative study was conducted through 33 semi-structured interviews with 33 participants and two group discussions with six participants and the data were analyzed through Hsieh and Shannon's conventional content analysis method. Then, the face, content, and construct validity and reliability of the scale were evaluated. Construct validity was evaluated through the exploratory factor analysis of the data obtained from 160 breastfeeding mothers. Results: The primary MBES had 47 items. Forty-one items had acceptable content validity ratio (i.e. more than 0.56) and content validity index (i.e. more than 0.70). In construct validity evaluation, four items were omitted and the remaining 37 items were loaded on six factors which explained 53.67% of the total variance. Using the data obtained from 160 mothers, Cronbach's alpha of the scale was 0.87. Conclusion: The 37-item MBES is a valid and reliable instrument and can be used to assess mothers' BE and develop need-based interventions for BE and breastfeeding promotion.

Background: Living with an implantable cardioverter-defibrillator (ICD) in the body can be challenging for patients. Identifying these challenges is, therefore, crucial for health promotion. Objectives: This study was conducted to explore the challenges experienced by patients living with an ICD. Methods: A qualitative content analysis study was conducted on 24 patients with an ICD. Purposive sampling and individual semi-structured interviews were conducted to collect the study data. After transcribing the interviews, content analysis was performed to analyze the data. Results: The participants were aged 35–60 years. Their education level varied between primary and tertiary levels. The participants had an ICD for an average of 35.70 ± 11.36 months. Three themes emerged, including “feeling disabled,” “problematic adaptation,” and “Financial constraints.” These themes indicated the most important challenges experienced by the participants. Conclusion: Patients with an ICD suffer more from psychological and financial problems than physical problems. Nurses and other health-care workers play a key role in supporting these patients.

Background: Identifying the barriers to acute pain management in older adults with dementia needs appropriate instruments adapted to the cultural structure of each community. Such an instrument can help to provide effective interventions. Objectives: This study aimed to develop and psychometrically validate Barriers to Postoperative Pain Management in Dementia Scale (BPPMDS) from the nurses' point of view. Methods: This methodological study was conducted in 2019–2020. In the first phase, semi-structured interviews with 15 nurses and literature review were conducted for item generation. In the second phase, face, content, and construct validity and reliability of the instrument were assessed. Results: In the first phase, 67 items were produced. In the second phase, the number of items reduced to 39 after the assessment of face, content, and construct validity. Exploratory factor analysis showed that the BPPMDS has three factors (i.e., older adult-related factors, health care provider-related factors, and system-related factors), which explain 57.57% of the total variance. The Cronbach's alpha coefficient of the scale was 0.956. Conclusions: The BPPMDS can be used as a valid and reliable scale to measure postoperative acute pain management in older patients with dementia and hip fracture.

Background: Timely cesarean section (CS) can be lifesaving, but its overuse may lead to health risks. Robson classification is a standard tool for monitoring and comparing CS rates at all levels. Objectives: The objective of this study is to analyze the CS rates based on Robson classification and its outcomes in a governmental tertiary referral teaching hospital in Zahedan city, Iran. Methods: A cross-sectional study was carried out on all CS (n = 1763) performed in Ali-Ibn-Abitaleb Hospital of Zahedan city from September 22 to March 19, 2019. Data were extracted from women's paper-based files. Descriptive analyses were performed. The Chi-square test was used to test the differences between groups. The odds ratio was used to calculate the risk of adverse maternal and perinatal outcomes in women with and without a previous CS. Results: The overall rate of CS was 44.81%. Women with previous CS (Robson group 5) were the largest contributors to the overall CS rate (39.82%), followed by Robson group 10 (i.e., women with a single cephalic pregnancy at ≤36 weeks' gestation: 19.45%). The CS rate in women in Robson groups 1 and 2 was 9.93% and 5.61%, respectively. The main indications for CS among nulliparous women were fetal distress (42.99%), malpresentation (14.95%), and prolonged and obstructed labor (10.98%). Adverse maternal outcomes were similar in women with and without a previous CS. Conclusions: The Robson classification system showed a high rate of CS in the study setting, and many CSs were performed in women with low-risk pregnancies.

Background: The new coronavirus (COVID-19) pandemic has extensive psychological effects on pregnant women. Objectives: The aim of this study was to assess mental health, fear of COVID-19, and their association among pregnant women. Methods: This cross-sectional study was conducted on 607 pregnant women in Isfahan, Iran, from September 26 to December 20, 2020. The pregnant women were randomly selected from health centers affiliated with Isfahan University of Medical Sciences using a two-stage cluster sampling. A three-part web-based questionnaire (i.e., a demographic questionnaire, the Fear of COVID-19 Scale, and the General Health Questionnaire) was used to collect data. Chi-square test, independent-samples t-test, and logistic regression analysis were used for data analysis. Results: Most participants (73%) had a high level of fear of COVID-19, while 11% had a history of COVID-19 infection. In the final model, poor financial status (odds ratio [OR] = 3.06, 95% confidence interval [CI]: 1.32–7.10), COVID-19 infection (OR = 2.25, 95% CI: 1.22–4.16), history of mental disorders (OR = 10.11, 95% CI: 2.44–41.75), and number of pregnancies (OR = 2.59, 95% CI: 1.39–4.81) were associated with a significant increase in the chance of mental health disorder. A high COVID-19 fear score resulted in a 29% increase in mental health disorders, although this increase was not statistically significant. Conclusion: The prevalence of fear of COVID-19 was high among pregnant women. Poor financial status, number of pregnancies, history of COVID-19 infection, and a history of mental problems were associated with an increased risk of mental health disorders in pregnant women.

Background: Injuries and accidents are essential issues in public health, where the school teachers are considered the first caregivers in schools. Objective: The purpose of this study was to assess the effectiveness of an educational program on first aid (FA) knowledge, cardiopulmonary resuscitation (CPR) skills, and teacher self-confidence among school teachers. Methods: One-group pretest–posttest preexperimental design was conducted. Three schools were enrolled using simple random sampling, and 40 teachers were participated. The Wilcoxon signed-ranks test was performed to compare the pre- and posttests' mean scores. Results: The mean posttest scores of FA knowledge, CPR skills, and self-confidence were significantly higher than the mean pretest scores (P < 0.01). Conclusion: The educational program was effective in improving FA knowledge, CPR skills, and teachers' self-confidence.