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.

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Background: Image remains crucial for nursing profession. How nurses view professional self-image has an impact on their professional self-esteem. Objectives: This study explored the image of nursing as perceived by Indonesian nurses. Methods: This was a phenomenological study with a purposeful sample of 19 clinical nurses participated in in-depth interviews. The interviews were audio-recorded, transcribed verbatim, and validated by relistening to the recording by researchers. The analysis was thematic. Results: Five themes emerged (a) Islamic culture, (b) job definition, (c) role of nurses, (d) self-confidence, and (e) relationship between multigenerations of nurses. Conclusion: This study addressed positive and negative images of nursing in Belitung, Indonesia. The findings may be used for nurse managers to improve nursing image through the improvement of nurse competence and continuing professional development.

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Background: Menopause is associated with alterations in women's behaviors and sexual function. Altered sexual function can in turn causes serious health problems for women and negatively affect their marital relationships. Objective: This study aimed to investigate the effects of melatonin on the sexual function of postmenopausal women. Methods: This randomized double-blind placebo-controlled clinical trial was made in 2012–2013 on 240 postmenopausal women who aged 40–60 and referred to public obstetrics and gynecology clinics affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Participants were randomly divided into a melatonin and placebo group. Women in the melatonin and the placebo groups, respectively, received melatonin (3-mg tablets) and placebo for 3 consecutive months. Before and every 1 month during the intervention, participants' sexual function was assessed using Female Sexual Function Index. The repeated measures analysis of variance, the least significant difference, the independent sample t test, the Chi-square, and Fisher's exact tests were done for data analysis. Results: Sexual function mean score in the melatonin and placebo groups significantly increased from 12.49 ± 7.07 to 20.72 ± 8.57 and from 12.11 ± 7.82 to 15.55 ± 9.06, respectively. Yet, the amount of increase in the melatonin group was significantly higher than the placebo group. Moreover, there were significant differences between the groups regarding the variations of sexual function mean score across the four assessment points (P < 0.001). In addition, except for the baseline assessment point, the mean score of sexual function in the melatonin group was significantly greater than the control group at all other assessment points (P < 0.05). Conclusion: Melatonin significantly improves sexual function among postmenopausal women.

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Background: Primary dysmenorrhea (PD) is one of the most common gynecologic problems. Objectives: The objective of this study was to determine the effects of dry cupping on PD severity and dysmenorrhea-associated systemic symptoms. Methods: In this randomized clinical trial, 150 young single students with PD were randomly allocated to either an intervention (n = 75) or a control (n = 75) group. Data collection tools were a demographic and menstrual characteristics checklist, Andersch and Milsom's Verbal Multidimensional Dysmenorrhea Severity Scoring System, and a Dysmenorrhea-associated Systemic Symptom Scale. In the intervention group, students were provided with daily sliding dry cupping therapy from 3 days before to 3 days after the onset of menstruation for three successive menstrual cycles. In each cupping therapy session, two cups were placed on the lower back on each side of the spine and another on the suprapubic area for 10–15 min. Students in the control group did not receive cupping therapy. Data were analyzed through the Chi-square and the independent-samples Student's t-tests, the repeated measures analysis of variance, and generalized estimating equation. Results: The mean scores of dysmenorrhea severity and systemic symptoms in the intervention group significantly decreased over time, while they did not significantly change in the control group. Thus, there were significant between-group differences respecting the variations of dysmenorrhea severity and systemic symptoms over time (P = 0.03). The odds of severe dysmenorrhea and the odds of severe dysmenorrhea-associated systemic symptoms in the intervention group were, respectively, 52% (odds ratio [OR]: 0.48; 95% confidence interval [CI]: 0.27–0.85) and 78% (OR: 0.22; 95% CI: 0.05–0.98) less than the control group. Conclusion: Dry cupping can significantly reduce the severity and the systemic symptoms of PD. Therefore, it can be used as an effective, inexpensive, and safe therapy for PD management.

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Background: Aging is associated with declines in individuals' physical and mental abilities. Technological assistance can improve older adults' independence, functional performance, and health. Objectives: The purpose of this study was to explore experiences regarding barriers to use technology in daily life among older adults. Methods: This qualitative study was conducted on twenty older adults referred to Urban Comprehensive Health Service Centers, Kashan. The main interview questions were “What does the word technology bring to your mind? Which electrical household appliances do you use during your daily life? and What are the barriers you experience during the use of technology?” Data were collected through semi-structured interviews and analyzed using conventional content analysis. Results: Three main themes emerged: aging-related barriers (physical and mental limitations), individual barriers (educational limitations, limited access to technology, and unfavorable attitudes toward technology), and barriers related to the appliances. Conclusion: Older adults experience multiple barriers to use technology in their daily life. Educational interventions may enhance older adults' utilization of technology in daily life of this population.

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Background: Despite the importance and the necessity of humanistic approaches to care, there are limited studies into their outcomes for nurses. Objectives: The aim of this study was to explore the outcomes of humanistic nursing for critical care nurses (CCNs). Methods: This qualitative study was conducted through conventional content analysis. Data were collected through semi-structured interviews with 16 CCNs purposively selected from hospitals in Ahvaz, Iran. Trustworthiness of the data was ensured using Lincoln and Guba's criteria. Results: The outcomes of humanistic nursing were grouped into three main categories, namely personal growth and self-actualization, protection of personal dignity, and greater satisfaction and comfort. Each of these categories had three subcategories which were development of abilities, self-concept and self-worth, spiritual transcendence; greater popularity, improved social status of nursing, appreciation, respect, and support for nurses; and happiness, satisfaction, and motivation, respectively. Conclusion: Humanistic approaches to care help fulfill the needs of both patients and nurses. The findings of this study provide a deeper understanding about how to reinforce humanistic behaviors and can be used in nursing education and practice.

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Background: Maternal postpartum depression (PPD) is a common problem after childbirth. It is a risk factor for low-quality mother–infant interaction. Infant massage may help alleviate depressive disorders. Objectives: This study aimed to investigate the effects of infant massage by mothers on maternal PPD. Methods: This clinical trial was conducted on 120 primiparous mothers with PPD. Mothers were randomly recruited and allocated to a control and an intervention group. In the intervention group, mothers were instructed to give their infants 15-min massage twice daily for 6 consecutive weeks from the 3^rd postnatal week onward. However, mothers in the control group did not receive such training. Before and after the intervention, PPD was assessed using the Edinburgh Postnatal Depression Scale. Data analysis was performed using the Chi-square test, independent-samples t-test, paired-samples t-test, Wilcoxon signed-rank test, and univariate and multivariable logistic regression. Results: Groups did not significantly differ from each other concerning parents' and infants' demographic characteristics (P > 0.05) and the pretest mean score of PPD (P = 0.46). However, the posttest mean score of depression in the intervention group was significantly lower than the control group (7.75 ± 2.18 vs. 9.2 ± 2.04; P < 0.001). In addition, the posttest relative frequency of PPD was significantly lower in the intervention group (15/60 [25%] vs. 26/60 [43.3%]; χ² = 4.48; P = 0.034). After controlling the effects of other variables, the odds of PPD in the intervention group was 0.5 times (95% confidence interval: [0.2, 0.94]) less than the control group (P = 0.003). Conclusion: Infant massage by mothers significantly alleviates maternal PPD. Health-care professionals, particularly midwives, are recommended to instruct mothers to provide infant massage in order to alleviate their own PPD.

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Background: Sleep disorders are a source of stress for patients hospitalized in coronary care units (CCUs). Objective: The aim of this study was to investigate the effects of nature sounds on sleep quality among patients in CCUs. Methods: This randomized controlled trial was conducted on 93 patients hospitalized in the CCUs of three teaching hospitals in Tehran, Iran. Patients were randomly allocated into three groups, namely, nature sounds, silence, and control groups. Patients in the nature sounds group listened to nature sounds for 30 min in two consecutive nights while their counterparts in the silence group only wore mute headphones. Patients in the control group neither listened to nature sounds nor wore headphones. The Richards–Campbell sleep questionnaire was used for the evaluation of the patients' sleep quality two days before and during the intervention. The mean scores of sleep quality at the first two and the last two nights, respectively, were considered as the pretest and the posttest sleep quality. Cohen's d, one-way analysis of variance, paired-sample t, Chi-square, Fisher's exact, and the Scheffe post hoc tests were used to analyze the data. Results: Posttest-pretest mean differences of the sleep depth, the number of awakenings, and the returning to sleep domains of sleep quality in the control group were significantly less than nature sounds group (P < 0.001). Moreover, the posttest-pretest mean differences of the total sleep quality and its sleep latency and subjective sleep quality domains in the control group were significantly lower than both the nature sounds and the silence groups (P < 0.001). On the other hand, none of the differences between the nature sounds and the silence groups were statistically significant (P > 0.05). Conclusion: Both nature sounds and silence can significantly improve sleep quality among patients in CCUs. Nurses can use these strategies to improve the sleep quality of a patient in these units.

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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.

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Background: Surrogates are women who bear a genetically unrelated child for another individual or couple. Experiences of surrogate mothers need further investigation. Objective: The objective of the study was to answer the questions of what were the experiences of surrogate mothers and what problems they confronted during the process of surrogacy. Methods: The present study was a qualitative content analysis. Purposive sampling was used in the study. Pregnant women with various ages and educational levels were invited for semi-structured interviews. Graneheim and Lundman's method was used for analyzing the data. Results: In this study, 15 participants were interviewed. The codes extracted from the interviews were categorized into five main themes and 13 subthemes. The main themes were: (1) desperation; (2) pain and suffering with the subthemes of physical pain, emotional suffering, suffering caused by others, and fears; (3) emotional involvement and self-alienation; (4) looking for the positive aspects of the surrogacy with subthemes of positive interpretation of the experience, and the sense of pride; (5) and supportive systems including the commissioning parents, the surrogate's family, the health system, and the community as subthemes. Financial motivations were the reason for surrogacy which made women endure many physical, psychological, and social problems. The women expressed some positive feelings about surrogacy and also mentioned several support sources. Conclusion: Surrogate mothers reported numerous physical, emotional, and social problems that require better counseling services. A supportive system, especially the health system, should provide better and more humanistic services for surrogate mothers.

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Background: Labor pain is a major reason behind preferring cesarean section over normal vaginal delivery. Aromatherapy is among the most common nonpharmacological therapies for pain. Objectives: The objective of this study aimed to evaluate the effects of inhalation aromatherapy with Boswellia carterii (BC) essential oil on the intensity of labor pain among nulliparous women. Methods: This randomized controlled trial was carried out on 126 nulliparous women. Women were randomly allocated to an aromatherapy (n = 63) and a placebo (n = 63) group. For each woman in the aromatherapy group, a piece of gauze was soaked with 0.2 ml of 0.2% BC essential oil diluted in 2 ml of normal saline, and then, it was attached to the collar of each woman. The intervention was repeated for each woman every 30 min up to a cervical dilation of 10 cm. The intervention in the placebo group was the same as the aromatherapy group except that the gauze was soaked only with 2 ml of normal saline. A numeric pain rating scale was used to assess the labor pain intensity before the intervention and at cervical dilations of 3–4, 5–7, and 8–10 cm. Statistical analyses were performed using descriptive and inferential statistics such as the Chi-square, the independent sample t- test, and paired t-test. Results: Between-group comparisons revealed that labor pain intensity in the aromatherapy group was significantly lower than the control group at cervical dilations of 3–4 (4.98 ± 0.93 vs. 6.68 ± 1.28, P < 0.001), 5–7 (5.79 ± 1.13 vs. 7.23 ± 1.54, <0.001), and 8–10 cm (6.35 ± 1.63 vs. 7.71 ± 1.38, P < 0.05). However, there were no significant between-group differences regarding 1 and 5 min Apgar scores (P > 0.05). Conclusion: Inhalation aromatherapy with BC essential oil has positive effects on labor pain. Therefore, it can be used for relieving labor pain in the first stage of labor.

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Background: Many nurses experience job stress in their workplace. Given the wide range of differences in the statistics about job stress among nurses, the question that arises is what is the general prevalence of job stress among Iranian nurses? Objective: The present study aimed to evaluate the prevalence of job stress among Iranian nurses through meta-analysis. Persian and English databases including SID, MagIran, IranMedex, Google Scholar, Sciencedirect, and PubMed were searched by using the keywords such as “job stress, occupational stress, work-related stress, job related stress” and their combinations and 30 articles were finally selected. All the observational research articles that had information regarding the prevalence of job-related stress, sample size, and job stress instruments were entered into the meta-analysis. The form used to extract information included variables such as the first author's name, publication year, the place where the study had been carried out, type of the study, sample size, data collection instruments, and the most important findings. Results: The general prevalence of job stress was estimated to be 69% (confidence interval [CI] 95%: 0.58–0.79) based on the report of 30 papers with sample size of 4630. By region, type of hospital and the type of study, the highest prevalence of nurses' job stress was 90% (CI 95%: 0.85–0.96) in region one (Provinces of Alborz, Tehran, Qazvin, Mazandaran, Semnan, Golestan, and Qom), 70% (CI 95%: 0.60–0.80) in public and private hospitals, and 79% (CI 95%: 0.58–1.01) in studies where the type of study had not been mentioned. Conclusion: Given the high prevalence of job stress among nurses, developing programs to reduce nurses' job-related stress seems to be essential.

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Background: Episiotomy is the most common surgical procedure in obstetrics. It may be associated with wound infection and delayed wound healing. Objectives: This study aimed to compare the effects of honey and curcumin on episiotomy pain and wound healing. Methods: This double-blind three-group randomized controlled trial was done on 120 women admitted for vaginal delivery to Shahid Yahyanejad hospital, Babol, Iran. Participants were randomly assigned to three groups of 40 subjects and were taught to apply honey, curcumin, or placebo creams on their own episiotomy wound twice daily for 10 successive days after birth. Pain and wound healing were assessed 2 h, 5 days, and 10 days after birth via a visual analog scale and the Redness, Edema, Ecchymosis, Discharge, and Approximation scale. The primary outcomes of the study were episiotomy wound healing and pain intensity. The Chi-square test as well as the one-way analysis of variance and the repeated measures analyses of variance were conducted for data analysis. Results: The study was completed with 30 women in each of the honey and the curcumin groups and 29 in the placebo group. There were no statistically significant differences among the groups respecting the variations of pain intensity and wound healing mean scores across the three measurement time points. However, based on the complete pain relief on the 10^th day and compared with the placebo group, number-to-treat values in the curcumin and the honey groups were around 6 and 5, respectively. Moreover, compared with the placebo group, number-needed-to-treat values for complete wound healing on the 10^th day in the curcumin and the honey groups were 6 and 8, respectively. Conclusion: Curcumin and honey creams have almost the same effects on episiotomy wound healing and pain intensity.

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Background: Physical activity is among the most significant factors behind sleep quality. However, there are limited data on the effects of different types of physical activity on sleep quality. Objectives: This study aimed to compare the effects of aerobic and anaerobic exercise on sleep quality among male nonathlete students. Methods: As a three-group randomized controlled trial, this study was done on ninety male nonathlete nursing students of Zahedan Islamic Azad University, Zahedan, Iran. Students were randomly assigned to an aerobic exercise, an anaerobic exercise, and a control group. For 10 consecutive weeks, students in the aerobic and the anaerobic groups respectively attended aerobic and anaerobic exercise programs thrice a week. Data were collected using a demographic questionnaire and the Pittsburgh Sleep Quality Index and were analyzed using the one-way analysis of variance, the Tukey's post hoc, the Chi-square, and the paired-sample t-tests. Results: At baseline, the mean scores of sleep quality in the aerobic exercise, anaerobic exercise, and control groups were 4.06 ± 3.62, 4.56 ± 4.93, and 4.50 ± 4.01, respectively (P = 0.98). However, after the intervention, these values significantly changed to 2.03 ± 2.96, 1.96 ± 3.60, and 4.66 ± 4.16, respectively (P = 0.008). Pairwise between-group comparisons showed that the mean scores of sleep quality in both intervention groups were significantly lower than the control group (P < 0.05) while the difference between the intervention groups was not statistically significant (P > 0.05). Conclusion: Exercise, either aerobic or anaerobic, significantly improves sleep quality among male nonathlete students.

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Background: Nurses need to have high levels of clinical competence for the provision of quality care to patients. The use of modern teaching methods can help nursing students develop their clinical competence. Objectives: This study aimed to evaluate the effects of the Clinical Teaching Associate (CTA) model on clinical skills and satisfaction with clinical education among nursing students. Methods: This two-group posttest-only trial was conducted on 120 nursing students recruited through the census method from Tabriz Faculty of Nursing and Midwifery, Tabriz, Iran. They had just taken the oncology nursing clinical education course. Participants were randomly allocated to a control group to receive clinical education through routine teaching method and an intervention group to receive clinical education through the CTA model. At the end of the course, participants' clinical skills and satisfaction were assessed using a checklist and a questionnaire, respectively. The study data were analyzed using the measures of descriptive statistics and independent-samples t-tests. Results: The mean score of overall clinical skills in the intervention group was significantly greater than that of the control group (75.54 ± 4.24 vs. 65.46 ± 5.32; P = 0.003). Moreover, the mean score of overall satisfaction with clinical education in the intervention group was significantly greater than that of the control group (98.16 ± 1.23 vs. 84.41 ± 1.52; P < 0.001). Conclusion:This study shows the positive effects of the CTA model on nursing students' clinical skills and satisfaction. Therefore, it can be used to improve learning outcomes among nursing students.

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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.

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Background: Lifestyle modification and self-care have potential effects on hypertension management among older women. Objectives: The aim of this study was to assess the effects of using Orem's Self-Care Deficit (OSCD) theory on self-care behaviors among older women with hypertension. Methods: This clinical trial was conducted in 2018–2019. A 70-year-old woman with hypertension were conveniently recruited from healthcare centers in Ramsar, Iran, and randomly allocated to a control and an intervention group. Participants in the intervention group received self-care education based on the OSCD theory. The control group received no intervention. Data were collected using a personal characteristics questionnaire, a researcher-made self-care need assessment checklist, and the Hypertension Self-Care Activity Level Effects questionnaire. The Wilcoxon and the Mann–Whitney U-tests were used to analyze the data. Results: There were no significant differences between the groups respecting the pretest mean scores of medication adherence, weight control, physical activity, and nutrition-related self-care behaviors (P > 0.05). However, after the intervention, the between-group difference respecting the mean scores of these behaviors were statistically significant (P < 0.001). Conclusion: The OSCD theory is effective in promoting self-care behaviors among women with hypertension. Therefore, its use is recommended to improve hypertension management and quality of life and reduce treatment-related costs in these patients.

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Background: Aging population is progressively increasing. Older adults suffer from the different chronic health conditions such as hypertension. Behavior change is a key strategy for effective hypertension management. Successful behavior change necessitates the adequate self-efficacy. Objectives: This study aimed to evaluate the effects of a self-management program based on the 5 A's model on self-efficacy among the older men with hypertension. Methods: This randomized controlled trial was conducted in 2016–2017 on older men with hypertension in Ramsar, Iran. In total, 60 eligible participants were randomly allocated to an intervention and a control group. The participants in the intervention group were offered a self-management program based on the 5 A's behavior change model. Data were collected using a demographic questionnaire, a hypertension assessment form, the Self-Efficacy for Managing Chronic Disease Scale, and the hypertension Self-Efficacy Scale. Self-efficacy scales were completed for participants both before and 12 weeks after the intervention onset. The paired- and independent-sample t, Wilcoxon signed-rank, Mann–Whitney U, and Chi-square tests were used in the data analysis. Results: The pretest mean scores of hypertension self-efficacy in the intervention and the control groups were, respectively, 48.62 ± 11.71 and 44.65 ± 15.4, which significantly increased to 79 ± 13.13 and 62.06 ± 15.38 at posttest (P < 0.001). Moreover, the pretest mean scores of chronic disease management self-efficacy in these groups significantly increased from, respectively, 5.64 ± 1.28 and 5.35 ± 1.40 at pretest to 8.05 ± 1.29 and 6.12 ± 1.48 at posttest (P < 0.001). The pretest–posttest mean differences of the mean scores of both types of self-efficacy in the intervention group were significantly greater than the control group (P < 0.001). Conclusion: The self-management program based on the 5 A's model is effective in significantly improving the self-efficacy among older men with hypertension.

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Background: Medication errors may happen in any hospital setting. Medication error reporting can enhance patient safety and provide valuable information about reasons behind errors. Objectives: The present study aimed to determine nurses' perspectives on the reasons behind medication errors and the barriers to error reporting. Methods: This cross-sectional study was conducted in 2015 on 213 hospital nurses working in three hospitals in Kerman, Iran. Nurses working in different inpatient wards were selected through random sampling. Data were collected using a three-part questionnaire on nurses' demographic characteristics, reasons behind medication errors, and reasons for not reporting them. Data analysis was done through the independent sample t-test and the one-way analysis of variance. Results: The most and the least important reasons behind medication errors were nurses' insufficient attention to patients' medical records (3.63 ± 1.29) and the high number of tasks (2.01 ± 0.99), respectively. Moreover, the most and the least important reasons for not reporting medication errors included forgetting to report (2.80 ± 1.20) and fear over being blamed by doctors (2.03 ± 0.98), respectively. Conclusion: Nurse- and management-related factors were the most important reasons behind medication errors and not reporting them, respectively. Designing an efficient system for medication error reporting and a systematic approach for evaluating and managing error risk factors is recommended.

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Background: Parents of children with autism need to have unique competencies which are different from the competencies of parents with healthy children. Nurses and other health-care providers should know these competencies to be able to provide these parents with quality care and education. Objectives: This study aimed to define the concept of parental competence from the perspectives of parents with autistic children. The main question of the study was, “What does parental competence mean?” Methods: This qualitative study was done in 2016 on 20 parents (12 mothers and eight fathers) of 20 autistic children. Parents were purposively recruited from the Autism Association of Shiraz University of Medical Sciences, Shiraz, Iran. Data collection was done through 16 semi-structured interviews and two focus group discussions. Interviews and focus group discussions were digitally recorded, transcribed verbatim, and analyzed using conventional content analysis. Results: Data analysis led to the development of 13 subcategories, five main categories, and two main themes, namely, “restoration of family stability” and “excellence in child care.” The three main categories of the first theme were adaptation to the current situation, organization of family affairs, and improvement of satisfaction in the family. The second main theme also had two main categories, namely, self-confidence in child care and stability on the difficult path of child care. Conclusion: Parental competence among parents with autistic children is defined as “the ability to restore family stability and achieve excellence in child care.” Appropriate strategies are needed to evaluate and improve parental competence among parents with autistic children.

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Background: Medication adherence is a complex behavioral pattern affecting treatment success. A stepping stone to improve medication adherence is to determine its contributing factors. Objectives: This study intended to evaluate medication adherence and its predictors among patients with heart failure in Mazandaran Heart Center, Sari, Iran. Methods: This cross-sectional study was conducted on 300 patients with heart failure who were hospitalized from January to March 2015. Sampling was done through the census method. Data were collected using the Morisky Medication Adherence Scale and were analyzed using the Chi-square test and logistic regression analysis. Results: The mean score of treatment adherence was 5.82 ± 2.54. Medication adherence had a significant correlation with education level (P = 0.012), number of children (P = 0.013), comorbidity (P = 0.002), ejection fraction (P = 0.046), and the number of tablets used per day (P = 0.001). However, it was not significantly correlated with age, gender, employment status, place of residence, income level, and the number of hospitalizations for heart failure (P > 0.05). Logistic regression analysis showed that none of the demographic and clinical characteristics was a significant predictor of medication adherence. Conclusion: Medication adherence is affected by different factors such as education level, number of children, comorbidity, disease severity, and the number of tablets used per day. Nurses need to take these factors into account when developing care plans and patient education programs.

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Background: A number of studies on Iranian nurses' job stress or job satisfaction are available. However, studies on the relationship between these two variables among Iranian nurses are rare. Objectives: This study aimed to investigate job stress and job satisfaction among nurses working in Kashan Shahid-Beheshti Hospital, and the relationship between these two variables. Methods: A cross-sectional study was conducted on 260 nurses with 1 year experience in nursing who worked in Shahid Beheshti Hospital in Kashan, Iran, during 2015. A three-part questionnaire was used including questions on demographic variable, the organization's performance satisfaction scale, and the 35 items hospital stress scale. Descriptive and inferential statistics were used to analyze the data. Results: Among the respondents, 65.7% were female, 82.7% were staff nurse, 68.9% had a bachelor degree, and 72.8% of the respondents worked in rotating shifts. The mean overall job stress and job satisfaction scores were 109.06 ± 16.22 and 129.03 ± 17.63, respectively. A significant correlation was found between job stress and job satisfaction scores (r = 0.30, P < 0.001). Married and unmarried nurses were not significantly different in job satisfaction or in job stress scores. However, the mean job stress score was significantly higher in female nurses than in males (P = 0.042). The mean job satisfaction scores and the mean job stress scores were significantly different in nurses with various degrees (P < 0.001 and P = 0.002). The mean job satisfaction scores were significantly different in nurses with different job positions (P = 0.042). Conclusion: Nurses showed a moderate job stress score and a moderate job satisfaction. A significant correlation was found between nurses' job stress and job satisfaction. Steps should be taken by the authorities to improve the nurses' working conditions and to decrease their job stress.

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Background: No study is available on the effect of cognitive behavioral therapy (CBT) on self-esteem and quality of life (QOL) of amputee elderly patients. Objectives: This study aimed to examine the effects of CBT on self-esteem and QOL of hospitalized amputee elderly patients. Methods: A randomized controlled trial was carried out on a sample of 64 amputee elderly patients. The subjects were selected consecutively and then were randomly assigned into either the experimental or the control groups (32 patients in each group). The data collection instrument consisted of a demographic data form, the Rosenberg self-esteem scale, and the short form of the World Health Organization QOL Questionnaire (WHOQOL). Patients in the intervention group participated in six sessions of CBT and the control group received routine care. At the start and after the 3^rd week, all patients answered the Rosenberg self-esteem scale and the WHOQOL-short form. Descriptive statistics, Chi-square, Fisher's exact, and t- tests were used to analyze the data. Results: No significant differences were found between the intervention and the control groups regarding their baseline mean scores of self-esteem and QOL. The observed changes in the QOL and self-esteem of the control group were not statistically significant. However, significant statistical differences were observed between all mean differences in the two groups that indicate the positive effect of the intervention. Conclusion: The CBT employed in the present study could significantly improve the self-esteem and QOL in amputee elderly patients. The same protocol is suggested to be added into the rehabilitation process for amputee elderly patients.

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Background: Nurses' lack of knowledge about domestic elder abuse and their limited ability to recognize it can result in negative consequences. Education has the potential to improve nurses' ability to recognize elder abuse. Yet, there is no conclusive result about its effectiveness. Objectives: The main objective of the present study was to assess the effects of education on nurses' ability to recognize elder abuse. Methods: This randomized controlled trial was conducted in two public hospitals in Ramsar and Tonekabon, Iran. Participants were 120 nurses who were randomly recruited and allocated to an intervention (n = 60) and a control (n = 60) group. The study intervention was an educational program implemented in two successive 2-h sessions in 1 day. Data were collected using a demographic questionnaire and The Nurses' Recognition of Elder Abuse by Family Caregiver Questionnaire. The possible total score of the latter questionnaire was 67–335. The data were analyzed using the Chi-square, the Fisher's exact, and the paired- and the independent-samples t-tests as well as the one-way and the repeated-measures analyses of variance. Results: The mean score of elder abuse recognition ability significantly increased in the intervention group (P < 0.001), while it did not significantly change in the control group (P = 0.85). Participants had a good ability to recognize physical elder abuse and limited ability to recognize sexual abuse. Conclusion: In-service education about elder abuse for nurses not only improves their elder abuse recognition ability but also can help them take appropriate measures for its management.

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Background: Patients with breast cancer (BC) suffer from sleep disorders, pain, fatigue, and nausea after receiving chemotherapy. Objectives: The objective of this study was to assess the effects of the continuous care model (CCM) on sleep quality, pain, fatigue, and nausea among patients with BC who were receiving chemotherapy. Methods: This randomized clinical trial was conducted on 78 patients with BC who referred in April–June 2013 to the chemotherapy clinic of Ahvaz University of Medical Sciences, Ahvaz, Iran. Initially, patients were paired with each other respecting their age, type of surgery, and educational level, and then through tossing a coin, one patient in each pair was randomly allocated to the intervention and the other to the control group. The CCM was used for care provision to patients in the intervention group, while care services were provided to patients in the control group through routine methods. Data were collected 4 days after chemotherapy onset and 2 months after the intervention using a demographic questionnaire, a visual analog scale for nausea assessment, the Pittsburgh Sleep Quality Index, the Brief Fatigue Inventory, and a 10-cm ruler for pain assessment. For data analysis, the independent-sample t and the Chi-square tests were used. Results: Before the intervention, the groups did not significantly differ from each other concerning the scores of sleep quality, fatigue, pain, and nausea (P > 0.05). However, after the intervention, between-group differences of the intervention group and the controls were statistically significant for sleep quality (7.81 ± 4.50 vs. 16.80 ± 4.32, P < 0.0001), fatigue (36.23 ± 15.60 vs. 61.00 ± 12.32, P < 0.0001), pain (2.90 ± 2.82 vs. 6.81 ± 2.31, P < 0.0001), and nausea (2.16 ± 2.90 vs. 5.2 ± 2.93, P < 0.0001). Conclusion: This study proves the positive effects of the CCM on sleep quality, pain, fatigue, and nausea among patients with BC. Nurses can use this model to improve the patient outcomes.

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