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: Illnesses influence patients as well as patients' relatives and cause emotional problems, such as anger, fear, and anxiety. Determining the needs of patients' relatives increases satisfaction of patients and relatives and enhances health-care goal achievement. Objective: The objective of this study was to examine the needs of critically ill patients' relatives in emergency departments and the state of meeting these needs. Methods: This descriptive study was conducted on 202 critically ill patients' relatives at emergency department of Atatürk University Research Hospital. The data were collected using the Critical Care Family Needs Inventory for Emergency Departments (CCFNIED) and a form for meeting the needs of critically ill patients' relatives. Data were analyzed using percentage distribution, mean, analysis of variance, Mann–Whitney U test, and Kruskal–Wallis test. Results: The needs of patients' relatives according to the order of importance included communication with family members (3.88 ± 0.28), being supported (3.40 ± 0.42), being involved in care in the emergency department (3.27 ± 0.34), and comfort (3.20 ± 0.51). Using CCFNIED, the total mean score was 3.52 ± 0.31. Conclusion: Related studies are recommended to consider patients' relatives in the emergency department as a part of care, enable them to be involved in patient care, provide support for them, and enhance their comfort.

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Background: Diabetes mellitus (DM) management is challenging, particularly for people in developing countries. Objective: This study aimed to examine the effects of a home-based nursing care (HBNC) program on metabolic control among patients with type II DM. Methods: This single-blind randomized controlled trial was conducted in Hamadan, Iran, in 2014. Sixty patients with type II DM were consecutively recruited from a public diabetes care clinic in Hamadan, Iran, and randomly allocated to an experimental and a control group. Patients in the control group received usual discharge services, while their counterparts in the experimental group received HBNC services in addition to usual discharge services. The levels of fasting blood glucose, hemoglobin A_1C, total cholesterol, triglycerides, high- and low-density lipoprotein cholesterols, and systolic and diastolic blood pressures were measured before and 3 months after the intervention. Data analysis was performed through the Chi-square, the paired-sample and the independent-sample t-tests. Results: HBNC program significantly decreased the levels of fasting blood glucose (from 206.60 ± 84.93 to 141.40 ± 48.75; P < 0.001), hemoglobin A_1C(from 9.25 ± 2.19 to 7.55 ± 1.54; P < 0.001), and triglycerides (from 165.80 ± 78.96 to 126.63 ± 45.21; P < 0.01). However, it had no significant effects on total cholesterol, high- and low-density lipoproteins, and systolic and diastolic blood pressures (P > 0.05). Conclusion: HBNC is an effective strategy for managing type II DM and decreasing the risk of its complications.

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Background: Cancer is a serious illness which can cause significant complications such as mental disorders. Objective: This study aimed to investigate the effects of stress-coping strategies (SCS) and life skills (LS) trainings on mental health and academic progress among adolescent cancer patients. Methods: This quasi-experimental study was conducted on 120 Iranian adolescent cancer patients. Participants were randomly allocated to a control (n = 60) and an experimental group (n = 60). A demographic questionnaire and the General Health Questionnaire were used to collect data on adolescents' mental health and grade point average (GPA) both before and after study intervention. A SCS and an LS training programs were held for the adolescents in the experimental group. However, adolescents in the control group received no training about the strategies and skills. The Chi-square, the Fisher's exact, as well as the independent- and the paired-sample t-tests were used for data analysis. Results: In the experimental group, the mean scores of the somatic symptoms, anxiety/insomnia, depression, and social dysfunction subscales of mental health were 8.91 ± 6.17, 10.33 ± 5.43, 15.33 ± 7.34, and 16.23 ± 3.61 at baseline and significantly decreased to 4.71 ± 2.51, 6.61 ± 2.62, 11.05 ± 2.84, and 12.31 ± 5.45, respectively (P < 0.05), while the mean GPA significantly increased after the study (P < 0.05). However, in the control group, neither mental health nor GPA changed significantly (P > 0.05). Conclusion: SCS and LS trainings can promote mental health and academic achievement among adolescent cancer patients.

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Background: Postpartum depression with high prevalence and unpleasant complications needs to be identified and treated. Objective: This study aimed to compare the effect of problem-solving therapy (PST) and relaxation on the severity of postpartum depressive symptoms. Methods: This randomized controlled trial was performed in health-care centers of Mashhad city, Iran, in women on the 3^rd postpartum week. A total of 120 women were selected conveniently and randomly assigned to three groups (i.e., PST, relaxation, and control groups). The women completed Edinburgh Depression Scale and Beck Depression Inventory (BDI). Problem-solving skills were educated during six weekly sessions. Progressive muscle relaxation exercises and guided imagery were performed daily and once a week during 6 weeks, respectively. In the control group, women received usual postpartum care. All groups completed a daily checklist for recording depression symptoms. The three groups completed the BDI once again a week after the end of the intervention. Data analysis was conducted using Chi-square, paired t-test, analysis of variance (ANOVA), and repeated measures ANOVA. Results: The mean difference of severity of depressive symptoms was significantly different between the three groups at 9 weeks after delivery (−14.86 ± 6.15 in PST group, −10.71 ± 5.23 in relaxation group, and −4.72 ± 4.51 in the control group, P < 0.001). The frequency of mild depression decreased from 57.1% to 3.8% in PST group, from 65.4% to 23.1% in the relaxation group, and from 60.7% to 33.3% in the control group. Conclusion: Both PST and relaxation can reduce the severity of depressive symptoms. However, the effects of PST were more than those of relaxation.

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Background: The available instruments for work–family conflict measurement are not specific to women. Objective: The current study was conducted to design and psychometrically evaluate a married women's work–family conflict questionnaire (MWWFCQ). Methods: This study consisted of two phases. The first phase was item generation and questionnaire design. In this phase, a qualitative approach was used to develop items. Seventeen in-depth individual interviews and two group discussions were carried out and available texts and questionnaires were reviewed to generate the items. The second phase was item reduction and psychometric evaluation of the formulated questionnaire including, face, content, and construct validity and reliability assessment. For the assessment of construct validity, a cross-sectional study was performed. Participants included 400 employed married women with different jobs living in Bushehr Province that were recruited through cluster sampling. Results: In the first step, 108 items were generated. After assessing face and content validity, 39 items were remained. In the exploratory factor analysis, two items were removed. This analysis revealed a four-factor structure for the scale that altogether explained 45.87% of the total variance. Cronbach's alpha was 0.926 for the total scale. The interclass correlation coefficient between the test and retest was 0.983. Conclusion: The 37-item MWWFCQ is a questionnaire with acceptable reliability and validity and can be used in studies on married women.

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Background: Risk of diabetes mellitus is higher in women with a history of gestational diabetes mellitus (GDM). Postpartum diabetes screening is recommended in women with GDM. However, the rate of this screening is low. Objectives: The purpose of this study was to perform an in-depth exploration of perceived facilitators of attendance to postpartum diabetes screening in women with recent GDM. Methods: This qualitative study was conducted in 2016 in Tehran. Semi-structured interviews carried out with 22 women with a recent GDM who gave birth at least 6 months before the interview. Results: Four main categories were emerged from the data. Each category included two to three subcategories. The first category was appropriate education and included two subcategories of prenatal education and postpartum education. The second category was feeling the ease of screening and included two subcategories of spousal support, and appropriate laboratory facilities. The third category was self-regulation and included three subcategories of importance of health, a desire toward learning about health, and proper planning. The fourth category was attitudes toward the screening and included three subcategories of initial fear better than consequences, feeling comfortable, and uncertainty regarding glucometers' accuracy. The last category was perceived threat and included three subcategories of fear of developing diabetes, being healthy to serve the child/children, and being healthy for other roles. Conclusion: Iranian women with recent GDM reported several facilitators for diabetes postpartum screening. Further studies are suggested.

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