Background: The declining levels of estrogen during menopause are linked with numerous somatic and psychological complications. Objectives: This study aimed to examine the effect of Nigella sativa (N. sativa) oil on early menopausal symptoms and serum levels of some oxidative markers in postmenopausal women. Methods: This randomized placebo trial was conducted on 72 menopausal women aged 45–60 years. Participants were randomly allocated to placebo and intervention groups with an equal allocation ratio (1:1). Patients in the intervention group received one N. sativa oil capsule (1000 mg), whereas the placebo group received a placebo capsule at night for 8 weeks. Data were collected through the demographics questionnaire, the Greene's Climacteric Scale, and a form for recording the number of daily hot flashes. Furthermore, the serum levels of total antioxidant capacity (TAC) and malondialdehyde (MDA) were measured before and 8 weeks after the intervention. Data were analyzed using the independent-samples t, Chi-square, Mann-Whitney U, and Friedman tests as well as the repeated-measures analysis of variance. Results: The participants were matched in baseline values. The mean baseline score of the Greene's scale was 22.5 ± 9.5 in the intervention group and 20.0 ± 8.0 in the placebo group (P = 0.397). Mean scores had significantly reduced in both groups at the end of weeks 4 and 8. However, the intervention group experienced a more remarkable decrease in Greene's score (adjusted MD_Log10 = −0.16 (−0.29 to −0.05); P = 0.019). There were no significant differences between the two groups in the subscales of Greene's scale (P > 0.05). No significant difference was observed between the groups in serum levels of TAC (P = 0.250) and MDA (P = 0.444). Conclusion: N. sativa reduced the total score of menopausal symptoms and hot flashes in menopausal women; however, it had no significant effect on the serum levels of oxidative stress markers.

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Background: Pressure ulcer (PU) is a common problem in intensive care unit (ICU). Risk assessment is the first step to PU prevention. Nonetheless, there is no consensus over the best PU risk assessment scale. Objectives: The objective of the present study was to compare the accuracy of the Braden and the Waterlow scales in predicting the risk of PU in ICU. Methods: This cross-sectional study was conducted in 2019 on 186 patients hospitalized in ICUs of Tohid and Kowsar teaching hospitals, Sanandaj, Iran. The Braden and the Waterlow scales were simultaneously used by two trained nurses for daily PU risk assessment for 15 consecutive days. The predictive validity of the scales was assessed in terms of sensitivity, specificity, and positive and negative predictive values. Results: The mean of participants' age was 55.6 ± 20.3 years. In total, 102 participants (54.8%) developed PU during the study. The sensitivity and the specificity of the Braden scale at the cutoff score of 18 were 97% and 34.5% and the sensitivity and the specificity of the Waterlow scale at the cutoff score of 10 were 95% and 28.5%, respectively. Conclusion: Compared with the Waterlow scale, the Braden scale has a slightly better predictive validity for PU risk assessment.

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Background: Sleep disorders and compassion fatigues are two main physical and psychological problems among nurses, particularly during the coronavirus disease 2019 (COVID-19) pandemic. Objectives: The aim of this study was to assess the effects of acupressure on sleep quality and compassion fatigue among emergency and critical care nurses during the COVID-19 pandemic. Methods: This randomized controlled trial was conducted in 2020. Participants were eighty nurses recruited from two hospitals in Iran and randomly allocated to control and intervention groups. Acupressure on the Shenmen point was self-administered by participants twice daily for 30 days. The Pittsburg Sleep Quality Index and the Nurses' Compassion Fatigue Inventory were used for data collection before and after the intervention. Data analysis was done using the paired-sample t, independent-sample t, Chi-square, and Mann–Whitney U tests as well as the analysis of covariance. Results: The mean score of the subjective sleep quality, sleep latency, sleep duration, and sleeping medication dimensions of sleep quality significantly decreased in the intervention group (P < 0.05). Moreover, despite no significant between-group difference respecting the pretest mean scores of sleep quality and its dimensions (P > 0.05), the posttest mean scores of sleep quality and its subjective sleep quality, sleep latency, sleep disturbances, and sleeping medication dimensions in the intervention group were significantly less than the control group (P < 0.05). Conclusion: As a noninvasive technique, acupressure can be used to significantly improve sleep quality among nurses during the COVID-19 pandemic.

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Background: Hypothermia appears predominant among low birth weight (LBW) newborns. This condition tends to instigate severe medical complications, including acidosis, cerebral hemorrhage, hypoglycemia, and hyaline membrane disease. Objective: The purpose of this study was to examine the effectiveness of swaddling technique in hypothermia prevention among LBW neonates. Methods: This randomized controlled trial was conducted on 40 recent babies (20 controls and 20 interventions), using a pre- and post-test design. In the intervention group, a polyethylene swaddling was used, and in the control group, a cloth swaddling was used. Digital axillary thermometer was used to detect the body temperature. Mann–Whitney U-test and Wilcoxon test were employed to examine the temperature difference between the two groups. Results: This observation showed a trend toward improvement in average temperature in the intervention group (pre 34.8°C, post 36.4°C) compared to the control group (pre 33.3°C, post 34.9°C). There were significant within-group changes in both groups (P < 0.05) although no significant difference was found between the two groups (P = 0.267). Conclusions: Both polyethylene and cloth swaddling methods showed improvement in neonate temperature. These methods are therefore highly recommended as alternatives in hypothermia prevention among LBW infants.

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Background: Patients with traumatic brain injury (TBI) experience changes in their level of consciousness (LOC). Royal Jelly is used in the treatment of neurological diseases. Objective: This study aimed to examine the effect of royal jelly on the LOC of patients with TBI. Methods: This double-blind randomized trial was performed in 2020 on 61 patients with TBI admitted to the intensive care unit. The patients were recruited consecutively and randomly assigned to an intervention (n = 33) and a control (n = 28) group. Patients in the intervention group received 3000 mg of royal jelly orally each day for 14 days, while those in the control group received routine care. The LOC was evaluated using the Glasgow Coma Scale (GCS) and Full Outline of Unresponsiveness (FOUR) score from day 1 to day 14. Data were analyzed using the repeated measures analysis and analysis of covariance. Results: The mean baseline GCS scores of the intervention and the control group were 4.39 ± 0.61and 4.82 ± 0.77, respectively, and changed to 11.93 ± 2.41 and 7.60 ± 2.51 at the end of the 14^th day (P < 0.001). Furthermore, the mean baseline FOUR scores of the intervention and the control groups were 6.06±0.93 and 6.42 ± 1.16, respectively, and changed to 13.88 ± 2.57 and 9.71 ± 2.40 at the end of the study (P < 0.001). Conclusion: Using royal jelly for 2 weeks could improve the LOC of patients with TBI. However, further studies are recommended to determine the dose and duration of the usage.

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Background: Family caregivers of patients with cancer deal with high levels of psychological distress. Objectives: This study aimed to investigate the effect of online mindfulness self-compassion (MSC) training programs on psychological distress in family caregivers of patients with cancer. Methods: This quasi-experimental study was conducted in 2020 on 92 family caregivers of patients with cancer. The participants were conveniently recruited from the family caregivers of patients referred to Seyed Al-Shohada Oncology Hospital, in Isfahan, Iran, and randomly allocated to two groups to receive either 1.5 months of online MSC training program or be treated as usual. All participants completed the Kessler psychological distress scale before, immediately after, and 1 month after the intervention. Data were analyzed using the Mann–Whitney U, Chi-square, repeated measures analysis of variance, t, and least significant difference post hoc tests. Results: The mean baseline psychological distress scores were 36.39 ± 4.71 and 35.97 ± 4.06 in the intervention and control groups, respectively (P > 0.05). Immediately after the intervention and 1 month after, the mean scores of psychological distress decreased significantly in the intervention group to reach 26.30 ± 3.91 and 27.73 ± 3.49 (P < 0.001), but no significant changes were found in the mean distress scores of the control group in the second and third measurements. Conclusion: The implementation of an online MSC training program reduced the psychological distress of family caregivers of patients with cancer. Therefore, the same program can be implemented to support such caregivers.

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Background: Hospitalization induces anxiety and causes sleep disorders in children. Objective: This study aimed to examine the effects of listening and reading a tale on anxiety and sleeping onset time (SOT) among hospitalized children with fracture. Methods: This randomized clinical trial was conducted on 102 children with extremity fracture in Shohada Hospital of Tabriz in 2018–2019. Subjects were recruited consecutively and randomly allocated into three groups: control, storytelling, and simultaneous listening to and reading a tale. The data were collected using a demographic information questionnaire: questions on SOT, heart rate, and the Reynolds and Richmond Children's Anxiety Questionnaire. One-way analysis of variance, paired t-test, Chi-square and Fisher's exact test, and analysis of covariance were used to analyze the data. Results: Mean SOT, mean anxiety, and mean pulse rate did not significantly differ between the three groups at baseline. After the intervention, the mean SOT and mean pulse rate decreased significantly in all three groups (P < 0.001); however, the between-group differences were not statistically significant (P > 0.50). The mean manifest anxiety did not change significantly in any of the groups (P > 0.05). Conclusion: Storytelling had no effect on anxiety, heart rate, and SOT of children with fractures. Further studies can help determine the best method of storytelling for children with fractures.

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Background: Postoperative shoulder pain is one of the complications after laparoscopic cholecystectomy (LC). Medications used to treat shoulder pain have side effects. Objectives: The aim of this study was to examine the effect of lavender oil aromatherapy on shoulder pain after LC. Methods: In this single-blind randomized controlled trial, 64 patients who underwent LC were randomly allocated into two groups to receive lavender oil aromatherapy or routine treatment. The intervention began in the recovery room after the patient responded to stimuli. First, the patient's pain was assessed. Then, aromatherapy was started for the intervention group, and afterward, pain measurement was repeated at 5, 25, and 60 min after the intervention. The pain intensity was assessed using a visual analog scale. Patients in the control group received no intervention other than routine care and treatment, but their pain intensity was measured at the same time as patients in the intervention group. Data analysis was performed using the Chi-square, independent-samples and paired t-tests, and repeated-measures analysis. Results: The mean baseline pain severity of the control and aromatherapy groups was 6.26 ± 1.44 and 7.20 ± 1.44, respectively, and changed to 9.06 ± 0.65 and 3.73 ± 0.86 at the end of the study. Repeated-measures analysis showed that over time, the mean pain intensity was decreasing in the intervention group (P < 0.05), while it had an increasing trend in the control group. Conclusion: Lavender oil aromatherapy was effective in reducing the postsurgical shoulder pain after LC.

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Background: Nurses' caring behaviors (CBs) are affected by several factors, including their moral intelligence (MI). However, nurses' MI and its association with their CBs have not been well studied, and the published studies have also found conflicting results. Objective: This study aimed to determine the association between nurses' MI and their CBs. Methods: A descriptive, correlational study was conducted on nurses and patients in Urmia, Iran, in 2020. Using random sampling, 100 nurses and 300 patients were recruited for the study. Demographic characteristic form, the Lennick and Kiel Moral Competency Index, and the CB Inventory were used to collect data. Descriptive statistics and the Pearson's correlation test were used to analyze the data. Results: A direct correlation was found between the total scores of MI and CB (r = 0.54, P < 0.001). Furthermore, the subscales of MI were correlated with the most subscales of CB, including ensuring human respect, respect for others, and attentiveness to the other's experience (P < 0.05). Conclusion: Authorities should establish in-service training programs to strengthen the nurses' MI and CBs.

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Background: Medication errors (MEs) threaten patient safety and can lead to patient death. Some studies have shown the relationship between spirituality and professional commitment, but no study has been conducted on the relationship between nurses' professional commitment, spiritual well-being, and MEs. Objectives: This study aimed to examine the relationship between nurses' professional commitment, spiritual well-being, and MEs. Methods: This cross-sectional study was conducted in 2018 on 326 nurses working in educational hospitals of Urmia University of Medical Sciences, Urmia, Iran. Data were collected using four questionnaires, including a demographic data form, a researcher-made self-report questionnaire about nurses' MEs, the Palutzian and Ellison Spiritual Well-being Questionnaire, and the Nurses' Professional Commitment Scale. The Pearson correlation coefficient, independent samples t-test, analysis of variance, and regression analysis were used to analyze the data. Results: The mean ME in the past 3 months was 1.1 ± 1.64. The mean professional commitment and spiritual well-being were also 30.67 ± 7.6 and 56.99 ± 13.8, respectively. Significant correlations were found between spiritual well-being and MEs (r = −0.32, P < 0.001), but no significant correlation was found between professional commitment and MEs (r = 0.035, P = 0.52). However, a significant correlation was observed between professional commitment and spiritual well-being (r = 0.3, P < 0.001). Conclusion: Higher professional commitment among nurses would enhance their spiritual well-being and reduce MEs. Professional commitment may promote spiritual well-being, resulting in fewer MEs as an indirect effect.

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Background: Patients receiving hemodialysis experience high levels of anxiety and stress. Objectives: This study aimed to examine the effect of humor on anxiety in patients receiving hemodialysis. Methods: This open-label, randomized, controlled trial was conducted in 2018, on 63 patients receiving hemodialysis in Sabzevar, Iran. The participants were randomly assigned to an intervention and a control group using a permuted block randomization method. The intervention group participated in humor therapy sessions twice a week for 3 weeks. The control group received no intervention. Data were collected using Spielberger's State-Trait Anxiety Inventory (STAI) before and 3 weeks after the intervention. Data were analyzed using the independent samples and the paired t tests. Results: The mean age of the participants was 61.85 ± 7.93 and 54.61 ± 5.89 in the intervention and control groups, respectively (P = 0.217). The mean baseline and posttest trait anxiety (TA) scores were not significantly different between the two groups (P = 0.152 and 0.170, respectively). Also, the mean baseline scores of state anxiety (SA) in the intervention and the control groups were 48.45 ± 14.21 and 47.28 ± 15.12, respectively (P = 0.133). However, after the intervention, the mean score of SA decreased to 27.45 ± 16.65 in the intervention group (P < 0.001), but this score increased to 49.43 ± 15.42 in the control group (P = 0.227). Conclusion: Humor therapy was effective in reducing SA. Hence, nurses working in hemodialysis departments are advised to use humor therapy as an easy, low-cost, and effective complementary therapy to reduce patients' anxiety during a hemodialysis session.

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Background: Cardiovascular disease is the most common chronic disease and the leading cause of death in the world. Stress and anxiety are among the most important risk factors of cardiovascular disease. Objectives: The aim of this study was to assess the effects of ceiling display and natural sounds on stress and anxiety among cardiac patients. Methods: This randomized controlled trial was conducted in 2018–2019 in the coronary care units (CCUs) of two teaching hospitals affiliated to Kerman University of Medical Sciences, Kerman, Iran. Participants were 220 cardiac patients randomly allocated through block randomization to four 55-person groups, namely ceiling display group, natural sounds group, combined ceiling display and natural sounds (display sound) group, and control group. The Spielberger State-Trait Anxiety Inventory and the Perceived Stress Scale were used for data collection at the beginning of the study and at the time of discharge from CCU. Data were analyzed by the Chi-square and paired-sample t-tests and the analysis of variance. Results: The mean scores of state and trait anxiety and stress significantly decreased in all intervention groups (P < 0.05) and did not significantly change in the control group (P > 0.05). There were significant differences among the groups respecting the posttest mean scores of state and trait anxiety and stress (P < 0.05). The posttest mean scores of state and trait anxiety in the combined display-sound group and the posttest mean scores of stress in the natural sounds group were significantly less than other groups. Conclusion: Ceiling display and natural sounds are effective in significantly reducing state and trait anxiety and stress among cardiac patients in CCU and their combination produces more significant effects.

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Background: One strategy that parents use to achieve peace and recovery following the death of a child is to continue bonding with their dead children. Older adults with the death of a child are a vulnerable group, but no study has been conducted on them in Iran. Objectives: The current study aimed to explore the relationship between older adults and their dead children. Methods: This qualitative study utilized the grounded theory method. The data were gathered through purposive sampling during 2020–2021. Semi-structured interviews were conducted with 13 older adults who had experienced a child death. The method of Corbin and Strauss (2015) was used to analyze the data. The Guba and Lincoln criteria were used to ensure the data trustworthiness. The data were managed using MAXQDA12. Results: The participants' mean age was 68.30 ± 7.39 years, and 76.9% of them were female. The findings were categorized into three major categories and nine subcategories. The three major categories of “staying connected with the dead child,” “attempting to seek peace for the dead child,” and “keeping the child's memories alive” emerged from the participants' experiences, along with the theme of “unbreakable bond with the child.” Conclusion: As a protective strategy, the continuing bond between the older parents and their dead children aided in their adjustment. It is suggested that health-care providers facilitate the acceptance of child death in these older adults through providing group counseling and reminiscence sessions.

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Background: Over-the-counter use of herbal products puts patients with cardiovascular diseases (CVDs) at risk for drug interactions. Belief and attitude have significant effects on behavior. Objectives: This study was conducted to develop and evaluate the psychometric properties of the Belief and Attitude about Herbal Medicine Inventory (BAHMI). Methods: In this methodological study, the BAHMI draft was developed based on the approach of Waltz and colleagues and using the existing instruments and the three main theory of planned behavior subscales. After face and content validity assessment, BAHMI construct and concurrent validity were assessed. Accordingly, 200 patients with CVD were consecutively recruited from a heart clinic in Kashan, Iran, 2018. BAHMI reliability was also assessed through the internal consistency and the test–retest methods. Results: The BAHMI draft included 40 items. Seven items were excluded during psychometric evaluation phases. Exploratory factor analysis revealed a five-factor structure for BAHMI which explained 42.636% of the variance of its total score. The correlation coefficient between the scores of BAHMI and Hashem-Dabaghian and colleagues' questionnaire was –0.7 (P < 0.0001). BAHMI mean score was significantly different among patients with different levels of agreement on herbal product use (F = 19.16, P < 0.0001). Cronbach's alpha, intraclass correlation coefficient, standard error of measurement, and smallest detectable change of BAHMI were 0.864, 0.888, ±13.46, and 10.2, respectively. No participant obtained the minimum and maximum possible BAHMI scores. Conclusion: The 33-item BAHMI is a valid and reliable instrument for the assessment of belief and attitude about herbal medicine among patients with CVD. The findings of this study can be used for health policy-making and planning.

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