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   Table of Contents - Current issue
November-December 2021
Volume 26 | Issue 6
Page Nos. 469-573

Online since Friday, October 22, 2021

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Evaluation of couple's sexual function after childbirth with the biopsychosocial model: A systematic review of systematic reviews and meta-analysis Highly accessed article p. 469
Saiedeh Sadat Hajimirzaie, Najmeh Tehranian, Fatemeh Razavinia, Ahmad Khosravi, Afsaneh Keramat, Arezoo Haseli, Mehdi Mirzaii, Seyed Abbas Mousavi
Background: After childbirth, sexual dysfunction refers to a chain of psychiatric, physiological, social changes and a couple's experiences. The purpose of our Systematic Review (Syst.Rev.) is to evaluate available high-quality evidence and construct a Bio Psycho Social (BPS) model of couple's sexual function after childbirth. Materials and Methods: A systematic search was done with MeSH terms in databases, including PubMed, Web of Science, Scopus, and Science direct. A total number of 9 Syst.Rev. were evaluated from 2009 to 2019 years. The quality of extracted articles was evaluated based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist of contents using two qualified reviewers. Data synthesis was performed using the thematic analysis. Results: Biopsychosocial Model of Postpartum Couple's Sexual Function (BMPCSF) is proposed as a developmental process similar to Bronfenbrenner's Bioecological Systems Model. Studies showed a significant relationship among the type of childbirth, trauma of perineum, breastfeeding, mood swings, fears, changes in the self-body image, spousal support, and Postpartum Sexual Dysfunction (PSD). Hence, the evidence about male sexuality in the postpartum period doesn't seem sufficient. Conclusions: The information from this study will help health policymakers develop the appropriate guidelines to inform couples and healthcare professionals about the BPS changes after childbirth and PSD. Besides, BMPCSF can be used in postpartum sexual counseling to improve sexual health and marital relationships. We propose comprehensive original study on couples' postpartum sexuality, especially men's conduct, emphasizing socio-cultural factors.
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Patient commitment to cardiac rehabilitation: A qualitative study Highly accessed article p. 479
Neda Sanaie, Ali Darvishpoor-Kakhki, Fazlollah Ahmadi
Background: Commitment to Cardiac Rehabilitation (CR) is one of the essential strategies to reduce the long-term complications of cardiovascular disease. The attributes of patients' commitment have not been defined distinctly. Thus, the present study aimed to describe the attributes of commitment to CR from the participants' perspective. Materials and Methods: This qualitative study was carried out in Tehran from 2018 to 2019. Data were collected using semi-structured interviews with 30 participants, including 13 CR specialists, 13 patients, and four caregivers, through purposeful sampling. The analysis was performed through the conventional content analysis using the Elo and Kyngäs approach. Results: Commitment to CR has one theme titled the attitudinal-motivational aspect that consists of four categories including attitudinal-cognitive, attitudinal-behavioral, attitudinal-emotional, and motivational as the core features. The commitment to CR is devotion, internal desire, and voluntary obligation to initiate and continue CR cooperatively, all of which are accompanied by the purposeful initiation of the treatment plan. Conclusions: The patient's commitment to CR is an intrinsic interest in achieving health that stems from the acceptance of the disease and the need for treatment. Besides, the rehabilitation team facilitates purposeful interpersonal relationships between the patient and the treatment group. It provides the basis for the patient's active efforts to meet the challenges of the treatment process.
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The effects of cool dialysate on vital signs, adequacy and complications during hemodialysis p. 487
Fatemeh Ahmadi, Tahereh Toulabi, Mahbobeh Sajadi, Farzad Ebrahimzadeh
Background: Cooling the dialysate is an important factor that contributes to the hemodynamic stability in patients during hemodialysis. The aim of this study was to determine the effect of cool dialysate on vital signs, and the adequacy and common complications of hemodialysis. Materials and Methods: The present crossover, triple-blind, clinical trial was performed on 62 dialysis patients, who were selected through stratified block randomization. First, one group underwent hemodialysis using a cool dialysate (35°C), and the other received routine hemodialysis (36.5°C). Each patient received a total of eight hemodialysis sessions. Then, treatment methods were swapped, and each group received the other group's method. The patients' blood pressure, pulse rate, and temperature were measured before dialysis, and in the first, second, third, and fourth hours of dialysis. The frequency of common complications of hemodialysis and dialysis efficacy were measured. The marginal model and Generalized Estimating Equations (GEE) were used to analyze the data. Results: The participants' systolic (p = 0.01) and diastolic blood pressures significantly increased with a decrease in temperature (p = 0.005). The patients' pulse rate (p = 0.143), adequacy of dialysis (p = 0.922), and common complications of hemodialysis did not significantly differ between the two temperatures (p > 0.05). Conclusions: Reducing dialysate temperature from 36.5 to 35°C led to hemodynamic stability; the blood pressure of the patients undergoing hemodialysis was more stable with the cool dialysate method and the number of drops in the blood pressure during the hemodialysis was reduced.
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Factors predicting mothers' intention toward human papilloma virus vaccination of adolescents: A cross-sectional study among iranian families p. 495
Nezal Azh, Kazem Hosseinzadeh, Amir Javadi, Samaneh Gholami-Toranposhti
Background: Adolescents are prone to Sexually Transmitted Diseases (STDs) such as Human Papilloma Virus (HPV). Although HPV is a preventable disease, the vaccination rate is low. As parents should vaccinate their children to prevent HPV, the goal of this study was to identify the factors related to mother's intention to vaccinate adolescents against HPV. Materials and Methods: This cross-sectional study was performed in Qazvin from 2019 to 2020. The participants included 126 literate mothers who had a daughter between 12 and 14 years and health system information registry. To collect the data, a questionnaire was made based on the educational model of behavioral intent. Parents were interviewed in person in health centers or via phone at home. Data were analyzed using Spearman's correlation. Results: The mean (SD) age of the mothers, fathers, and girls were 39.60 (6.18), 43.51 (7.58), 13 (0.82) years, respectively. They hadn't received education regarding HPV. The mean (SD) of the knowledge, attitude, and HPV vaccination intention scores were 27.77 (18.08), 67.38 (10.25), and 15.44 (18.44), respectively. The factors related to HPV vaccination intention were parents' knowledge (r = 0.29, p = 0.001), positive attitude (r = 0.22, p = 0.010), parents' education (r = 0.22, p = 0.050) and family income (r = 0.21, p = 0.010). Conclusions: The high cost of vaccines, economic problems, and lack of knowledge were strong limitations for HPV vaccination. Thus, health workers should have informed parents and teens of the benefits of HPV vaccination. This process should be supported by policy makers.
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Comparison of maternal-infant attachment in cesarean delivery based on robson classification: A cross-sectional study p. 500
Zohreh Rookesh, Maasumeh Kaviani, Mahnaz Zarshenas, Marzieh Akbarzadeh
Background: The Robson criteria allows for standardized comparisons of data and possible driving changes in Cesarean Section (C/S) rates and complications. The aimed to compare maternal-infant attachment in C/S based on Robson Classification. Materials and Methods: This cross-sectional prospective study was conducted on 369 women who had undergone C/S in Hazrate Zeinab Peace Be Upon Him (PBUH), Hafez, and Shooshtari hospitals affiliated to Shiraz University of Medical Sciences, Iran from April 2018 to March 2019. The study data were collected using a demographic form, an obstetric form, and Avant Checklist (AC) at postpartum and pre-discharge stages. Each participant was placed in Robson classification and the attachment score was calculated in each Robson Classification, and a comparison was made among the 10 groups. The data were analyzed into the SPSS 16 software and using descriptive statistics and paired t test. Results: The total mean (SD) score of attachment was 38.73 (18.65) at 1–7 h postpartum and 90.52 (23.79) at pre-discharge. The highest total mean (SD) score of attachment was observed in group 6 (86.78 (8.70) at postpartum and 118.67 (4.47) at pre-discharge). The lowest total mean (SD) score of attachment was observed in group 10 (12.79 (2.37) at 1–7 h postpartum and 45.44 (7.99) at pre-discharge). Conclusions: Obstetric characteristics in Robson Classification, parity, previous C/S, gestational age, onset of labor, fetal presentation, and number of fetuses were effective in clarifying information. The use of this system is necessary to determine the causes of increased C/S cases in low-income and middle-income countries.
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The omission of some patterns of knowing in clinical care: A qualitative study p. 508
Forough Rafii, Alireza Nikbakht Nasrabadi, Fereshteh Javaheri Tehrani
Background: Providing holistic and humanistic care to patients requires a variety of factors. A care solely based on objective knowledge might be unsafe and of low quality. Using the patterns of knowing in an integrated manner and relative to the context of caring is one of the necessities for proving a holistic and efficient nursing care. This study aimed to explore the role of patterns of knowing in the formation of uncaring behaviors. Materials and Methods: The researchers used a qualitative research design for this study. Participants included 19 clinical nurses who attended semi-structured and in-depth interviews. In addition, theoretical and purposeful sampling methods were used in this research. Observation of caring processes in different hospital wards was another method used for collecting data. The data analysis was carried out according to conventional content analysis technique. Results: The study findings revealed five categories for the theme of “omission of some patterns of knowing” including omission of scientific principles, omission of therapeutic relationship, omission of ethics, omission of social justice, and omission of flexibility. Conclusions: The omission of some patterns of knowing creates an ugly image of nursing and a negative outcome of caring as well.
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Effect of health belief model-based education on infection control standard precautions in prehospital emergency staff: A clinical trial study p. 515
Roya Amini, Mahnaz Mohamadkhani, Masoud Khodaveisi, Manoochehr Karami
Background: Standard precautions are a basic strategy to prevent occupational exposure in prehospital emergency staff. The Health Belief Model (HBM)-based education can be used to promote and educate health behavior. The aim of this study was to investigate the effect of the HBM-based education on infection control standard precautions in prehospital emergency technicians. Materials and Methods: This clinical trial study was conducted on 84 prehospital emergency staff of Hamadan who were randomly assigned to two groups: Experimental (n: 42) and control (n: 42) using a cluster method. The data were collected by a researcher-developed questionnaire. Before education, the questionnaires were completed by both groups, and then three educational sessions were held for the experimental group within one month. Two months after the intervention, the two groups completed the questionnaire and the data were analyzed by SPSS 21 software. Results: Before education, there was no significant difference in the mean scores on HBM constructs and performance between the two groups (p > 0.05). The results of the Analysis of Covariance (ANCOVA) after educational intervention showed there was a significant difference in the mean scores of all constructs and performance between the two groups (p < 0.05). Conclusions: HBM-based educational intervention could affect the scores of the model's constructs and improve the use of standard precautions in emergency medical technicians. In-service training is recommended to be developed for the staff based on HBM.
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Comparison of the effects of nika vaginal cream with clotrimazole cream on vaginal candidiasis symptoms: A randomized single-blind clinical trial p. 521
Hamideh Parsapour, Seyedeh Zahra Masoumi, Arezoo Shayan, Shirin Moradkhani, Seyed Amir Ghiasian, Mohammad Kazem Rashidi
Background: The prevalence of vaginal candidiasis is high in women and proper treatment is essential in this regard. Materials and Methods: This single-blind randomized controlled clinical trial was conducted on 120 women who were referred to Hamadan health centers in 2019. The patients were randomly divided into Clotrimazole cream and Nika vaginal cream groups each including 60 cases. The intervention group received Nika vaginal cream once a day for a week and those in the control group were given Clotrimazole vaginal cream in the same way. The clinical symptoms were studied by clinical examinations and the culture of vaginal discharge before and 7 days after the treatment to confirm the diagnosis of Candida albicans. The results were analyzed by SPSS 21.0 using an independent t test, Mann–Whitney U test, and Chi-square, Fisher's exact, and McNemar's tests, the significance level was set at 0.05. Results: Most patients in both groups reported no clinical symptoms after the intervention, and no significant difference was observed between the two groups in this regard (χ2 = 2.23, p = 0.566). Conversely, a significant difference was found in Nika and Clotrimazole groups before and after the intervention regarding improving Vulvovaginal Candidiasis (VVC) symptoms χ2 = 86.01, χ2 = 99.41, respectively (p < 0.001). Finally, 84.48% and 75.86% of women in the Nika χ2 = 45.02 (p < 0.001) and Clotrimazole cream χ2 = 40.02 (p < 0.001) groups had negative culture results after the intervention. Conclusions: In general, the Nika and Clotrimazole vaginal creams have the same effects concerning improving the symptoms of vaginal candidiasis and thus can be used to treat VVC.
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Perceived child abuse and neglect in hospitalized children with special health care needs in Iran p. 526
Niloofar Bahrami, Maryam Tork-Torabi, Reza Sotoudeh, Mahboobeh Namnabati
Background: Child Abuse and Neglect (CAN) is an important public health concern. Nurses play a key role in caring for the children and keeping them safe from abuse and neglect. The aim of this study was to determine the rate of perceived CAN in Hospitalized Children with Special Health Care Needs (CSHCN) as well as the relationship between the rate and some effective factors. Materials and Methods: This is a descriptive cross-sectional study on 199 CSHCN aged 6–18 years old, admitted to the pediatric wards in an educational hospital, in Isfahan, Iran, in 2018. Children were selected through convenience sampling method and assessed for CAN through a child abuse questionnaire. The Pearson correlation coefficient and Kruskal–Wallis and Mann–Whitney U tests were used to analyze the data. The p values smaller than 0.05 were regarded as significant. Results: According to the findings, 173 children (86.93%) had perceived CAN, the average total score of which was 9.36 contributing commonly to malnutrition 3.01 (2.36) followed by psycho-emotional abuse 2.71 (1.76), neglect 1.62 (1.23), and physical 1.52 (1.08) and sexual 0.54 (0.31) abuse based on mean (SD). Statistical analysis indicated a significant effect of child's age, economic situation of the family, mother's education and occupation, and parents' illness on the total score of perceived CAN (p < 0.05). Conclusions: Malnutrition was found to be the most common type of perceived CAN. Therefore, parents and the health system are advised to prioritize nutritional needs when planning their nutrition.
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The effect of emotional freedom technique on fatigue among women with multiple sclerosis: A randomized controlled trial p. 531
Zeinab Ghaderi, Fatemeh Nazari, Vahid Shaygannejad
Background: This study aimed to investigate the effect of Emotional Freedom Technique (EFT) on the severity of fatigue among women with Multiple Sclerosis (MS). Materials and Methods: This was a single-blind, randomized controlled trial study conducted on 50 women with MS in Isfahan, Iran. Sampling was performed using simple sampling method, then the participants were randomly divided into two groups of case and sham using the minimization method. The EFT intervention was performed on the case group, 2 sessions per week for a 4-weeks period. In the sham group, with the same psychological part of the EFT technique like case group, mild tapping was applied on false points for the same period of time. Fatigue severity score was obtained using the Fatigue Severity Scale (FSS) before and immediately and 4 weeks after the intervention in the two groups. Data analysis was conducted using descriptive and inferential statistical methods. Results: The results of the independent t-test indicated that the mean (SD) score of fatigue severity before the intervention was not significantly different between the case and sham groups 5.48 (0.75) and (5.39 (0.71) with (p = 0.67). However, this difference was significant immediately [(3.05 (0.89) and 5.15 (0.94)] and 4 weeks after the intervention 3.10 (0.81) and 5.59 (0.57) (p < 0.001). Conclusions: It seems that EFT is effective in diminishing fatigue among patients with MS and is recommended as a convenient and safe non-medicament strategy for self-management of fatigue among these patients, and can be used at the bedside by nurses.
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Lived experiences of nurses in the care of patients with COVID-19: A study of hermeneutic phenomenology p. 537
Fatemah Moghaddam-Tabrizi, Roghieh Sodeify
Background: Nurses are at the forefront of caring for patients with COVID-19 and face a life-threatening risk to perform their duties. The complexity of disease conditions such as emerging disease may interfere with good nursing care and holistic care. The aim of this study is to reveal the lived experiences of nurses in the care of patients with COVID-19. Materials and Methods: This qualitative study was conducted in Khoy, Iran from March 2020 to May 2020. Fourteen nurses underwent in-depth semi-structured interviews at COVID-19 Central Hospital. All interviews were recorded, transcribed, and analyzed. Diekelmann's hermeneutic phenomenological approach was used to analyze and interpret the data. MAXQDA software version 2007 was used to manage and organize the data. Results: After extensive analysis and reflection, four main themes emerged, including staying in an ethical dilemma, emotional turmoil, response to professional commitments, and seeking help. Conclusions: The results of this study provided basic information about the lived experiences of nurses in different dimensions. Nursing managers need to be aware of these needs and expectations and provide a variety of programs and strategies not only to support nurses but also to ensure the quality of patient care.
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Impact of telenursing on blood pressure and body mass index of people with prehypertension: A randomized controlled clinical trial p. 544
Habib Sadeghi-Gandomani, Zahra Habibi, Maryam Eghbali-Babadi, Alireza Khosravi
Background: Prehypertension is an important global health challenge. This study determines the effect of telenursing on Blood Pressure (BP) and Body Mass Index (BMI) in patients with prehypertension. Materials and Methods: This randomized controlled clinical trial study included 81 patients with prehypertension discharged from an emergency room at Isfahan University of Medical Sciences (Iran) in 2016. Participants joined a session about hypertension, risk factors, and lifestyle modification to reduce its risk. Using a random number table, 41 subjects were assigned to the experimental group and 40 subjects to the control group. Only the experimental group received four SMS messages each week and a 10–15 min phone call once a month to help them change their lifestyle and reinforce their health behaviors. Eventually, patients' information was collected, and the data were analyzed using independent t, paired t, and Chi-square tests. Results: The experimental group after the intervention had a significantly lower mean (Standard Deviation [SD]) of Systolic Blood Pressure (SBP) (from 126.67 [5.15] to 119.21 [5.72] [t40 = 8.40, p < 0.001]) and Diastolic Blood Pressure (DBP) [from 85.28 (2.29) to 78.79 (4.16) (t40 = 10.02, p < 0.001)]. However, the same means were not significantly different in the control group [SBP (p = 0.116) and DBP (p = 0.096)]. The mean (SD) of changes between BMI before and after the intervention was -0.75 (0.66) in the experimental and 0.042 (0.41) in the control group, which was significantly different between the two groups (t79= –6.44, p < 0.001). Conclusions: Telenursing can have potential benefits to maintain BP within the normal range and reduce BMI in patients with prehypertension.
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The effect of fetus stimulation techniques on newborn behavior p. 550
Mahboubeh Valiani, Samira HadiAlijanvand
Background: Many factors affect fetal behavior, which can also affect the baby's capacity and change interaction with the caregiver. The aim of this study was to investigate the effect of performing fetal sensory systems stimulation techniques by mother during pregnancy on the neonate's habituation behavior. Materials and Methods: This semi-experimental study was conducted in 2019 in Isfahan, Iran. Mothers who referred to public comprehensive health centers in the 27th week of gestation and met the inclusion criteria were selected by convenience sampling method and randomly assigned to two groups of intervention and control. Fetal learning programs were held twice a day from the 27th week to the end of the pregnancy. The habituation domain of the neonate's behavior was assessed by the Brazelton's Neonatal Behavioral Assessment Scale (BNBAS) 3–5 days after the delivery. The mean score of habituation domain of BNBAS among 72 subjects in the intervention and control groups was compared by the Mann–Whitney test. Results: The habituation domain of all 72 newborns born approximately at the gestational age of 38 weeks was assessed. The Mann–Whitney test results indicated that the two groups were significantly different in terms of the total mean score of habituation domain 3–5 days after birth (z = –4.37, p < 0.001) and the score of the intervention group was higher than that of the control group. Conclusions: Generally, it can be concluded that the fetal stimulation techniques can positively affect the neonate's behaviors including the domain of habituation.
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Motivation for healing in cancer patients: A qualitative study p. 555
Fatemeh Hosseini, Negin Masoudi Alavi, Eesa Mohammadi, Zohreh Sadat
Background: Studies have revealed that motivation plays a vital role in a person's ability to heal. The nature of motivation for healing in cancer patients is unknown. The aim of this study was to explore the meaning of motivation for healing in cancer patients. Materials and Methods: A qualitative research approach was used as the study design. Data were collected using individual semi-structured interviews and the themes were derived from the data using the inductive content analysis method. The patients consisted of 34 cancer patients, 4 family members, 1 psychologist, 1 oncologist, and 3 nurses. The participants were interviewed in the cancer clinics or chemotherapy wards. Results: Based on the results of the interviews, three main themes and seven categories were determined. The themes were identified as (i) the desire to survive, (ii) a spirit of optimism, and (iii) belongingness and responsibility. Conclusions: The results of this study could be used by researchers to develop tools to measure motivation in cancer patients, and to design intervention mechanisms to enhance the patients' motivation in cancer care. Moreover, a better understanding of motivation can improve psychosocial support in oncology nursing.
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The effect of sex counseling based on (permission, limited information, specific suggestions, intensive therapy) model on sexual satisfaction in women with cyclic mastalgia: A randomized controlled clinical trial p. 562
Fatemeh Ghodsi, Nasim Bahrami, Maryam Mafi, Forouzan Olfati
Background: More than half of the population of women suffer from cyclic mastalgia which can interfere with women's sexual function and affect their sexual satisfaction. The current study was conducted to determine the effect of sexual counseling on sexual satisfaction in women with cyclic mastalgia. Materials and Methods: This randomized controlled trial study was performed on 81 women with cyclic mastalgia. The subjects were randomly divided into two groups of intervention (n = 40) and control (n = 41). Intervention was performed as Permission, Limited information, Specific suggestions, Intensive therapy (PLISSIT) sex counseling in four sessions for a maximum of 90 min in the intervention group. The demographic checklist and Index of Sexual Satisfaction (ISS) were used for data collection. Follow-up was performed 1 and 3 months after the intervention. The obtained data were analyzed using repeated-measures test. Results: The intervention and control groups were in good balance in terms of demographic characteristics and sexual satisfaction scores prior to the intervention and no statistically significant differences were observed. There was a statistically significant increase in the mean (SD) score of female sexual satisfaction in the intervention group: 93 (12.52), 101.15 (7.70),101.37 (5.31), (F(1,39) = 27.4, p < 0.001). We also observed a decrease in the mean (SD) score of sexual satisfaction in the control group: 93.39 (13.12), 90.68 (8.41), 90.85 (6.57), (F (1,40) = 11.9, p < 0.001) 1 and 3 months following the intervention. Conclusions: This study revealed that individual counseling by PLISSIT sex counseling could lead to improvement in sexual satisfaction index in women with cyclic breast pain.
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Knowledge, attitude, and practice of nurses toward COVID-19: A cross-sectional study in a referral hospital of Indonesia p. 569
Marthoenis Marthoenis, Maskur Maskur
Background: Limited study has been conducted on the Indonesian nurses' knowledge, attitude, and behavior toward Coronavirus disease 2019. We investigated the Knowledge, Attitude, Practice (KAP) of nurses working in the referral hospital toward the COVID-19 disease. Materials and Methods: Using a questionnaire on KAP toward COVID-19, a cross-sectional online data collection was conducted in the mid of 2020 to examine the nurses' KAP, perception, and experience toward COVID-19. Results: The correct rate of knowledge was 85.60%. No significant difference of all KAP items between the COVID-19 and regular nurses was observed (P>0.05). They had positive attitudes regarding the pandemic and good practices for virus transmission prevention. Most nurses were worried that they will be infected by COVID-19 (91.53%). Conclusions: The Indonesian nurses have good knowledge, a positive attitude, and good practices regarding the virus, transmission, and prevention. The fact that the majority of nurses feel worried demands further investigations.
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Learning together matters: Interprofessional education to avoid medication errors p. 573
Frincy Francis, Sheeba Elizabeth Johnsunderraj, Harshita Prabhakaran, Arcalyd Rose Ramos Cayaban, Raya Abdullah Al Zahli
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