Background: In order to achieve the major goals of transformation in the health care system, organizing and developing the existing potential properly play a pivotal role. The objective is to conduct a scoping review to describe available extent of literatures about scattered structure, process, and outcome factors of the clinical specialist nurse and redesign those as three cohesive and interconnected factors. Materials and Methods: A scoping review of studies was conducted from 1970 to June 20, 2020, focusing on the structure, process, and outcome factors of the clinical specialist nurse from six databases. Results: Forty-six studies were carried out. Structure (individual characteristics, intra-organizational, and governance factors), process (professional interactions, and roles and duties of a specialist nurse), and outcome (patient and family, nurse, and organizational outcomes) factors were identified. Conclusions: With the correct knowledge of the factors, it is possible to achieve the desired therapeutic, organizational, and professional results of nursing by providing the necessary fields in the structure, process, and outcomes. The identification of structures, processes, and outcomes that influence clinical nurse's role implementation may inform strategies used by providers and decision makers to optimize these roles across healthcare settings and guarantee the delivery of high-quality care.

Background: Delay in parenthood and the related consequences for health, population, society, and economy are significant global challenges. This study was conducted to determine the factors affecting delay in childbearing. Materials and Methods: This narrative review was conducted in February 2022 using databases: PubMed, Scopus, ProQuest, Web of Science, Science Direct, Cochrane, Scientific Information Database, Iranian Medical Articles Database, Iranian Research Institute for Information Science and Technology, Iranian Magazine Database, and Google Scholar search engine. The search terms used included “delayed childbearing,” “delayed parenthood,” “delayed fertility,” “delay of motherhood,” “parenthood postponement,” “deferred pregnancy,” “reproductive behavior,” and “fertility.” Results: Seventeen articles were selected for final evaluation. The factors were studied at micro and macro levels. The factors in micro level fell into two classes: personal and interpersonal. Personal factors included extension of women's education, participation in the labor market, personality traits, attitude and personal preferences, fertility knowledge, and physical and psychological preparation. The interpersonal factors included stable relations with spouse and other important people. The macro level included supportive policies, medical achievements, and sociocultural and economic factors. Conclusions: Policy-making and enforcement of interventions, such as improvement of the economic conditions, increased social trust, providing adequate social welfare protection, employment, and support of families using such strategies as creating family-friendly laws, taking into consideration the conditions of the country will reduce the insecurity perceived by the spouses and contribute to a better childbearing plan. Also, improving self-efficacy, increasing couples' reproductive knowledge and modifying their attitude can be helpful to better decision-making in childbearing.

Background: Preterm Birth (PTB) is one of the leading causes of infant morbidity and mortality. Prenatal care is an effective way to improve pregnancy outcomes but there is limited evidence of effective interventions to improve perinatal outcomes in disadvantaged pregnant women. This review was conducted with the aim to assess the effectiveness of prenatal care programs in reducing PTB in socioeconomically disadvantaged women. Materials and Methods: We searched the Scopus, PubMed, Web of Science, and Cochrane Library databases from January 1, 1990 to August 31, 2021. The inclusion criteria included clinical trials and cohort studies focusing on prenatal care in deprived women with the primary outcome of PTB (< 37 weeks). Risk of bias was assessed using the Cochrane Collaboration's tool for assessing risk of bias and the Newcastle–Ottawa Scale. Heterogeneity was evaluated using the Q test and I² statistics. The pooled odds ratio was calculated using random-effects models. Results: In total, 14 articles covering 22,526 women were included in the meta-analysis. Interventions/exposures included group prenatal care, home visits, psychosomatic programs, integrated intervention on socio-behavioral risk factors, and behavioral intervention through education, social support, joint management, and multidisciplinary care. The pooled results showed that all types of interventions/exposure were associated with a reduction in the risk of PTB [OR = 0.86; 95% confidence interval: (0.64, 1.16); I² = 79.42%]. Conclusions: Alternative models of prenatal care reduce PTB in socioeconomically disadvantaged women compared with standard care. The limited number of studies may affect the power of this study.

Background: Coronary Artery Disease (CAD) complications cause patients to experience a great deal of concerns and challenges that have adverse effects on their mental health. This study aimed to assess the effect of an empowerment program on life orientation and optimism in CAD patients. Materials and Methods: This randomized clinical trial was conducted on 84 CAD patients admitted to post-CCU wards of Tehran Heart Center during 2018–2019 Patients were allocated to intervention and control groups by block randomization method based on inclusion criteria. Demographic and disease characteristics, and optimism and Life Orientation Test-Revised (LOT-R) questionnaires were completed before and eight weeks after intervention. In the intervention group, an empowerment program was implemented. Data were analyzed by independent t-test, paired t-test, and Chi-square test. Results: The results showed that the mean of patients' age in the intervention and control group was Mean [Standard Deviation (SD)] 54.59 (7.93) and 55.92 (7.81) years, respectively. Most patients in both intervention (61.90%) and control (66.70%) groups were male. The majority of patients in the intervention group (92.90%) and the control group (95.20%) were married. There were no significant differences between the two groups in terms of demographic characteristics and disease history before the intervention (p > 0.05). After the intervention, a significant difference was observed in the life orientation and optimism scores between the intervention and control groups (p < 0.001). Conclusions: By stimulating self-awareness, providing knowledge and encouraging patients to control, and manage their disease, the empowerment program changes patients' view of their disease, and increases their optimism and positive life orientation.

Background: Social support has been found to positively influence the mothering experience. Yet little is known concerning primiparous mothers' perceptions of social support following childbirth. This qualitative study aims to explore primiparous mothers' perception and expectations regarding social support during the postpartum period. Materials and Methods: This qualitative study with content analysis approach was conducted on 11 postpartum mothers who had been routinely referring to comprehensive health service centers in Kermanshah, Iran, from October 2020 to January 2021 for receiving postpartum care within the first 6 months after birth. Also, to further enrich the study data, interviews were conducted with healthcare providers (n = 6) and husbands (n = 3). Twenty-two semi-structured interviews were conducted individually through a purposive sampling method. Two participants were interviewed twice. Interviews were recorded and transcribed verbatim in Persian and analyzed using conventional content analysis. Results: Three main categories and thirteen subcategories emerged. The main categories were: “comprehensive support”, “support barriers,” and “support promotion strategies.” The main perception and expectation of mothers regarding social support was the sense of not being alone and receiving comprehensive support, especially from the husband and increasing his awareness about this support. Conclusions: An understanding of a comprehensive support, support barriers, and support promotion strategies with respect to social support can help healthcare professionals to develop interventions and programs aimed at promoting mothers' social support in the postpartum period.

Background: Sexual health is one of the most important aspects of health. In Iran, most services associated with reproductive and sexual health are provided by midwives at health centers. As different factors are effective in providing care services associated with sexual health, the present study aims to investigate the factors affecting the provision of sexual health services by midwives. Materials and Methods: In this qualitative content analysis study, data were collected by conducting in-depth interviews with 16 midwives, 7 key informants, and 6 stakeholders. Besides, the sampling method was purposeful, and data analysis was conducted using conventional content analysis and MAXQDA software. Results: After analyzing the content of the qualitative data, two themes were extracted, which included facilitators of and barriers to providing sexual health services by midwives. Conclusions: By modifying educational curricula, providing in-service training, and adopting appropriate policies, barriers for providing accessible sexual health services by midwives can be reduced.

Background: Women are known to use Complementary and Alternative Medicine (CAM) during pregnancy despite the subsequent potential unknown effects associated with its use. This study was performed to evaluate the use of CAM products and its related factors among pregnant women in Shiraz, Iran. Materials and Methods: This cross-sectional study of 365 pregnant women referred to obstetrics clinics affiliated to Shiraz University of Medical Sciences (Iran) was conducted in 2020. Sampling was performed in all three affiliated centers based on a probability, proportional to size protocol. Pregnant women were nominated using a systematic random sampling scheme using their health record numbers. A 20-item questionnaire was administered via in-person interviews and data on demographics, use of CAM products, reasons for use, and referral and information sources were collected. Binary logistic regression was applied and adjusted odds ratios were estimated. Results: CAM use was reported for recent pregnancies by 56.92% of participating women, with a significantly higher use in participants of low socioeconomic status (Chi21 = 5.12; p < 0.024). The main reason for CAM use was having faith in the efficacy of CAM (72.73%). Reported CAM use was restricted to herbal preparations. Most of the women who used CAM (73.0%) did not report their CAM use to their doctor. Conclusions: There is a high rate of CAM use among pregnant women. More maternal care services during current pregnancy, parity, and general and pregnancy-related history of CAM use were correlated with CAM use. Mother–healthcare provider relationship should be improved in the field of CAM.

Background: A caring education program is proven effective in improving nurses' behavior in several countries. This study aimed to assess the effect of the Caring-Based Training Program (CBTP) on nurses' caring behaviors of Indonesian nurses as perceived by patients. Materials and Methods: This non-equivalent control group post-test-only design was conducted on 74 patients from a public hospital in Malang district, Indonesia, in 2019. The patients who only met the inclusion criteria were recruited through convenience sampling. The Caring Behaviors Inventory-24 (CBI-24) items were utilized to measure nurses' caring behaviors as perceived by patients. Data were analyzed using frequency, mean, standard deviation, t-test, and ANOVA test at 0.05 levels of significance. Results: The overall mean score of CBI-24 for the experimental group was higher than the control group (5.48 and 5.04, respectively). According to the patient's perception, these findings indicated that the caring behavior of nurses in the experimental group was better than that in the control group. The independent t-test showed a significant difference in the nurses' caring behaviors between the experimental and control groups (p-value = 0.001). Conclusions: The study demonstrated that a CBTP could improve nurses' caring behaviors. Therefore, the developed program is essential and required by Indonesian nurses to increase their caring behaviors.

Background: Psycho-educational interventions might play a crucial role in the management of diseases. This study was conducted to determine the effect of psycho-educational interventions via social networks on self-efficacy and anxiety among Coronavirus Disease 2019 (COVID-19) patients in home quarantine. Materials and Methods: This randomized clinical trial was conducted on 72 COVID-19 patients, in Shiraz, Iran, in 2020. The patients were randomly assigned to an intervention and control group. Patients in the intervention group underwent psycho-educational interventions daily for 14 days. The data were collected using the Strategies Used by People to Promote Health (SUPPH) questionnaire and the State-Trait Anxiety Inventory (STAI) before and 2 weeks after the intervention. Results: After the intervention, the mean score of SUPPH was mean = 120.75 (16.56) and mean(SD) 111.27 (14.40) in the intervention and control groups, respectively. Moreover, after the intervention, the mean score of state and trait anxiety were 34.69 (10.75) and 38.31 (8.44) in the intervention group, and mean(SD) 45.75 (13.01) and 43.50 (8.44) in the control group, respectively. After the intervention, a difference was observed between the groups concerning the mean score of SUPPH (t70 = 2.58; p = 0.01), state anxiety (F1 = 16.52; p < 0.001), and trait anxiety (t70 = −2.49; p = 0.01). Conclusions: Considering the effectiveness of psycho-educational interventions in self-efficacy and anxiety, healthcare providers are recommended to use these interventions in COVID-19 patients.

Background: Disrespect and abuse during childbirth is regarded as harassment of women and a violation of their rights. The aim of this study was to assess the psychometric properties of the disrespect and abuse questionnaire in Iranian parturient women. Materials and Methods: This cross-sectional study was conducted on 265 postpartum women in both private and public hospitals in Tabriz, Iran. The scale was translated from English into Farsi. In the quantitative face validity, the impact score was determined for each item. Moreover, in the quantitative content validity, the Content Validity Ratio (CVR) and Content Validity Index (CVI) were assessed based on the comments of experts on the relevance, clarity, and simplicity of items (CVI) and the necessity of items (CVR). Construct validity was assessed through exploratory and confirmatory factor analyses. Results: In the face validity assessment, all items received a minimum impact score of 1.5. In assessing the content validity, all the items attained the minimum acceptable value of CVR (>0.69) and CVI (>0.79). According to the exploratory factor analysis, the Disrespect and Abuse Questionnaire has 23 items and five factors, including abandoning the mother, improper care, mother's immobility, not talking to the mother, and mother's deprivation. The construct validity of the scale was confirmed by the confirmatory factor analysis, in which X²/df <5 and root mean square error of approximation <0.08. Conclusions: The Farsi version of the disrespect and abuse questionnaire can be used as a valid tool for assessing instances of lack of respectful maternity care in the postpartum period.

Background: Accidents are the main cause of mortality in children aged less than 5 years throughout the world. The present study was conducted to empower mothers with children aged less than 5 years in preventing home accidents through the implementation of a risk management training program based on the Health Belief Model (HBM). Materials and Methods: The present pretest-posttest, quasi-experimental study was conducted on 70 mothers with children aged less than 5 years who referred to Community Health Centers of Shahid Beheshti University of Medical Sciences, Iran, in 2019. The subjects were selected through multistage random sampling and were randomly assigned to intervention (n = 35) and control (n = 35) groups. The data were collected using a two-part questionnaire for demographic characteristics and HBM constructs before, immediately after, and 45 days after the implementation of the risk management training program at a significance level of <0.05. Results: No significant difference was observed between the two groups before the intervention in terms of HBM constructs (p>0.05). However, they significantly differed between the intervention and control groups after the intervention. Moreover, scores of HBM constructs were significantly different immediately and 45 days after the intervention (p <.05). Conclusions: The study results showed the effectiveness of the HBM-based risk management training program; thus, it is essential to design and implement such programs in community health centers to prevent and reduce injuries caused due to home domestic accidents.

Background: Neuropathy in diabetic foot is the onset of diabetic foot complications. The COVID-19 pandemic has caused changes in the health service system. The lockdown decision can make it difficult for patients to get medication and consult with health workers due to physical activity restrictions. This research aimed to analyze the factors that contribute to peripheral neuropathy in diabetic foot during the COVID-19 pandemic. Materials and Methods: The research is a cross-sectional study with a sample of 122 patients with type 2 diabetes mellitus who participated in the Chronic Disease Management Program at community health centers in Malang, Indonesia, and was selected using a purposive sampling method. Data were analyzed using multivariate linear regression. Results: Variables that contributed to the development of neuropathy were ankle-brachial index of the right foot (β = 7.35, p = 0.06), irregular exercise (β = 2.01, p = 0.07), glycated hemoglobin A (HbA1c) (β = 0.97, p < 0.001), and Low-Density Lipoprotein (LDL) (β = 0.02, p = 0.06). Meanwhile, the variables that contributed to reducing neuropathy were ankle-brachial index of the left foot (β = −1.62, p = 0.73) and being female (β = −2.62, p = 0.02). The regression model could explain the variation in the scores of neuropathy in diabetic foot during the COVID-19 pandemic (R² = 20.10%). Conclusion: The factors that contributed to the incidence of neuropathy in diabetic foot during the COVID-19 pandemic were ankle-brachial index, exercise for diabetes, LDL, HbA1c, and sex.

Background: Clinical Practice Guidelines (CPGs) have been recommended to manage palliative care and take the best treatment measures and decisions. This study aimed to adapt the interdisciplinary CPG to provide palliative care for patients with Heart Failure (HF) in Iran based on the ADAPTE method. Materials and Methods: Guideline databases and websites were systematically searched up to April 2021 to determine appropriate publications related to the study topic. Followed by assessing the quality of the selected guidelines via the Appraisal of Guidelines for Research & Evaluation Instrument (AGREE II), those with appropriate standard scores were selected to be used in designing the initial draft of the adapted guideline. The developed draft contained 130 recommendations and was evaluated by a panel of interdisciplinary experts in terms of its relatedness, comprehensibility, usefulness, and feasibility in two phases of Delphi. Results: In the first phase of Delphi, the adapted guideline was derived from five guidelines and evaluated by 27 interdisciplinary pundits working in the universities of Tehran, Isfahan, and Yazd cities. After the assessment in Delphi Phase 2, four recommendation categories were removed because they did not receive the required scores. Finally, 126 recommendation items were included in the developed guideline, which were classified into three main categories of palliative care features, essentials, and organization. Conclusions: In the present study, an interprofessional guideline was designed to enhance palliative care information and practice in patients with HF. This guideline can be administered as a valid tool for interprofessional team members to provide palliative care to patients with HF.

Background: Type 2 diabetes (T2D) is a chronic disease with a high prevalence globally, which is in the second place of importance for the investigation of chronic diseases. According to previous studies, Quality of Life (QOL) is low in diabetic patients. Hence, this study was conducted with the aim to evaluate the effect of the empowerment model on the QOL of patients with T2D. Materials and Methods: A randomized controlled trial was performed on 103 T2D patients over 18 years of age, with a definitive diagnosis of diabetes and medical records in a diabetic center. Patients were randomly assigned to either the intervention or the control groups. Routine education was presented to the control group, and the empowerment model was used for education in the experimental group for 8 weeks. The data collection tools used consisted of a demographic characteristics form and the diabetic clients QOL questionnaire. The one-way analysis of variance, Chi-square test, paired t-test, and independent t-test were used for data analysis. Results: After the intervention, there were significant differences between the two groups in terms of the physical (p = 0.003), mental (p = 0.002), social (p = 0.013), economic (p = 0.042), and illness and treatment dimensions of QOL (p = 0.033), as well as the total QOL score (p = 0.011). Conclusions: According to the results of this study, the training program based on empowerment significantly increased the QOL of patients with T2D. Therefore, using this method can be recommended in patients with T2D.

Background: Women may experience different problems in every aspect of their sexual life throughout their lives; therefore, it is essential to check women's sexual health and try to improve it. The present research aims to assess core stability trainings on postpartum mothers' sexual desire. Materials and Methods: This quasi-experimental research was conducted by random sampling on 72 mothers who referred to comprehensive health centers in Isfahan in 2019 in postpartum period. The samples were divided into experimental and control groups by random placement method (blocking). Core stability exercises were performed in the experimental group for 24 sessions. The demographic questionnaire and Female Sexual Function Index (FSFI) were filled out in two stages (before and one month after the intervention) by the samples, and the data were analyzed by Mann-Whitney, independent t-test, paired t-test, Chi-square. Results: The result of this study showed that the average score of the sexual desire after intervention in the experimental group was significantly higher than that in the control group (p = 0.03). The average score of the sexual desire after the intervention in the experimental group was significantly higher than that before the intervention (p < 0.001). The average scores of the sexual desire before and after the intervention in the control group were not significantly different (p = 0.40). Conclusions: Eight weeks of core stabilization exercises can improve endurance of the pelvic floor muscles and the central part of the body, subsequently promoting females' sexual desire. The findings of this study can be considered in the fields of education, health, clinical, and policy.

Background: Change in respiratory indices is the most common problem in Chronic Obstructive Pulmonary Disease (COPD) patients. This problem is managed through pharmaceutical and non-pharmaceutical methods. This study aimed to determine local hyperthermia effect on respiratory parameters of COPD patients. Materials and Methods: This randomized controlled trial study was conducted on 46 patients with COPD referred to Allameh Bohlool Hospital in Gonabad, Iran in 2019. The participants were randomly assigned into two groups using quadrupled blocks. In both groups, a local pack was placed on the anterior chest for 23 min twice daily for 5 days. In the intervention group, the temperature of the hot pack was 50° and in the placebo group was the same as the body temperature. Respiratory indices including force vital capacity (FVC), forced expiratory volume in first second (FEV1), etc., were measured and compared before and after the last intervention in both groups. To gather data, demographic information form and respiratory indices record form were used. Results: Compared to before the intervention, all respiratory indices such as vital capacity (VC) (z = -4.25, p < 0.001), FEV1 (t22 = -114.18, p < 0.001), PEF (t22 = 5.91, p < 0.001) in the experimental group were increased significantly. Moreover, the difference in the mean respiratory indicators such as Pick Expiratory Flow rate (PEF) (t44 = 94.63, p < 0.001) and SPO2 (z = -3.27, p < 0.05) was also statistically significant in the two groups before and after the intervention. Conclusions: Local hyperthermia is effective in the improvement of respiratory indices among COPD patients, but it is recommended to conduct further studies before the implementation of this approach.

Background: Nursing care contributes to the safety and the quality of care of patients. During the COVID-19 pandemic, nurses became frontline care providers. Materials and Methods: A qualitative study was conducted using an online focus group discussion of eight nurse committee members from six hospitals. After the data were collected, the study continued with inductive thematic analysis. The data were organized and extracted to identify meaningful statements and formulate meanings. Inductive thematic analysis was used, resulting in three themes and six subthemes. Results: The themes related to managing the nursing workforce, schedules, rosters, shifts, goals of re-design staffing, and the nurse-patient ratio. Conclusions: The management of the nursing staffing was modified to protect nurses during the COVID-19 pandemic. The nurse manager redesigned workforce planning to ensure a safe environment for nurses.