Background: Participation of woman in decision-making processes is one of the key indicators of an appropriate relationship between a woman and the health care professionals. This study aimed to recognize the factors facilitating respect for woman's decision-making in spontaneous birth. Materials and Methods: This paper employed a meta-synthesis on articles published in four biomedical databases including MEDLINE, Web of Science, CINAHL, and Cochrane Library. All qualitative studies published after 1990 and directly or indirectly discussing the women's and the health care professional's attitudes toward respect for woman's decision-making in spontaneous birth were searched. Of 5372 citations, 95 full-text papers were considered, of which 14 satisfied the inclusion criteria. Results: In this meta-synthesis, initial codes were obtained through meticulous, line-by-line coding of the findings of the primary studies. Then, thematic synthesis was performed on the codes to search for concepts, and 20 descriptive themes were obtained in the second stage. Finally, through an inductive process, five new interpretations were obtained in the last stage of the thematic synthesis. These interpretations included confidence to health care providers, the central role of midwives in maintenance of women's dignity, childbirth as a natural phenomenon, the impact of contextual conditions, and the political and human factors affecting the delivery management and women seek place of safety for childbirth. Conclusions: Studies suggested that midwifes have a central role in maintenance of women's dignity and their experience of childbirth.

Background: The functions and use of mouthwashes are variable depending on their type. Oral care in patients with endotracheal tubes is important to prevent side effects such as pneumonia. The aim of this study was to determine the antimicrobial effects of chlorhexidine, drop of Matrica mouthwash (chamomile extract), and normal saline on hospitalized patients with endotracheal tube in an intensive care unit (ICU). Materials and Methods: In this clinical trial, 39 patients admitted to the ICU were selected by convenience sampling, were matched based on age and sex, and randomly assigned to three groups (chlorhexidine, Matrica, saline). Mouth washing was performed every 8 to 48 hours. The samples were taken at time zero (before the intervention) and 48 hours after the intervention for bacterial culture. Antibacterial activity of each mouthwash on microorganisms was measured based on the growth of Staphylococcus aureus, Pneumococcal, Enterococcus, Pseudomonas, and Escherichia coli. The obtained data were then analyzed using Chi-square and Fisher's exact tests with the Statistical Package for the Social Sciences Package version 18. Results: Chlorhexidine mouthwash was more effective in preventing colonization of bacteria in the mouth (point probability = 0.06) in comparison with chamomile and saline mouthwashes. Nevertheless, none of the tested mouthwashes were able to remove pathogens, including Staphylococcus aureus, Pseudomonas, Klebsiella, and Acinetobacter. Conclusions: 0.2% chlorhexidine mouthwash has a significant effect on the bacterial colonization rate in comparison with Matrica and normal saline mouthwashes in ICU hospitalized patients with endotracheal tube.

Background: Application of a reliable and authentic behavioral tool for measuring patients' pain, hospitalized in intensive care units who are not able to establish relationship, is needed severely. Therefore, this study is conducted with the aim of validating Critical Care Pain Observation Tool (CPOT) in patients hospitalized in surgical wards. Materials and Methods: CPOT was first translated into Persian and was psychometrically measured in terms of content. Then, this study was conducted as cross-sectional study on 60 patients who were hospitalized in surgical wards. The degree of pain was measured by the patients using a self-report pain tool (NRS) and with the help of two nurses using CPOT during two painful and nonpainful procedures. Eventually, diagnosed validity and reliability was studied. Results: It should be noted that the content validity of CPOT was approved by panel of specialists. In addition, validity of this tool was confirmed with high internal cluster correlation (nonpainful procedure (0.997) and painful procedure (0.726). The diagnostic validity was supported with the increased CPOT score during position change and its constancy during the measurement of blood pressure (P < 0.001). Despite higher NRS scores than CPOT, CPOT criterion validity was confirmed due to the correlation between the scores obtained by these two tools (P < 0.001). Conclusions: CPOT is a valid and reliable tool to study pain in patients hospitalized in intensive care units.

Background: Athletes' recovery is important in improving their performance. Nutritional strategies can be effective in enhancing recovery rate. Choosing the best food items in appropriate intervals can play effective roles in resynthesis of fuels and recovery of muscle injury. Beverage micro and macronutrient content are helpful in fuel restoration. In this study, we assess the effects of various kinds of beverages on oxidative stress, muscle injury, and metabolic risk factors in taekwondo players. Materials and Methods: This quasi-experimental study was performed on 21 taekwondo players of Isfahan. After collecting fasting blood, they performed runningbased anaerobic sprint test (RAST). Blood lactate was tested again and participants were divided into 3 intervention groups, that is, receiving 500 cc dough, non-alcoholic beer, and chocolate milk at 4 day intervals. After a 2-h recovery period, blood sampling was repeated. Elites consumed other beverages in later phases. Dietary intake and fasting triglyceride, cholesterol, blood sugar, lactate dehydrogenase, and F ₂ -isoprostane concentrations were determined. Data were analyzed with a simple repeated-measures test and post-hoc tests using the Statistical Package for the Social Sciences software. Results: Data showed that cholesterol levels non-significantly decreased after intervention. Triglyceride level was lower after taking dough and carbohydrate replacement drink. Blood glucose concentration increased after intervention periods, however, this increase was significant only after non-alcoholic beverage consumption. Lactate dehydrogenase levels reduced after all cycles, however, F ₂ -isoprostane level showed no significant change. There was not significant change in lactate dehydrogenase and F ₂ -isoprostane levels. Conclusions: Non-alcoholic beer consumption can reduce lactate dehydrogenase concentration; however, it leads to blood sugar increase. Moreover, dough consumption significantly reduced triglyceride level in taekwondo players.

Background: Menopause is associated with various complications such as depression, sleep disorders, and genitourinary atrophy. Vaginal atrophy occurs due to the loss of steroid hormones, and its major symptoms include vaginal dryness, itching, dyspareunia, and bleeding after intercourse. According to the literature, vitamin E plays a key role in estrogen stability. The aim of this study was to compare the effects of vitamin E suppositories and conjugated estrogen vaginal cream on vaginal atrophy. Materials and Methods: In this clinical trial, 52 postmenopausal women, who were referred to a gynecology clinic in 2013, were recruited and randomly divided into two groups (26 cases per group). One group received 100 IU of vitamin E suppositories (n = 26), whereas the other group applied 0.5 g of conjugated estrogen cream for 12 weeks. Vaginal maturation value (VMV) was compared between the two groups before and after the intervention. VMV ≤ 55 was regarded as a cut-off point for vaginal atrophy. Treatment success was defined as a 10-unit increase in VMV, compared to the baseline value. Data were analyzed by Friedman test and Mann-Whitney test. P value less than 0.05 was considered statistically significant. Results: The mean VMV in the vitamin E group before the treatment and after 4, 8, and 12 weeks of treatment was 43.78 ± 13.75, 69.07 ± 22.75, 77.86 ± 21.79, and 80.59 ± 19.23, respectively. The corresponding values in the estrogen cream group were 42.86 ± 14.40, 86.98 ± 12.58, 92.65 ± 15, and 91.57 ± 14.10, respectively. VMV significantly improved in both the treatment groups after the intervention, compared to the preintervention period (P < 0.001). Treatment success was reported in both groups, although estrogen cream (100%) appeared to be more effective after 4 weeks of treatment, compared to vitamin E suppositories (76.9%) (P = 0.01). Conclusions: Based on the findings, use of vitamin E suppositories could improve the laboratory criteria for vaginal atrophy and treatment success. Therefore, vitamin E suppositories are suggested for relieving the symptoms of vaginal atrophy, especially in women who are unable to use hormone therapy or cope with the associated side effects.

Background: Medication errors and adverse drug events of high alert medication are one of the major problems in therapeutic system. The purpose of the present study was to investigate ύthe effect of clinical supervision model on high alert medication safety in intensive care units nurses. Materials and Methods: This was a quasi-experimental study conducted on 32 nurses of intensive care units. The researcher observed the administration of high alert drugs including heparin, warfarin, norepinephrine, dobutamine, and dopamine by nurses and recorded the scores of "the work in preventing medication errors," "the work in preventing adverse drug events," and "medication safety." Then, the researcher performed clinical supervision model and during performance of the model, the researcher reassessed the score of "the work in preventing medication errors", "The work in preventing adverse drug events" and "medication safety". Tool of data collection was "action plan of high alert medication safety" checklists (heparin, warfarin, norepinephrine, dobutamine, and dopamine checklists). Results: The result of the statistical trials showed that before and after applying the clinical supervision model, there was a statistically significant difference between the average scores of medication safety of heparin (15.7 vs 18.73), warfarin (11.08 vs 15.67), norepinephrine (14.60 vs 19.72), dobutamine (13.80 vs 19.30), and dopamine (14.25 vs 19.47). Conclusions: Based on the results of this study, it seems that administration of clinical supervision model in intensive care units can lead to improving the status of safety of high alert medication.

Background: The most important part in experiencing and recognizing the threshold of pain is the perception of pain. Reflexology is a kind of complementary therapy which is rooted in the beliefs of the community. This study was aimed to determine the effect of reflexology on pain perception aspects in patients with chronic low back pain. Materials and Methods: This single-blind clinical trial study was performed on 50 nurses with chronic low back pain, who were selected by convenient sampling and then randomly divided into the case and the control groups. Reflexology was conducted for 2 weeks in both groups as three 40-min sessions per week. Perception aspects of pain were measured using the McGill pain perceptual dimension scale score. Data analysis was performed using SPSS. Results: The overall mean scores of perceptual aspects of pain after the intervention in the case and the control groups were 20 ± 5.97 and 29.60 ± 7.38, respectively, and independent t-test showed a statistically significant difference between the two groups (P < 0.001). Comparing the results in the cognitive aspects of pain separately showed a significant difference between the two groups in the aspects of sensory, pain assessment, and diversity before and after the intervention (P < 0.001), but the difference in the emotional aspect was not significant. Conclusions: Reflexology, which can be done by nurses, has the ability to reduce the intensity score and cognitive aspects of pain. Therefore, it is proposed to be included in patients' surveillance.

Background: There are several evaluation models that can be used to evaluate the effect of in-service training; one of them is the Kirkpatrick model. The aim of the present study is to assess the in-service training of cardiopulmonary resuscitation (CPR) for nurses based on the Kirkpatrick's model. Materials and Methods: This study is a cross-sectional study based on the Kirkpatrick's model in which the efficacy of in-service training of CPR to nurses was assessed in the Shahadaye Lenjan Hospital in Isfahan province in 2014. 80 nurses and Nurse's aides participated in the study after providing informed consent. The in-service training course was evaluated in reaction, learning, behavior, and results level of the Kirkpatrick model. Data were collected through a researcher-made questionnaire. Results: The mean age of the participants was 35 ± 8.5 years. The effectiveness score obtained in the reaction level (first level in the Kirkpatrick model) was 4.2 ± 0.32. The effectiveness score in the second level of model or the learning level was 4.70 ± 0.09, which is statistically significant (P < 0.001). The effectiveness score at the third and fourth level were 4.1 ± 0.34 and 4.3 ± 0.12, respectively. Total effectiveness score was 4.35. Conclusions: The results of this study showed that CPR in-service training has a favorable effect on all four levels of the Kirkpatrick model for nurses and nurse's aides.

Background: In-service training of nursing personnel has a significant role in increasing the empowerment of nurses and promotion of the quality of health services. The objective of this study is to identify and explain the process of in-service training of nursing personnel in the hospitals affiliated with Baqiyatallah University of Medical Sciences in Tehran. Materials and Methods: The present study employed a qualitative approach using Corbin and Strauss method (2008) in 2015, and examined the viewpoints and experiences of 35 nurses, nurse managers, and educational managers with the in-service education of nursing staffs. According to this method, comparisons, asking questions, flip-flop technique, depicting personal experiences, and raising red flag were used for data analysis. Results: In this study, five major themes including unsuccessful mandatory education, empowering education, organizational challenges, weakness in the educational management, and educational-job resiliency were derived from the results. Unsuccessful mandatory education was the main concern of participants and empowering education was the core category derived from this study. Conclusions: Empowering education emphasizes the practice-oriented and self-directed training. It is an applied education, is participation-oriented, facilitates job functions, and is based on exploration.

Background: Ignoring reproductive health services during natural disasters leads to some negative consequences such as reduced access to contraceptive methods, sexual disorders, and pregnancy complications. Despite previous researches, there is still more need for research on this area of health. This study attempts to identify the indicators of reproductive health in the women affected by the East Azarbaijan earthquake on August 2012. Materials and Methods: In this descriptive study, reproductive health information pertaining to the years before, during, and after the earthquake were collected and compared in the health centers of the three affected cities including Ahar, Heriss, and Varzaghan as well as the health and forensics centers of the East Azarbaijan province in Iran by census method. Results: Findings indicated a decrease in live birth rate, general marriage fertility rate, stillbirth rate, contraceptive methods coverage, and prevalence of sexually transmitted diseases during and after the earthquake. Moreover, important indicators such as neonatal mortality rate and percentage of infants screened for breast milk, decreased during the disaster year in comparison with the years before and after. Other indicators such as preconception care, pregnancy first visit, rate of caesarian delivery, and under 1-year formula milk-fed infants' percentages increased during the year of disaster in comparison with the years before and after. Conclusions: During the earthquake, some indicators of reproductive health have been reported to decrease whereas some others have gone through negative changes. Despite the partly favorable status of services, decision-makers and health service providers should pay more attention to the needs of women during disasters.

Background: Level of stress and its management affects the dimensions of psychosomatic patients' quality of life (QoL), which is an important psychological issue. The present study aimed to investigate the effect of cognitive behavioral stress management program on psychosomatic patients' QoL. In cognitive behavioral method, patients discover thought and behavioral mistakes and recover them. The criterion to evaluate the success of the present study was measurement of the patients' QoL and its notable improvement after intervention. Materials and Methods: This is a before-and-after clinical trial with a control group. The study participants comprised 70 psychosomatic patients referred to subspecial psychiatry clinic in Isfahan who were selected through convenient sampling and allocated to the study and control groups. Quality of Life Questionnaire (SF36) was adopted to collect the data. The questionnaire was completed by the participants in three stages of before-and-after up to a month after intervention. Cognitive behavioral stress management program was administrated in study group for eight straight sessions, two month, and a month after intervention. Along with this, conventional medical treatments were conducted for both the groups. Data were analyzed by ANOVA. The significance level was P < 0.001. Results: There was no significant difference in QoL mean scores between the two groups before intervention (44, 43.1), but mean scores of QoL were significantly higher in intervention G (55.7, 59.1), compared to control (39.8, 35.7), after intervention (P < 0.001) and one month after intervention (P < 0.001). Conclusions: Cognitive behavioral stress management, conducted in the present study, had a notable effect on QoL. Therefore, designing psychological interventions based on cognitive behavioral stress management is suggested as an efficient clinical intervention.

Background: Various factors threaten the health and recovery of hospitalized elderly, including stressors in medical service centers. Therefore, the aim of the present study was to develop and preliminary validate a measurement tool to assess hospitalization-related stressors (HRS) among the elderly. Materials and Methods: This methodological research was conducted in 2015. The study was performed in two main phases. In the first phase, which was to develop the questionnaire, the data were collected through literature review, interview with few elderly patients, and calculating content validity index with the participation of 16 experts. The second phase included preliminary validation of the questionnaire in which a convenient sample of 200 hospitalized elderly patients recruited from 4 educational medical centers of the Isfahan University of Medical Sciences were studied. Principal component analysis method was used to identify the factorial structure of the questionnaire. In order to evaluate validity, Cronbach's alpha coefficient was calculated. Results: After evaluating the results and relocating and merging some of the items, a version of 26 items in 7 categories was prepared with acceptable internal consistency (Cronbach's alpha coefficient from 0.67 to 0.78 for the components and 0.83 for the tool). Conclusions: In this study, we were able to identify a set of important components and indicators of HRS in elderly; so it can be used as a useful instrument. Future studies are recommended in order to develop and validate this tool in other communities.

Background: In recent studies, using virtual reality (VR) has been proposed as a nonpharmacological method for anxiety reduction, but until this time, its effects have not been assessed on anxiety during episiotomy repair. This study aimed to determine the effect of audiovisual distraction (VR) on anxiety in primiparous women during episiotomy repair. Materials and Methods: This clinical trial was conducted on 30 primigravida from May to July 2012 in the maternity unit of the Omolbanin Hospital, Mashhad city, Iran. The samples were divided randomly into two groups with the toss of a coin. Anxiety were evaluated by the numeric 0-10 anxiety self-report, in the first and during labor. However, after delivery, anxiety was measured with the Spilberger scale. Mann-Whitney, Chi-square, Fisher tests, and repeated-measures analysis of variance were used to analyze data. Results: Anxiety scores were not significantly different between the two groups (wearing video-glass and receiving routine care), but anxiety scores were lower in the intervention group during and after repair (P = 0.000). Conclusions: VR are safe, appropriate, and nonpharmacologic to decrease and manage the anxiety-associated episiotomy.

Background: Vulnerable women are prone to sexually transmitted diseases due to their high-risk behaviors. The present study aimed to investigate the effect of self-care training program based on Orem's model on the behaviors leading to sexually transmitted diseases in vulnerable women. Materials and Methods: This field trial was initially conducted on 100 women covered under health services and welfare organization in Isfahan city, who were selected by rationing ssampling. For needs assessment, they filled the self-care needs assessment questionnaire in three domains of knowledge, attitude, and practice. Then, at the stage of intervention (self-care training), 64 subjects were selected through convenient sampling and were assigned to experimental and control groups by random allocation. Data were analyzed by descriptive and analytical statistical tests through SPSS 18. Results: Results showed that mean scores of knowledge (P < 0.001), attitude (P < 0.001), practice (P = 0.04), and behavior change (P = 0.01) were significantly higher immediately after and 3 months after intervention, compared to before intervention, but there was no significant difference in mean scores between immediately after and 3 months after intervention. Conclusions: With regard to these results, it can be concluded that if the educational programs are planned based on clients' real needs assessment, the learners follow the educational materials, related to their problems, more seriously and it results in a notable behavior change in them.

Background: Nurses face a great amount of stress that can threaten their health and reduce their motivation. Nurses' present working conditions lead to an increase in emotional pressures and depression. Conducting a study on this seems to be necessary, with regard to nurses' stressful working conditions, in order to take steps toward achieving different and non-meditational treatments to treat their stress, anxiety, and depression and, consequently, promote nurses' and patients' health. Materials and Methods: This is a randomized clinical trial conducted on 52 nurses working in cancer patients wards, who were randomly assigned to intervention and control groups. Happiness educational program was administered for six sessions once a week in the study group and a communication training sessions with the patients in the control group, and DASS-42 questionnaire was completed before, immediately after, and 1 month after intervention by the subjects in both study and control groups. Data were analyzed by Chi-square, independent t-test, and analysis of variance (ANOVA) through SPSS 18. Results: Mean scores of stress, anxiety, and depression showed no significant difference before and after intervention. Meanwhile, independent t-test showed that mean scores of stress, anxiety, and depression were significantly lower in the study group compared to the control group immediately after and 1 month after intervention (P < 0.05). Conclusions: Educational planning of happiness can reduce nurses' depression, anxiety, and stress in the cancer patients' wards. Psychiatric nurses can reduce depression, anxiety, and stress of nurses working in other hospitals also through application of this program.

Background: Ventilator-associated pneumonia (VAP) is a common side effect in patients who receive intravenous sedation infusion. In routine care, after starting sedation infusion for patients who receive mechanical ventilation, interruption of sedation starts without protocol. This study aimed to evaluate the effect of daily sedation vacation protocol on the incidence of VAP in mechanically ventilated patients. Materials and Methods: In this clinical trial study, 80 patients with intravenous sedation infusion were selected and randomly allocated to intervention and control groups. In the intervention group, daily sedation vacation protocol and in the control group, routine sedation vacation was followed. Modified clinical pulmonary infection score questionnaire was completed before intervention and on the third, fourth, and fifth days after intervention. Data were analyzed by using repeated measures analysis of variance (ANOVA), Chi-square, and independent t-test. Results: The results of this study showed that the incidence rate of VAP in the intervention and control groups was 0% versus 15% on the third day of intervention, 12.5% versus 50% on the fourth day, and 27.5% versus 55.3% on the fifth day of intervention in the intervention and control groups, respectively. The incidence of VAP in the intervention group was significantly lower than in the control group (P < 0.05). Conclusions: The results of this study showed that in patients with intravenous sedation, infusion of a daily sedation vacation protocol may reduce the incidence of VAP. Therefore, in order to prevent VAP, nurses are recommended to use this daily sedation vacation protocol.

Background: An association of eating disorder with diabetes mellitus may lead to a serious lack of metabolic control, higher mortality and morbidity. There is no recent study conducted in the Iranian population about eating disorder and its variants. The aim of the present study is investigation of frequency of disturbed eating behaviors in adolescent girls with type 1 diabetes mellitus (T1DM) compared to non-diabetics. Materials and Methods: In this cross-sectional study, disturbed eating behavior were evaluated and compared in two groups of 12-22 year old adolescent and young females (126 with diabetes and 325 without diabetes). A self-report questionnaire including demographic data, Children's Depression Inventory (CDI), and Eating Attitude Test (EAT-26) was used for data gathering. Independent t-test, Chi-square test, and logistic regression [odds ratio (OR)] were used for data analyses in SPSS 15. Results: Findings revealed that higher percentage of diabetic girls are likely to have eating disturbances (67.9% vs. 53.8%, P = 0.01). Diabetic group obtained higher scores in both dieting (14.95 ± 6.28 vs. 11.79 ± 5.62, P < 0.001) and bulimia scales (4.9 ± 3.13 vs. 4.12 ± 2.89, P = 0.017), which supports a role for T1DM in inducing the symptoms. Diabetic girls were at more than double the risk of developing eating disturbance. Conclusions: The results indicate that a significantly higher percentage of diabetic girls are likely to have eating disturbances. Also, diabetic subjects had an increased probability of getting higher scores in all three EAT-26 subscales. Therefore, healthcare professionals, especially diabetic nurses, should be aware of the potential effects of the subclinical and clinical eating behaviors on adolescents with T1DM and evaluate them for these disturbances.

Background: In neonatal intensive care unit (NICU), neonatal sleep is disrupted due to different factors. Due to the critical role of sleep in premature infants' brain development, this study aimed to investigate the effect of nesting and swaddling on the sleep duration of premature infants hospitalized in NICUs. Materials and Methods: In a crossover clinical trial, 42 preterm infants who met the inclusion criteria were enrolled. They were randomly assigned to two groups of nest-swaddle and swaddle-nest. Sleep status was evaluated by observation and use of Prechtl's criteria. Then, durations of total sleep time (TST) and quiet sleep time (QST) were recorded. Data were analyzed using repeated measure analysis of variance (ANOVA). Results: Mean values of TST and QST during nesting and also swaddling periods were significantly higher than in the control period in both groups (P < 0.001). Mean values of TST and QST in the swaddling period were higher than in the nesting period in both groups, However, these differences were not significant (P = 0.245). Conclusions: Both swaddling and nesting could significantly increase the duration of TST and QST, compared to the control. There were no significant differences between the effects of these interventions on TST and QST. Therefore, using any of these methods is suggested to improve infants' quality of sleep in NICU, with respect to the ward policies.