Background: Nurses are members of the health care team for crisis response. Identifying nurses' capability in responding to a disaster and promoting their preparedness will lead to effective use of human resources and decreasing the detrimental effects of disaster. The purpose of this article was to determine emergency nurses' competences in triage, life support, and basic clinical skills in disaster response. Materials and Methods: This study was a descriptive study in which 40 emergency nurses were recruited by purposeful sampling. Moreover, their competencies in performing triage, life support, and basic clinical skills were evaluated by utilizing eight-station objective structured clinical examination (OSCE). Results: Our findings showed that the mean scores of nurses' performance were: In triage (4.3 ± 1.27), life support (4 ± 1.5), airway management (5.3 ± 1.7), chest tube insertion (7.3 ± 1.8), nasogastric tube insertion (5.6 ± 2.5), IV therapy (2.5 ± 0.8), IV line insertion (6 ± 1.4), suturing (9.1 ± 1.6), and urinary catheterization (10.4 ± 2.2). No statistically significant correlation was found between demographic variables and nurses' performance (P > 0.05). Conclusion: According to our findings, it can be concluded that competencies of nurses in performing triage, life support, and basic clinical skills were undesirable. Because emergency nurses are members of the emergency medical team, they should be prepared for disaster response via continuous training programs.

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Background: The prevalence of self-neglect among the elderly is expected to rise with a rapid increase in the growth of the older population. However, self-neglect in the elderly and the factors related to it are not fully understood due to the limited research in the area, lack of consensus in the definition of the concept, and limited instrumentation. The purpose of this study was to investigate the relationship between selected socio-demographic factors on self-care and self-neglect among older persons living in the community. Materials and Methods: A cross-sectional survey design with cluster sampling was adopted for the study. Data were gathered from 201 older persons aged 60 years and over in the state of Selangor, Malaysia, through face-to-face interviews in their homes with a team of trained enumerators. A new instrument was developed to measure self-neglect. Results: The internal consistency of the new instrument showed a reliability of 0.90. A significant bivariate relationship was noted between self-care and self-neglect. The socio-demographic  factors were also reported between self-care and self-neglect. Conclusions: The new instrument of elder self-neglect (ESN) could be used to measure self-neglect in a community dwelling. The need to increase the self-care skills and the capacity of self-care among older adults is crucial in order to reduce self-neglect and enhance their well-being.

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Background: Pregnancy rate among Iranian adolescents below 20 years of age is increasing. Pregnancy during adolescence is considered a social issue associated with medical, emotional, and social outcomes for the mother, child, and family . The current research examines the experience of pregnancy among Iranian adolescents. Materials and Methods: The qualitative content analysis method was used. A purposive sample of 14 pregnant adolescents was enrolled in the study. Deep interviews were carried out with them. Results: Three themes were came up after analyzing the interviews: 1. Psychological reactions including three subthemes of feelings, concerns, and fears; 2. physical reactions including the subthemes of symptoms and feelings; and 3. spiritual reactions including religious beliefs and faith. Conclusions: The present study showed that for the purpose of assessing pregnancy in adolescents, one should consider the context and culture in which the adolescent lives. This is because factors such as preplanned or unwanted pregnancy and imposed or consensual marriage within or outside the family may draw different reactions from adolescents. Hence, all those factors need to be considered in order to plan health education during pregnancy for this age group.

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Background: Nurses' clinical judgment development is essential for the professional nursing practice. The aim of this study was to explore the facilitators to the development of Iranian nurses' clinical judgment. Materials and Methods: A qualitative design using conventional content analysis method was employed in the study. A purposive sample of 24 participants was recruited from three hospitals located at Sanandaj, Iran. Study data were collected in 2013 by using semi-structured individual interviews. A content analysis approach was used to analyze the study data and MAXQDA was used for coding and categorizing the data. Results: The main theme of the study was "professional support as a facilitator to the development of nurse's clinical judgment." The sub-themes of this main theme included "provision of direct support to nurses" and "provision of clinical judgment resources." The first sub-theme consisted of different types of managerial, clinical, educational, and social supports. The two categories of the second sub-theme included the provision of necessary clinical evidence and the provision of medical equipments. Conclusion: The study findings highlighted the importance of providing nurses with adequate professional support for facilitating the development of their clinical judgment.

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Background: Data was reported in Iran in 2013 has shown that almost 42 percent of deliveries in public hospitals and 90 percent in private hospitals were carried out with cesarean section. This high rate of cesarean requires careful consideration. It seems that making decision for cesarean is done under the influence of cultural perceptions and beliefs. So, this study was conducted to explore pregnant women's preferences and perceptions regarding cesarean delivery. Materials and Methods: A focused ethnographic study was used. 12 pregnant women and 10 delivered women, seven midwives, seven gynecologist and nine non-pregnant women referred to the health clinics of Tonekabon, who selected purposively, were included in the study. To collect data semi-structured in-depth interviews and participant observation were used. Study rigor was confirmed through prolonged engagement, member check, expert debriefing, and thick description of the data. Data were analysed using thematic analysis and MAXQDA software. Results: Four themes emerged from the data including personal beliefs, fear of vaginal delivery, cultural norms and values and also social network. These concepts played main roles in how women develop meanings toward caesarean, which affected their perceptions and preferences in relation to caesarean delivery. Conclusion: Most of pregnant women believed that fear of vaginal delivery is a major factor to choose caesarean delivery. Hence, midwives and physicians could help them through improving the quality of prenatal care and giving them positive perception towards vaginal delivery through presenting useful information about the nature of different modes of delivery, and their advantages and disadvantages, as well as the alternative ways to control labor pain.

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Background: Pregnancy with anxious or depressive symptoms might be associated with worse birth outcomes. The aim of this study was to determine the demographic predictors of anxiety and depression symptoms in pregnant women. Materials and Methods: We assessed pregnancy anxiety and depression levels among 142 women in three trimesters. All subjects completed two questionnaires: Demographic scale and the 21-item Depression Anxiety Stress Scale (DASS-21) questionnaire. Chi-square test and regression analysis were used to assess the association between anxiety and depression symptoms with maternal age, maternal education, family income, gestational age, body mass index, parity, and pregnancy risk. Results: 25.3% of the pregnant women reported having depressive symptoms. Also, 49.3% of the subjects reported having anxiety symptoms. There was positive correlation between body mass index, gestational age, and pregnancy risk with depression symptom. Also, there was negative correlation between family income and maternal education level with anxiety symptom. In linear regression model, the variables of maternal age, maternal education, parity, abortion, gestational age, family income, body mass index, and pregnancy risk predicted 44.7% anxiety (F = 1.903, P = 0.006) and 68.1% depression (F = 2.101, P = 0.003). The strongest predictors of depression in pregnant women were pregnancy risk (β = 0.361, P = 0.001) and maternal education (β = −0.297, P = 0.006). Also, pregnancy risk (β = 0.523, P = 0.001) and gestational age (β = 0.477, P = 0.01) were the important predictors of maternal anxiety in the pregnancy period. Conclusions: Pregnancy risk, gestational age, and education level are the strongest predictors of mental health in the pregnancy period. This result suggests that psychological support is needed for pregnant women with high risk and low education, especially in the third trimester, to improve their mental health.

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Background: Many factors have been mentioned to influence decision-making for different kinds of delivery. Decision-making for vaginal delivery is under the influence of culture, perceptions, beliefs, values, attitudes, personalities, and knowledge. The current study aims at exploring the determinants of decision-making for vaginal delivery in the north of Iran from women's perspective. Materials and Methods: A focused ethnographic method with purposeful sampling method has been used. Semi-structured interviews and observation were conducted with 12 pregnant women and 10 delivered women, 7 midwives, 7 gynecologists, and 9 non-pregnant women in Tonekabon clinics. Interviews and observations were recorded and transcribed. The accuracy of the extracted codes and themes was confirmed by restoration of the arranged and coded texts to the participants (member check) and by an expert person from outside the study context. Data were analyzed using thematic analysis and MAXqda software. Results: Five themes were extracted from the data: Economic influencing factors, Cultural values and norms related to normal childbirth, Positive attitudes towards vaginal delivery, Role of important others, and Facilitators of natural birth. Several sub-themes and sub-sub themes also emerged from the data (e.g. safe delivery, forming maternal feelings, painful but tolerable, maternal role facilitator, inexpensive delivery, a process with good outcome and less complications, relief messenger). Conclusions: Giving enough information about vaginal delivery for pregnant women and their family members, training pregnant women to increase tolerance during labor pain, and modifying expenses can increase economic affordability, positive cultural norms and attitudes about vaginal delivery, proper social support, use of normal delivery facilitators, and direct them toward vaginal delivery.

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Background: Chronic illnesses such as coronary heart disease are among the most prevalent and costly of all global health problems. Coronary heart disease is a leading cause of death worldwide, including Iran. One aspect of living with chronic illness is self-management which can reduce the impact of illness on daily life and maintain the quality of life. A qualitative understanding of how patients perceive the necessity of self-management is important for self-management support. The current study aims to determine patients' perception of the need for self-management following coronary artery bypass graft (CABG) surgery. Materials and Methods: We used a content analysis approach to conduct this qualitative study. Data were collected by interviews with 25 patients who underwent CABG surgery at least 1 year prior to the study. Purposeful, followed by theoretical sampling was used until data saturation. Data were analyzed by descriptive qualitative content analysis according to the Graneheim and Lundman approach. Results: Participants had different perceptions regarding the need for self-management. Three themes, "reflective thinking," "information revision," and "beliefs influences," comprised the basis of forming patients' perceptions to the need for self-management. Conclusions: Patients' perceptions vary regarding the need for self-management. The difference in perception should be the basis for training programs to guide CABG patients for successful self-management.

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Background: Gestational diabetes mellitus is a prevalent pregnancy complication that seriously endangers mothers' and babies' health. The aim of this study was to explore factors affecting treatment compliance among women with gestational diabetes mellitus. Materials and Methods: A qualitative content analysis approach was employed. Twenty-five semi-structured interviews were conducted with hospitalized pregnant women with gestational diabetes mellitus. The research was conducted in four teaching hospitals in Tehran, Iran; purposive sampling was used. Results: Participants' experiences regarding factors that influence treatment compliance fell into six categories: Unexpected diagnosis, the need for urgent change, temptation to consume inappropriate foods, life in the shadow of the illness, risk avoidance, and seeking adjustment. Conclusions: Holistic education of families on gestational diabetes, training specialist diabetes nurses, and referral to public health centers and diabetes clinics could increase treatment compliance. These findings could serve patients and the healthcare system in general, if considered by healthcare officials and policy makers. Furthermore, providing outpatient services, considering cultural dietary conventions when recommending diets, and alleviating the stigma associated with diabetes through mass media could also promote treatment compliance.

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Background: Body image is related to cognitive, emotional, and physical aspects of women's life. Therefore, it is expected to have an important role in women's sexual health and marital adjustment too. This issue seems to be salient in infertile women who suffer from psychological consequences of infertility. This study was conducted to investigate the relationship of body image with sexual function and marital adjustment in infertile women in 2011 in Mashhad, Iran. Materials and Methods: This correlational study was performed on 130 infertile women who referred to Montaserieh Infertility Research Centre in Mashhad, Iran. Subjects were selected using convenient sampling method. To collect data, valid and reliable questionnaires including demographic and infertility-related data tool, modified Younesi Body Image Questionnaire, Rosen Female Sexual Function Index (FSFI), and Spanier Dyadic Adjustment Scale (DAS) were used. Data analysis was performed by SPSS software using Student's t-test, correlation, analysis of variance (ANOVA), and Tukey post-hoc test. Results: The mean scores of body image, sexual function, and marital adjustment in women were 308.1 ± 45.8, 27.23 ± 3.80, and 113.8 ± 19.73, respectively. There was a direct correlation between overall body image and subscales of sexual function including sexual arousal (P = 0.003), sexual desire (P = 0.024), vaginal moisture (P = 0.001), orgasm (P < 0.001), sexual satisfaction (P < 0.001), and dyspareunia (P = 0.007). A direct correlation was also observed between overall body image and subscales of marital adjustment including agreement and consent (P < 0.001), satisfaction with life (P < 0.001), continuity of life (P = 0.007), and expressing emotions within the family environment (P < 0.001). Conclusions: Improved sexual function and marital adjustment in cases with higher body image provides evidence that one of the solutions to reduce sexual dysfunction and marital dispute in infertile women could be planning educational and counseling programs to improve women's body image.

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Background: Labor pain is one of the most intense pains experienced by women. Different factors including physiological, psychological, socio-cultural, environmental, and personality-related factors are relevant to perception of childbirth pain. The negative experience of pain causes mental, psychological problems and influences the relationship between the mother and infant. Therefore, considering the importance of women's health, this study was conducted to examine the predicting role of personality traits on perception of labor pain among pregnant women in Kazeroun, Fars Province, Iran. Materials and Methods: This study is a correlational descriptive-analytical study. The data were collected using big five factors questionnaire about personality traits (neuroticism, openness experience, agreeableness, conscientiousness, and extraversion) and a researcher-made questionnaire on the perception of labor pain (containing items such as reaction to pain, pain intolerance, pain depth, and pain acceptance) from 220 parturient women who referred to Valiasr Hospital in Kazeroun. The data were analyzed using statistical methods including Pearson correlation coefficient, factor analysis, and multiple regression analysis. All analyses were carried out with SPSS. Results: The results of the study indicated that among the factors influencing the perception of labor pain, the reaction to pain was meaningfully predicted by the personality dimensions of neuroticism (β =0.26, P < 0.01) and openness experience (β =0.20, P < 0.05). Neuroticism (β =0.20, P < 0.05) and openness experience (β =0.20, P < 0.05) were the positive predicting factors and conscientiousness (β = −0.20, P < 0.05) was a negative predicting factor for labor pain intolerance. Agreeableness (β =0.31, P < 0.01), neuroticism (β =0.20, P < 0.01), and openness experience (β =0.18, P < 0.01) were the predictive factors for pain depth. Among all personality traits, neuroticism (β =0.19, P < 0.05) and openness experience (β =0.20, P < 0.05) were the positive predictive factors and conscientiousness (β = −0.24, P < 0.05) was the negative predictive factor for the total score of the perception of labor pain. Conclusions: It is recognized that personality traits can have predictive roles in the perception of labor pain. As a result, using different methods in managing and reducing childbirth pain, along with good advice and suitable education in pregnancy based on personality traits of women can be helpful for mothers to have more pleasurable experience from childbirth.

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Background: In Malaysia, contraceptive prevalence rate (CPR) during past three decades has been steady, with only 34% of women practicing modern contraception. The aim of this study was to determine the factors associated with modern contraceptive practices with a focus on spousal communication and perceived social support among married women working in the university. Materials and Methods: A cross-sectional study was carried out using self-administered structured questionnaire. The association between variables were assessed using Chi-square test, independent sample t-test, and logistic regression. Results: Overall, 36.8% of women used modern contraceptive methods. Significant association was found between contraceptive practice and ethnicity (P = 0.003), number of pregnancies (P < 0.001), having child (P = 0.003), number of children (P < 0.001), positive history of mistimed pregnancy (P = 0.006), and experience of unwanted pregnancy (P = 0.003). The final model showed Malay women were 92% less likely to use modern contraception as compared to non-Malay women. Women who discussed about family planning with their spouses were more likely to practice modern contraception than the women who did not [odds ratio (OR): 2.2, Confidence Interval (CI): 1.3-3.7]. Those women with moderate (OR: 4.9, CI: 1.6-10.8) and strong (OR: 14, CI: 4.5-26.4) perception of social support for contraceptive usage were more likely to use modern contraception than the women with poor perception of social support. Conclusion: Spousal communication regarding family planning would be an effective way to motivate men for supporting and using contraceptives. Family planning education initiatives should target both men and women, particularly high-risk cases, for promoting healthy timing and spacing of pregnancies. Ethnic disparities need to be considered in planning reproductive health programs.

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Background: The experience of labor and birth, referred to as childbirth, is complex, multidimensional, and subjective, relating to both the outcome and the process that is experienced by an individual woman. The aim of this study was to describe the experience of childbirth among Kurdish women giving birth at Besat Hospital in Sanandaj, Iran. Materials and Methods: A qualitative study was conducted using phenomenological approach. Women eligible for the study were recruited from the postpartum ward. Inclusion criteria were being an Iranian Kurdish woman, being nulliparous, and having vaginal childbirth. Data collection was performed between 2010 and 2011. Women were interviewed by the first researcher 6-12 weeks after they had given birth to their first child. Results: All participants had spontaneous vaginal births without their husbands present. None of them received any analgesia or anesthesia during labor and birth. The findings are described under the following four themes: Feeling empowered, changing life, importance of being supported during labor, and the spiritual dimensions of giving birth. Conclusions: Women communicate through telling stories and create meaning as they articulate their feelings about pivotal life events such as childbirth. The findings of this study provide a useful first step toward the identification of aspects of Kurdish women's experience of giving birth. The women in this study identified that the presence or absence of effective support had a significant effect on their experience of labor and birth. It is important for midwives and other professionals to understand the benefits of support given for women during childbirth.

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Background: Thalassemia major is the most common hereditary anemia in Iran. Thalassemia major patients require lifelong care and suffer much pain during self-care. Knowledge of the nature, meaning, and impact of suffering from the perspective of patients is needed to determine which interventions are helpful. This study was designed to understand the experience of suffering in patients with thalassemia. Materials and Methods: This was a qualitative study conducted with content analysis method. In the present study, 21 patients with thalassemia were selected by purposive sampling. The research was performed at Kerman Samen Alhojaj Medical Center, Iran, in 2013. Data collection method was conducting unstructured interviews using open-ended questions and field notes. In addition, data were analyzed using qualitative content analysis and conventional approach. Results: Data analysis resulted in the emergence of the four central categories of physical exhaustion, mental and spiritual restlessness, society's behaviors and beliefs, and surviving a hard life, which were the suffering themes of the patients. Conclusions: Results showed that thalassemia in the physical, psychological, social, and spiritual aspects is very stressful for patients. Moreover, culture plays an important role in the patients' experience of suffering. Results of this study can help nurses improve nursing care to alleviate suffering based on these experiences.

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Background: With regard to the importance of quality of life in pregnant women, the present study aimed to determine the effect of spouses' educational classes held for primaparous women referring to Hajar hospital on women's quality of life and pregnancy outcomes. Materials and Methods: This clinical trial was conducted from September 2011 to June 2012 in the clinic of the Hajar university center in Shahrekord. Eligible primiparous women who registered for physiologic delivery educational classes were randomly assigned to study (n = 31) and control (n = 27) groups. In the control group, eight physiologic delivery educational sessions were held. In the study group, in addition to attendance of pregnant women, their husbands also attended the third and the eighth sessions of these classes. Women's quality of life was investigated with SF36 questionnaire and pregnancy outcomes after delivery were investigated. Data were analyzed by t-test and Chi-square test. Results: Before intervention, there was no significant difference between scores of quality of life and demographic characteristics (P > 0.05). After intervention, there was a significant difference only in the dimensions of mental health, hugging time, kissing, and breast feeding between the study and control groups (P < 0.05). There was no significant difference in gestational age, gravida, number of miscarriages, pregnancy outcomes, and spouses' age (P > 0.05). Conclusions: Educational classes held for the pregnant women's husbands during pregnancy can be efficient in promotion of pregnant women's quality of life, especially in improving their mental health.

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Background: Poor interaction of treatment personnel with patients' families leads to informational contrast in families, which may ultimately increase the tension and pressure in these conditions. Considering the necessity of caregivers' contribution for an optimized treatment, continuation of care, and supporting patients, and with regard to caregivers' important role, and also considering the emphasis placed by previous studies on the significance of the caregivers' experiences and as there are a limited number of studies on eastern countries, the present study attempts to justify caregivers' understanding of their own needs for interaction with the treatment team. Materials and Methods: This study is a qualitative research conducted through a content analysis method with an inductive approach. 23 familial caregivers of breast cancer patients from Seyed-Al-Shohada and ayat- ollah khan sari Hospital of Isfahan and Arak were selected through purposive sampling. Data were gathered through in-depth interviews and field notes. The content was read for several iterations and units of meaning and primary codes were extracted, and then categories were extracted based on the centrality and similarity of meanings. Results: Four categories were extracted: a) caregivers' contribution and acknowledging them in the treatment system, b) training in efficient caregiving, c) efficient interaction of the medical team with caregivers, and d) easy and dynamic access to the medical services. Conclusions: The results of the study showed that family caregivers should cooperate and interact with the medical team. They also need training from the medical team on caregiving to cancer patients. An understanding of caregivers' experiences and needs in their interaction with the medical team and identifying their needs as an important aspect in cancer care system assists in designing evidence-based healthcare interventions and a comprehensive family-cantered care program.

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Background: Pressure ulcers' treatment imposes a considerable cost on health system and patients. Electrical stimulation has already been introduced as an effective method for promoting wound healing. This study was conducted to determine the impact of interferential current (IF) on healing of pressure ulcers (grade1 and 2). Materials and Methods: In this clinical trial, 23 patients (12 as cases and 11 as controls) were recruited. The study group was treated with IF daily for 10 days. IF current was applied via  isoplanar current with a sweep frequency of 30-99 Hz and with tolerable intensity for 15-20 min. Before intervention, condition of the wounds was assessed and recorded. Routine characteristics of the ulcers in both groups were recorded before intervention (first day) and on the fifth and tenth days after intervention. SPSS (ver. 13) with paired t-test and Fisher's exact test was also used to analyze the data. A P-value of 0.05 was considered significant. Results: According to one-sample Kolmogorov-Smirnov test, demographic characteristics, features of ulcer, as well as the intensity of pain were not significantly different between the study and control groups. All patients in the control and study groups were complaining of pain (7.25 ± 1.21 in the intervention group vs. 6.35 ± 1.28 in the control group). Ulcer size decreased significantly in the study group (P = 0.012) with a significant reduction in pain intensity (P = 0.000), amount of discharge (P = 0.008), and level of edema (P = 0.000), compared to controls. Conclusion: As a first study in this field, the results showed that the use of IF current can accelerate pressure ulcer healing and reduce its size. As IF current  can be considered as a deeper form of Transcutaneous Electrical Nerve Stimulation (TENS), it seems to be a safe method with no side effects.

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