Background: Based on the results of many studies on the relationship between nutritional status and clinical implications in dialysis patients, malnutrition is one of the most important factors associated with mortality in these patients. The current study examined the effect of nutritional education based on Health Belief Model (HBM) on nutritional knowledge, HBM constructs, and dietary intake in Hemodialysis (HD) patients. Materials and Methods: One-hundred chronic HD patients entered to this randomized clinical trial in 2017 in Iran; 41 in control group and 45 in intervention group completed the study. Demographic data and four 24-h recalls were collected. To evaluate the nutritional knowledge and HBM constructs, a researcher-made questionnaire was used. Patients were evaluated before, immediately after, and 3 months after intervention. Eight 1-h education sessions in 4 weeks were considered for intervention group. Independent samples t-test, Chi-square test, and repeated measures ANOVA were used to analyze the data. Results: Repeated measures ANOVA test showed significant increases in scores of the nutritional knowledge test, perceived susceptibility, perceived severity, perceived barriers (p = < 0.001), perceived benefits (p = 0.010), and self-efficacy (p = 0.019) after the study in the intervention group. There were no significant differences between two groups in energy, protein, High Biologic Value (HBV) protein, carbohydrate, fat, cholesterol, fiber, vitamin B2, B3, B6, B12, E, calcium, phosphorus, and potassium intake. Conclusions: It seems that education based on HBM can improve nutritional knowledge but in order to influence on dietary intake, longer interventions that are more comprehensive are needed.

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Background: Taking into account the breadth of the concept of motivation and its importance for nursing students, it is imperative to clarify the concept of academic motivation. This study is an attempt to analyze the concept of academic motivation in nursing students. Materials and Methods: The study was carried out in 2018 as a combined literature review and qualitative research. Hybrid concept analysis model was employed to clarify the concept at three phases. At theoretical phase, articles indexed in credential databases were searched using keywords “academic motivation” and “nursing.” Totally, 30 articles were analyzed. At fieldwork phase, 12 nursing students were interviewed. At conclusive phase, the findings of the two earlier phases were analyzed. After determining the attributes, antecedents, and consequences, a final definition of academic motivation in nursing student was introduced. Results: Academic motivation has six main attributes including “being an internal process,” “purpose oriented,” “variable,” “unique,” “driving force of educational performance,” and “facilitator of learning and educational achievement.” In addition, antecedents and consequences of academic motivation in the nursing students were revealed and a general definition of the concept was codified. Conclusions: Academic motivation of nursing students is a broad and multi-dimensional concept that is affected by various personal, family, social, educational, and professional factors. Moreover, it is a factor in achieving academic success, better quality of learning, creativity, academic satisfaction, reduction of anxiety, continuing education, and training competent nurses.

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Background: These days, most of the admitted infants in neonatal intensive care units (NICU) are premature infants. Infant massage and prone position has been recommended for several decades to have a positive effect on preterm and low birth weight infants. The objective of this study was to determine the effects of neonatal massage with prone positioning in preterm infants on Heart Rate (HR), and Oxygen Saturation (O₂Sa) status. Materials and Methods: This is a controlled randomized three-group clinical trial study conducted on hospitalized infants in selected hospitals of Alborz University of Medical Sciences in Karaj-Iran. There are about 75 preterm infants (33-37 weeks) who met inclusion criteria were randomly assigned to groups of position, massage as intervention groups, and a control group. Intervention (prone position and massage) was administrated for five straight days. The repeated measure ANOVA test was performed to evaluate and compare the effect of interventions.p value less than 0.05 was considered as statistical significance. Results: The Repeated Measure two-way Analysis of Variance (RM-ANOVA) result showed a significant difference in HR and SaO₂ in different time points among control, position and massage groups with RM-ANOVA (F_10,360=10.376,p < 0.001). HR values was reduced and SaO₂ values was increased in intervention groups with RM-ANOVA (F_5,360=2.323,p < 0.001). Conclusions: Results showed that massage and prone position equally led to the reduction of HR and increase of SaO₂, compared to control group.

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Background: Correct triage is one of the most important issues in delivering proper healthcare in the emergency department. Despite the availability of various triage guidelines, triage is not still appropriately implemented. Therefore, this study was conducted to investigate the role of different underlying factors in triaging emergency patients through a qualitative approach. Materials and Methods: This study was conducted by conventional content analysis. For this purpose, 30 interviews were conducted with 25 participants. The participants included triage nurses, emergency general physicians, emergency medicine specialists, and expert managers at different position rankings in hospitals and educational and administrative centers in Yazd, selected by purposeful sampling. Data were collected through in-depth and unstructured interviews from April 2017 to January 2018, and then analyzed by inductive content analysis. Results: Four categories of profit triage, exhibitive triage, enigmatic, and tentative performance triage were drawn from the data, collectively comprising the main theme of responsibility-evading performance. Conclusions: The dominant approach to the triage in the emergency departments in a central city of Iran is responsibility evasion; however, the triage is performed tentatively, especially in critical cases. To achieve a better implementation of triage, consideration of the underlying factors and prevention of their involvement in triage decision-making is necessary.

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Background: Identifying the factors that lead to the beginning, continuing, or stopping the Exclusive Breastfeeding (EBF) by mothers can be of great assistance in the design of interventions to strengthen this behavior. The aim of this study was to predict EBF among mothers with Infants Less than Six Months of Age (ILSMA) according to the Theory of Planned Behavior (TPB). Materials and Methods: The study was a cross-sectional one that conducted among 304 mothers with ILSMA in Khorramabad-Iran in 2017 using Structural Equation Modeling (SEM). The sampling method was a combination of census, stratified random, and systematic random sampling. The data collection tool was a contextualized, valid, and reliable questionnaire according to the TPB. Data were collected by a trained interviewer. Data were analyzed using SPSS-16 and AMOS-20 software programs and SEM. Results: Perceived Behavioral Control (PBC) could explain 65% of mothers' EBF intention. Intention and PBC were able to predict 79% of the variance in EBF together. The fitness indices of EBF model in the current study were acceptable (RMSEA = 0.07, CMIN/DF = 2.58, NFI = 0.81, CFI = 0.87, and GFI = 0.83). Conclusions: TPB is an appropriate model for predicting the intention and behavior of EBF. Policy makers and health system managers are recommended for taking some measures to add a standardized questionnaire in the electronic health record to predict EBF according to TPB of pregnant women and mothers with ILSMA. In this way, they can empower primary healthcare providers to design and implement a theory-based interventional plan.

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Background: Normal vaginal delivery is considered a painful process and it is difficult to tolerate the pain. The goal of this study was to compare the effect of injection of sterile distilled water and normal saline on pain intensity in nulliparous women. Materials and Methods: This triple-blind clinical trial was conducted on 164 nulliparous women randomly selected from among those who were hospitalized in Motahari Hospital of Jahrom, Iran, from 1 May 2012 to 1 October 2013. Women with a gestational age of 37–42 weeks, dilatation of 4–6 cm, and delivery 180 min after the intervention were selected. The subjects were randomly allocated to four groups of intracutaneous and subcutaneous sterile water and normal saline injections. Pain severity was measured 5 min before the injection and every 30 min up to 3 h after the injection using a visual analog scale. The data were analyzed using Chi-square, Scheffe, and Spearman's correlation tests in SPSS software. Results: There was no significant difference among the four studied groups concerning gestational age and other demographic characteristics. Chi-square test showed lower pain intensity 120 min after the injection in group 4 (subcutaneous injection of normal saline) (F₃= 14.75, p < 0.001) and 150 min after the injection in group 3 (intracutaneous injection of normal saline) (F₃= 14.75, p < 0.001). Chi-square test showed that the duration of the second stage of labor was shorter in group 4 participants (subcutaneous injection of normal saline) (F₃= −'12.23, p < 0.001). Conclusions: The study showed that subcutaneous and intracutaneous injection of normal saline reduced the intensity of pain during childbirth.

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Background: Breastfeeding is an important issue in postpartum period and critical to the infant's health, but childbirth interventions such as childbirth analgesia may affect the onset and duration of the process. This study aimed to determine the status of breastfeeding in women receiving epidural analgesia. Materials and Methods: This cohort study was conducted on 393 mothers in the postpartum period that had vaginal delivery with or without using epidural analgesia (with their own choice) between December 2017 and September 2018. After selecting the convenient samples, the researcher-made outcome breastfeeding checklists were completed in selected hospitals in Isfahan, Iran, Within 24 hours and 4 weeks after delivery. Data were analyzed using statistical methods (Independent t test, Mann-Whitney, ANCOVA, and Chi-square). The significance level of the tests was less than 0.05. Results: According to the results, most of the subjects in the two groups began breastfeeding during the first hour after childbirth. There was no significant difference between the two groups in the beginning of breastfeeding while controlling the number of labors. There was no significant difference between the two groups in comparison to the type of milk given to the infant Within 24 hours after birth and 4 weeks after birth, either. There was no significant difference between the two groups in comparison to breastfeeding problems at either time. Conclusions: According to the results, saying that there is no negative effect by epidural analgesia on the breastfeeding process, using this analgesia is recommended to promote natural childbirth.

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Background: Episiotomy is the most commonly performed surgical procedure during delivery, and its associated pain is a major problem in obstetrics. This study aimed to determine the effect of Olea ointment on the severity of post-episiotomy pain in primiparous women. Materials and Methods: This paralleled randomized controlled clinical trial was performed on 73 primiparous women in Al-Zahra hospital in Rasht, Iran in 2017-2018. Women were randomly allocated into intervention (n = 39) and control (n = 34) groups. The first intervention was performed 4 h after the episiotomy. This continued every 8 h for 10 days. The pain intensity of episiotomy was assessed by the Visual Analogue Scale (VAS) before intervention, 2 and 24 h after the beginning of intervention, and 5 and 10 days after childbirth. Descriptive and inferential statistics (Mann-Whitney, Fisher exact test, Independent t-test, Friedman test, and Chi-square) were performed for statistical analysis. Results: There were no significant differences among two groups in terms of demographic and obstetrics characteristics. The severity of pain in intervention and control group before the intervention was not statistically significant, but the variable depicted a meaningful difference between the groups 2 h after the intervention (U = 483.50, p = 0.021), 24 h after the intervention (U = 489.50,p = 0.019), as well as the 5^th day (U = 112.50,p < 0.001) and 10^th day postpartum (U = 136.50,p < 0.001). Conclusions: Based on the findings, Olea ointment could be used effectively for reducing of episiotomy pain. Similar studies are recommended.

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Background: Professional and paramedical students have a key role in oral health promotion. The aim of this study was to assess oral health–related Knowledge, Attitude, and Practice (KAP) among the nursing students in Rajasthan. Materials and Methods: A cross-sectional, questionnaire-based study was carried out among 409 nursing students from five different institutes who were selected by simple random sampling. A 27-item questionnaire was used to assess KAP. The resulting data were analyzed using frequency distribution. Results: Over 50% of the students used toothbrush and toothpaste twice a day to maintain their oral hygiene. Besides, 41% recognized the importance of dental visit in case of gingival bleeding and knew that poor oral hygiene is responsible for bad breath. Conclusions: Oral health–related behavior among the nursing students needs improvement. More educational and preventive programs should be organized to achieve better results.

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Background: Gestational diabetes is the second common disorder in pregnancy period, which is detected in 24–28 weeks of gestational age through screening tests. Low-grade systematic inflammation is associated with an increased risk of type 2 diabetes. C–Reactive Protein (CRP), an acute phase protein produced by hepatocytes, may be associated with diabetes. This study aimed to investigate serum levels of CRP in women with Gestational Diabetes Mellitus (GDM) and impaired glucose tolerance test compared with control subjects. Materials and Methods: This observational longitudinal study was conducted on 176 pregnant women in Isfahan. After administration of a CRP test in these women in the first trimester, a screening test of Glucose Challenge Test (GCT) with 50-g oral glucose was conducted in 24–28 weeks of gestational age. Then, CRP levels and GCT were compared. Results: Serum CRP levels were not significantly correlated with positive GCT among the women. In GDM patients, there was not a significant correlation between CRP and BMI. Conclusions: There was no significant correlation between maternal serum CRP level and gestational diabetes. Maternal serum CRP level in the first trimester cannot predict Intolerance Glucose Test (IGT) in 26–30 weeks of gestational age.

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Background: The aim of this study was to investigate the adherence to medication and Physical Activity (PA) among People Living with HIV (PLHIV). Materials and Methods: In the present cross-sectional study, 122 PLHIV were selected. The research tools included the Baecke questionnaire and the AIDS Clinical Trials Group questionnaire. Data were analyzed by independent t test and multiple logistic regression. Results: The results of 7- and 30-day recalls showed that 76.21 and 82.23% of patients had proper medication adherence. The mean score of PA in patients was less than the recommended average score in the questionnaire. Furthermore, there was no significant difference observed between the medication adherence and PA. Conclusions: Although the adherence to medication was appropriate, nurses and health care providers should increase the level of PA for PLHIV by dealing with the related barriers to live an active life.

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Background: This study aimed at investigating the effect of showing surgery educational documentary film on the anxiety of patients candidate for lumbar disc surgery. Materials and Methods: This study, as a randomized clinical trial, was conducted in 2018 on 60 patients undergoing lumbar disc surgery, Iran. The patients were divided into two groups of intervention and control (N = 30). An educational film was shown to the patients of the intervention group for 20 min and the control group was provided with the ward's routine trainings. All patients completed demographic characteristics questionnaire and the Spielberger State-Trait Anxiety Inventory (SSTAI) on the admission day, 1 day before the surgery, and 2 h before the surgery. SSTAI was recompleted by the patients. Data analysis was performed using independent t-test, Chi-square, Mann–Whitney test, and paired t-test. Results: Before the intervention, the mean score of the state (obvious) and trait (hidden) anxieties was not significantly different between the two groups, but after the intervention, the mean [standard deviation (SD)] score of the state anxiety in the intervention group was significantly lower than that of the control group [mean (SD) = 40.78 (10.34) vs. 47.45 (10.33), F_10,33= 58,p= 0.01]. In addition, after the intervention, the mean (SD) anxiety score of the patients in the intervention group was significantly lower than that of the control group [mean (SD) = 38.65 (11.01) vs. 44.71 (10.34), F_10,34= 58, p= 0.03). Conclusions: The results showed that educational film reduces the patients' level of anxiety before the surgery. As such, it is recommended that these trainings be included in preoperative nursing practices.

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Background: Midwives, as the first family trainers, play a significant role in the proper formation of children's sexual identity. Virtual education allows flexible learning for an unlimited number of students. This study aims to examine the influence of virtual education on midwifery students' knowledge of child sexual training. Materials and Methods: This study was conducted as a clinical trial from March 2015 to March 2016, on 75 midwifery students studying in two state universities in Tehran, Iran. By flipping a coin, universities were randomly divided into intervention and control groups. Through census sampling, all students of one university were recruited as the intervention group (40 students) and those of the other university were recruited as the control group (35 students). The education offered to the intervention group included eight 1-h virtual education sessions consisting of PowerPoint, audio and video files. Both groups' knowledge was assessed before and 3 months after the completion of the course. A researcher-made questionnaire was used to measure students' knowledge based on certain scenarios. T-pair and t-test (p < 0.05) were used for within-group and between-group analyses, respectively. Results: The mean score difference of sexual knowledge before and after education was 17.60 and 1.59 in the intervention and control groups, respectively; an independent t-test showed a significantly higher level in the intervention group (t₇₃= 6.86,p= 0.001). Conclusions: When in-class learning in the field of child sex training is not feasible for various constraints, virtual education can be used as a feasible and effective method.

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Background: Nursing consultation is one of the important roles of nurses and is very effective in improving care results. But this role is unknown in Iran and there are no respective organizational positions. The purpose of this study is to examine the factors affecting the position of this role. Materials and Methods: This study, as a qualitative research was conducted from April to December 2017 using content analysis approach. We performed semi-structured in-depth interviews with 23 participants who were selected using purposeful sampling and were asked to describe the factors affecting the organizational position of nurse consultant. Results: The mean (standard deviation) age of the participants was 44.5 years (10.68). 279 meaning units, 39 codes, 6 subcategories and two categories were obtained in this essay. The two main categories include necessity for nursing consultation role with two subcategories (nursing consultation role as one of the main roles in nursing, and the need for nursing consultation in healthcare system in Iran), and the obstacles of nursing consultation role with four subcategories (healthcare system problems, problems associated with physicians, problems associated with nurses and problems associated with patients' culture). Conclusions: Considering the importance of nursing consultation role in improving the health of the patients, the policymakers should take into account the consultant role of nurses and they should understand the importance of and the need for this role. As such, we hope that managers and policymakers create a role position by removing the obstacles and considering the necessity of this role.

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