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   2020| January-February  | Volume 25 | Issue 1  
    Online since December 27, 2019

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Efficacy of progressive muscle relaxation on pregnancy outcome among anxious indian primi mothers
Singaravelu Rajeswari, Nellepalli SanjeevaReddy
January-February 2020, 25(1):23-30
DOI:10.4103/ijnmr.IJNMR_207_18  PMID:31956594
Background: Progressive Muscle Relaxation (PMR) helps to improve the emotional state of antenatal mothers with stress and anxiety, which is necessary to keep the fetus healthy inside the womb. This study assesses the efficacy of progressive muscle repose on stress and anxiety among primigravidae. Materials and Methods: A randomized controlled study was conducted from May 2015 to June 2017 with 250 primigravidae. The women were assigned using a lottery method to intervention and control groups, 125 in each group. Information on background variables, pregnancy outcome, maternal complications, fetal complications, and postpartum depression was collected during the interval following delivery. PMR was the intervention (video) installed on one-to-one basis for two consecutive days. Pearson correlation, ANOVA, and regression analysis were used to evaluate the data to determine pregnancy outcome and performance of PMR. Results: There was a significant reduction ((F3= 24.81, p < 0.001) in all aspects of stress among the intervention and control groups during the posttest. The mean gestational age at birth was significantly different (F2= 6.08,p = 0.014) in the control group. There was significant increase in the occurrence of fetal complications such as birth asphyxia (F2= 5.67, p < 0.050), respiratory distress (F2= 8.68, p < 0.050), and jaundice (F2 = 3.91, p < 0.050) in the control group. There was a negative correlation between PMR and stress (r = −0.22, p < 0.001), and PMR and state anxiety (r = −0.26, p < 0.001). There was an increased occurrence of maternal complications among the control group in comparison with the intervention group. Conclusions: The study suggests that PMR practice is useful during pregnancy to decrease stress, anxiety, and for reducing the occurrence of postpartum complications.
  4,760 744 18
The changes of endotracheal tube cuff pressure during manual and intermittent controlling in intensive care units
Roghieh Nazari, Christopher Boyle, Mojgan Panjoo, Mohammad Salehpour-Omran, Hamid Sharif Nia, Ameneh Yaghoobzadeh
January-February 2020, 25(1):71-75
DOI:10.4103/ijnmr.IJNMR_55_19  PMID:31956601
Background: Usually, the endotracheal tube cuff pressure is controlled by cuff pressure monitoring. However, the intermittent pilot-manometer connection and disconnection may cause a change in the adjusted pressure. This study aimed to investigate changes in the endotracheal tube cuff pressure using both manual and intermittent controls. Materials and Methods: A semi-experimental within-subject design was conducted. Fifty-nine intubated patients in the Mazandaran Intensive Care Units (ICUs) participated through convenience sampling in 2018. In the control condition, first, the cuff pressure was adjusted in 25 cm H2O then it was measured without manometer-pilot disconnection at 1 and 5 min intervals. In the intervention condition, cuff pressure was immediately adjusted in 25 cm H2O then it was measured with manometer-pilot disconnection in the 1st and 5th minutes. Data analysis was performed using Independent t-test, Chi-square test, and Phi coefficient. Results: The mean and Standard Deviation (SD) change of cuff pressure after 1 minute, from 25 cm H2O, in the intervention condition was 20.22 (3.53) cm H2O. The mean (SD) of this change in the control condition was 25.22 (3.39) cm H2O. This difference was significant (t116= 7.83, p < 0.001, d = 1.44). The mean (SD) change of cuff pressure after 5 minutes, from 25 cm H2O, in the intervention condition was 19.11 (2.98) cm H2O. The mean (SD) of this change in the control condition was 25.47 (4.53) cm H2O. This difference was significant (t116= 9.24, p < 0.001, d = 1.70). Conclusions: The tracheal tube cuff pressure has been significantly reduced during manual intermittent measuring. Therefore, it is suggested that continuous cuff pressure monitoring and regulation should be used.
  3,731 414 3
Assess the illness perception and treatment adherence among patients with end-stage renal disease
Sekar Suganthi, Arjunan Porkodi, Poomalai Geetha
January-February 2020, 25(1):12-17
DOI:10.4103/ijnmr.IJNMR_74_19  PMID:31956592
Background: Chronic Renal Disease (CRD) complications had a sizeable effect on the patients. This study evaluates illness perception, treatment adherence and clinical outcomes of patients with End-Stage Renal Disease (ESRD) and finds an association with variables. Materials and Methods: A descriptive cross-sectional study was conducted among patients at Sri Ramachandra Institute of Higher Education and Research, Chennai, India during October and November 2017. Data were collected through interviews of each patient separately before hemodialysis. Demographic, clinical variables, identity dimension and control dimension of patients were assessed. Adherence behaviours were measured using ESRD-AQ in four dimensions. Clinical outcome was evaluated based on biochemical parameters. The collected data were analysed by percentage distribution and regression analysis. Results: The study had 120 patients with ESRD with male to female ratio of 2:1 where the majority (35.80%) were in the age group of 51–60. The identity dimension mean (SD) score was 10.80 (1.51). Under the control dimension mean scores were higher in the sub-dimension of emotional representations, consequences and personal control. Among 120 patients, 63 (52.50%) had adherence to dietary restriction. A statistically significant association was observed between timeline with Body Mass Index (BMI) (F3 = 4.81, p = 0.003) and comorbidity (F2 = 2.99, p = 0.022). Conclusions: The higher mean score in the sub-dimensions of emotional representations indicates a higher degree of emotional distress due to low adherence to prescribed medications.
  3,436 530 3
The effect of family-oriented educational intervention on postoperative pain after orthopedic surgery
Monire Rahmani, Nasrin Bahraminejad, Mansour Rezaei
January-February 2020, 25(1):47-52
DOI:10.4103/ijnmr.IJNMR_127_18  PMID:31956597
Background: Non-pharmacological methods including the improvement of knowledge of patients and his/her family members in the management and control of pain can reduce patients' experiences of pain. The present study aimed to investigate the effects of family-oriented educational intervention on postoperative pain after orthopedic surgery. Materials and Methods: This study is a non-randomized controlled trial with the control group, which was carried out on 46 patients in orthopedic surgery units of Mousavi Hospital in Zanjan in 2017. Patients were selected based on convenience sampling and categorized into two groups of experimental (n = 23) and control (n = 23) groups. In the experimental group, educational intervention was performed with the attendance of the patient and his/her family members in two sessions of the preoperative and postoperative period. The control group received routine care. The pain intensity was measured by Visual Analog Scale (VAS) for 3 days in both control and experimental group. Data were analyzed by using Chi-square, Fisher exact test, independent t-test, and Analysis Of Variance (ANOVA) with repeated measures and Greenhouse–Geisser. Results: Mean (SD) of pain intensity in the experimental and control groups was 5.21 (1.47) vs 6.74 (1.30) on the first day, 2.91 (1.20) vs 4.81 (1.32) on the second day, and 1.75 (0.67) vs 3.38 (1.53) on the third day, respectively. Pain severity reduction was significant in the experimental group compared to control group in every 3 days after surgery (F = 152.30, df = 1.62, p = 0.005). Conclusions: Family-oriented educational intervention resulted in reducing the intensity of pain and the use of narcotic drugs after orthopedic surgery.
  3,257 446 3
Effect of a training programme on knowledge and practice of lifestyle modification among hypertensive patients attending out-patient clinics in lagos
Oluwatosin Mary Oyewole, Olaolorunpo Olorunfemi, Foluso Ojewole, Mojolaoluwa Omolade Olawale
January-February 2020, 25(1):58-64
DOI:10.4103/ijnmr.IJNMR_201_18  PMID:31956599
Background: Hypertension is the leading cause of cardiovascular disease and death in the world. Research shows that the best way to remediate this problem is through lifestyle modification, but the percentage of hypertensive patients with the right knowledge about life-style modification is very low. It is therefore imperative to develop different ways of improving the practice and knowledge of life-style modification. Consequently, this study aim to determine the effectiveness of a training programme on knowledge and practice of lifestyle modification among hypertensive patients. Materials and Methods: A quasi-experimental design was conducted with accidental sampling to select the sample size (n = 30). A modified structured questionnaire from World Health Organization (WHO), Hypertension Knowledge-Level Scale (HK-LS) were used to measure knowledge of hypertension, knowledge of lifestyle modification and practice. Tables, percentages, mean, Standard Deviation and t-test were used for data analysis at 0.05 levels of significance, through statistical package for the social science software. Results: The result showed that the t-test of the pre-knowledge about hypertension among hypertensive patients differed significantly from post-knowledge after intervention (t = 4.90, p = 0.001). In addition, there is significant different between the pre and post knowledge level about lifestyle modification after intervention (t = 3.62, p = 0.001). Significant different was also observed between the pre and post practice of lifestyle medication after intervention (t = 3.56, p = 0.001). Conclusions: The health care providers, especially the nurses, must provide a continuous and focused training programme for hypertensive patients in order to improve their knowledge and practice of lifestyle modification.
  3,175 427 1
The failure rate, related factors, and neonate complications of vaginal delivery after cesarean section
Azadeh Asgarian, Nayereh Rahmati, Farzaneh Nasiri, Abolfazl Mohammadbeigi
January-February 2020, 25(1):65-70
DOI:10.4103/ijnmr.IJNMR_101_19  PMID:31956600
Background: The rate of Cesarean Section (CS) is high in Iran. A successful Vaginal Birth After Cesarean (VBAC) section can protect mothers against the risk of having multiple CS. This study aimed to evaluate the success rate of VBAC, related factors, and the causes of failure. Materials and Methods: This cross-sectional study was conducted on 150 pregnant women who were candidates for VBAC and admitted at maternity hospitals in Qom from 2016 to 2018. The required data were collected from the patients' records and entered into the checklist. Then, the success rate of VBAC was estimated, and related factors together with the causes of failure were determined by t-test, Chi-square, and independent-samples t-tests in SPSS v. 18 software. Results: The mean (SD) maternal age was 32 (5.20) years and ranged from 21 to 45 years old. The success rate of VBAC was estimated to be 85.33%, and 14.67% of the patients had to repeat a CS after failure in vaginal delivery. The mean time between previous CS and present delivery was statistically significant between successful and failure groups (t125 = 2.32, p = 0.002). The results also revealed that the most important causes of VBAC failure were prolonged labor [odds ratio (OR) = 4.70)], full arrest (OR = 2.70), and decline fetal heart (OR = 5.31). Conclusions: The success rate of VBAC in our study was high. However, VBAC was more successful when the interval between inter-deliveries was long, and lower complications were reported when the interval was 2–4 years.
  3,143 428 2
The severity of post-abortion stress in spontaneous, induced and forensic medical center permitted abortion in Shiraz, Iran, in 2018
Sedighe Alipanahpour, Mahnaz Zarshenas, Fatemeh Ghodrati, Marzieh Akbarzadeh
January-February 2020, 25(1):84-90
DOI:10.4103/ijnmr.IJNMR_36_19  PMID:31956603
Background: Abortion and loss of pregnancy in the first trimester may affect maternal mortality and morbidity. This study aimed to determine the severity of post-abortion stress in spontaneous abortion, induced abortion, and Forensic Medical Center (FMC) referral abortions immediately after abortion and after 1 month of follow-up in Shiraz, Iran, in 2018. Materials and Methods: This cross-sectional study was conducted on 104 mothers selected through convenience sampling method in 2018. The data collection tools included a demographic characteristics questionnaire and the Mississippi Post-Traumatic Stress Disorder (M-PTSD) Scale that were filled out by mothers immediately and 1 month after the abortion. Data were analyzed using one-way ANOVA and post-hoc LSD test in SPSS software. Moreover, p < 0.05 was considered as statistically significant. Results: The mean (SD) of post-traumatic stress scores was 83.87 (18.35) and 77.40 (9.88) in spontaneous abortion, 82.28 (13.27) and 75.71 (14.73) in FMC permitted abortions, and 86.66 (10.10) and 74.98 (12.99) in induced abortions immediately and 1 month after abortion, respectively. Stress was reduced in the three groups of mothers, after one month of severe value. The score for frequency of stress was 3.10% in FMC-permitted abortions and 5.10% in induced abortions; moreover, no stress was observed in the spontaneous abortion cases. Conclusions: Stress was gradually reduced over time. The level of PTSD was lower after 1 month in women who had experienced spontaneous abortion. Given that 1 month after abortion, women are still often moderately stressed, follow-up care, and appropriate counseling for these women are necessary.
  2,952 466 1
Childbearing intention and its associated factors among adolescent girls: A narrative review
Zeinab Oshrieh, Najmeh Tehranian, Elham Ebrahimi, Afsaneh Keramat, Maryam Hassani, Roghaieh Kharaghani
January-February 2020, 25(1):7-11
DOI:10.4103/ijnmr.IJNMR_180_18  PMID:31956591
Background: Childbearing is an important phenomenon among adolescents. Studies that have evaluated teenagers' reproductive patterns have found that many adolescents are ambivalent regarding sexual activity and childbearing. In order to assess the patterns of adolescents' reproductive health and pregnancy to conduct interventions, every country needs to collect specific data about childbearing intentions. This study was conducted to determine the factors that may affect the childbearing intentions of adolescents. Materials and Methods: This article was a narrative review. Articles derived from PubMed, Scopus, and Web of Science from January of 2000 to February 2015 were assessed. Moreover, gray literature, such as conference abstracts, theses, and the result of technical reports were also used. Results: In total, 15 studies were included in the review. The findings of this study showed that childbearing motives are affected by several factors. According to the results of the qualitative studies, some of the most important effective factors were women's decision-making power and financial issues. In this regard, the quantitative studies noted that the cultural and economic factors were more effective than other factors in determining the childbearing motives of adolescents. Conclusions: Fertility expectations are affected by several factors and are compatible with a variety of conditions. Moreover, access to precise information on the effects of each factor (positive or negative) is necessary and useful for demographers, policymakers, and other planners in any community.
  2,891 504 2
The relationship between motivations and nurses' intention to share knowledge
Hamid Rafieian-Isfahani, Hamid-Reza Peikari, Mohsen Rafieyan-Isfahani
January-February 2020, 25(1):53-57
DOI:10.4103/ijnmr.IJNMR_211_18  PMID:31956598
Background: This study intended to examine the association between the intrinsic and extrinsic motivation and knowledge sharing intentions among the nursing staff. Materials and Methods: It was a descriptive-correlational study, and the population included 860 nurses, working in Al-Zahra hospital, from whom a sample of 275 subjects were selected through convenience sampling method. The intrinsic motivation was composed of two sub-instruments, namely, the public recognition instrument (covering 3 items) and reciprocity instrument (covering 3 items), while extrinsic motivation included a knowledge self-efficacy instrument and an altruism instrument with 3 and 4 items, respectively. Moreover, knowledge sharing intention itself was evaluated a by 4-item inventory. Once the content validity, face validity, and construct validity (using confirmatory factor analysis), as well as the reliability (Cronbach's alpha) were confirmed, the model was analyzed through the partial least square technique. Results: There was a statistically significant association between both the intrinsic motivation and knowledge sharing intention (t = 14.95, p < 0.01,) and extrinsic motivation and knowledge sharing intention (t = 3.07, p < 0.01). Moreover, it was found that knowledge sharing intention was positively associated with public recognition (t = 3.98, p < 0.01), knowledge self-efficacy (t = 3.17, p < 0.01), and altruism (t = 11.44, p < 0.01). However, the association between the reciprocal benefits and intention to knowledge sharing was not supported (t = 1.77, p < 0.05). Conclusions: The results indicate that both intrinsic and extrinsic motivations, including public recognition, altruism, and knowledge self-efficacy perceptions can be used to encourage knowledge-sharing practices among the nurses.
  2,941 337 2
Midwives' educational needs in Iran: A narrative review
Mahboubeh Hajifoghaha, Fatemeh Nahidi, Shiva Alizadeh, Samira Golezar, Fatemeh Dabiri, Seyedeh-Samira Mokhlesi, Amirhossein Babaei
January-February 2020, 25(1):1-6
DOI:10.4103/ijnmr.IJNMR_82_19  PMID:31956590
Background: Midwives have a major role in the improvement of health indicators in every country. In order for midwives to be able to play their role well, they must have sufficient updated knowledge. For this purpose, it is necessary to review their educational needs. The aim of the present research was to review Iranian studies that have investigated midwives' educational needs. Materials and Methods: In this narrative review, PubMed, Scopus, Web of Science, Google Scholar, ProQuest, Ovid, SID, and Magiran databases were searched for the full texts of Iranian studies published in Persian and English languages in the period of 2000–2018. Review, descriptive, and interventional articles consistent with the research aim were included in this study. Results: Of the 53 found articles, 23 articles that were relevant to midwives' educational needs in Iran were investigated. The findings of the studies showed that the educational needs of the midwives can be categorized into the four groups of knowledge and performance, communication skills, occupational rules/regulations, and religious rules. Conclusions: The results showed that midwives in Iran have different educational needs. Because the midwifery practice leads to the promotion of public health, it is imperative that midwives have comprehensive knowledge and the skills necessary for providing optimal care. In order to achieve this, short-term and long-term training programs tailored to the needs of midwives are recommended.
  2,754 415 2
The effect of peer education on knowledge, comprehension, and knowledge application of patients regarding chemotherapy complications
Leila Heydarzadeh, Leyla Alilu, Hossein Habibzadeh, Javad RasouIi
January-February 2020, 25(1):40-46
DOI:10.4103/ijnmr.IJNMR_69_19  PMID:31956596
Background: The aim of the present study was to determine the effect of peer education on the level of knowledge, comprehension, and knowledge application of patients regarding chemotherapy complications. Materials and Methods: This study was performed on 80 patients with cancer undergoing chemotherapy in 2018. The participants were selected through convenience sampling and randomly allocated to the two groups of control and intervention (40 participants per group). Before the intervention, the participants in both groups completed a demographic characteristics form and the Educational Needs Assessment Questionnaires. Then, the peer education intervention was designed based on the educational needs of the patients regarding chemotherapy complications for the intervention group. Peer education was performed face-to-face and individually during two chemotherapy sessions. The questionnaires were re-administered to both groups 2 weeks after the end of the second chemotherapy session and data analysis was performed using independent t-test, Chi-square. Results: The means of knowledge (t78 = 19.74, p < 0.001), comprehension (t78 = 17.27, p < 0.001), and knowledge application (t78 = 14.84, p < 0.001) were significantly increased after peer education in the intervention group compared to the control group. The difference in the means of knowledge (t39 = 17.40, p < 0.001), comprehension (t39= -18.53, p < 0.001), and knowledge application (t39= -13.94, p < 0.001) after peer education, compared to before the intervention, was significant in the intervention group. Conclusions: Peer education can lead to increased level of knowledge, comprehension, and knowledge application of patients in terms of chemotherapy complications.
  2,486 340 3
The role of students with practical nursing diplomas in the process of undergraduate nursing education: A qualitative study
Reza Hosseinabadi, Shirin Hasanvand, Mohammad Almasian, Somayeh Mirzayee-Sharifi
January-February 2020, 25(1):76-83
DOI:10.4103/ijnmr.IJNMR_38_19  PMID:31956602
Background: Awareness of the experiences of students and educators in the educational process plays an important role in facilitating and improving this process. This study aimed to explain and investigate the experiences of nursing educators and students about the presence of students with practical nursing diplomas in the process of undergraduate education. Materials and Methods: In this qualitative study conducted from 2016 to 2018, which adopted a content analysis approach, 24 nursing students and educators of Lorestan University of Medical Sciences were selected using the purposive sampling method and were interviewed in depth. The data were manually recorded and analyzed using the Graneheim and Lundman method. Results: The three main themes of “from contrast to alignment with professional competence,” “peaceful coexistence in the educational process,” and “reflection of the perceived reality of the clinical environment,” along with six categories and 30 subcategories were extracted from the interviews. Conclusions: It seems that monitoring and managing undergraduate courses more thoroughly, as well as raising the awareness of educators about the positive and negative dimensions of the presence of nursing students with practical nursing diplomas in undergraduate nursing courses can make it possible to optimize and improve students' learning process.
  2,460 272 2
Pregnant women's experiences of social roles: An ethnophenomenological study
Fatemeh Erfanian Arghavanian, Robab Latifnejad Roudsari, Abbas Heydari, Mohsen Noghani Dokht Bahmani
January-February 2020, 25(1):31-39
DOI:10.4103/ijnmr.IJNMR_54_19  PMID:31956595
Background: The role of women and men is changing across the world, and women, including pregnant women, are adopting newer roles in traditional societies like Iran. This study aimed to explore the meaning of pregnant women's experiences regarding their social roles in the sociocultural context of Iran. Materials and Methods: This study was carried out using an ethnophenomenological approach. Participants included 16 pregnant women who attended health centers, hospitals, and private obstetric clinics in Mashhad, Iran, between 2016 and 2017 and were selected based on purposive sampling. In-depth semistructured interviews, vignette interviews, participant observations, and field notes were used to collect data. To analyze data, six-step van Manen's (1997) descriptive-interpretive phenomenological approach was used. Results: Through data analysis, the overarching theme of “selection, management, and adjustment of various roles to play social roles” was emerged. This was consisted of four themes: “Mother's perspective regarding out-of-home employment, incompatibility between pregnancy and social roles, mother's management strategies to play different roles, and husband's authority regarding mother's employment.” Conclusions: The consequence of reciprocal endeavors of pregnant women along with their husbands as well as their work environment expectations tends to selection, management, and adjustment of feminine roles. Since the employment of pregnant women leads to their more physical and psychological involvement, not only the problems of working women but also the expectations and rules of the workplaces as well as the requests of their husbands should be taken into account.
  2,324 267 3
The effect of intelligence self-control program on the quality of life of the adolescents with type I diabetes
Zinat Mohammadi, Tayebeh Mehrabi, Soheila Jafari-Mianaei
January-February 2020, 25(1):18-22
DOI:10.4103/ijnmr.IJNMR_79_19  PMID:31956593
Background: Diabetes affects patients' quality of life in almost all physical, mental, and social areas. The aim of the present study was to determine the effect of self-control intelligence program on the dimensions of quality of life in the adolescents with diabetes. Materials and Methods: The present study is a randomized controlled trial with pre-test and post-test design in which 56 adolescents with diabetes referring to the Janan charity diabetic association in Najafabad in 2018 (Isfahan, Iran) were selected by convenience sampling method and were randomly divided into two groups of intervention (n = 28) and control (n = 28). Self-control intelligence program was performed for the intervention group. The data were collected using standard Quality of Life Questionnaire for adolescents with diabetes and were analyzed using Chi-square test, independent and dependent t-test, Mann-Whitney. Results: Statistical tests showed no significant difference between the groups in terms of their demographic characteristics such as gender, duration of diabetes, and the number of insulin injections. There was, however, a significant difference in the mean scores of all quality of life dimensions except for the dimension of physical symptoms both before and after the intervention in the intervention group (t23 = 4.46, p < 0.001). By contrast, no significant difference was observed in the mean scores of quality of life before and after the intervention in the control group (t24 = 0.08, p = 0.93). Conclusions: Based on the results, self-control program can have an effective role in the adoption of coping strategies and, thus, improves the patients' quality of life.
  2,073 271 1