نشریه پرستاری ایران
پیاپی 122 (اسفند 1398)

Patients with bipolar disorder are faced with the phenomenon of stigma. On the other hand, self-compassion plays a key role in the improvement of their mental health. The present study aimed to determine the correlation between stigma and self-compassion in patients with bipolar disorder.

This cross-sectional, descriptive-analytical study was conducted on 200 patients with bipolar disorder hospitalized in Iran Psychiatric Center in Tehran, Iran. The patients were selected via continuous sampling. Data were collected using the questionnaire of demographic data and validated, reliable scales of stigma and self-compassion. Data analysis was performed using descriptive (mean and standard deviation) and inferential statistics (Pearson's correlation-coefficient, independent t-test, and ANOVA).

The mean scores of stigma and self-compassion were 77.03±7.06 and 77.57±4.47, respectively. Pearson's correlation-coefficient showed no significant correlation between stigma and self-compassion in the patients (P=0.301; r=-0.073). On the other hand, significant correlations were observed between the dimensions of discrimination (P=0.030; r=-0.153), disclosure (P=0.045; r=-0.142), and positive aspects of stigma with the isolation dimension of self-compassion (P=0.034; r=-0.150), which was an inverse, weak correlation as reduced isolation was associated with increased stigma in these dimensions. Moreover, significant correlations were denoted between the number of family member, age, and family history of mental disorders with stigma (P<0.05). However, no significant associations were observed between the demographic characteristics and self-compassion.

The results indicated no significant correlation between stigma and self-compassion. However, significant associations were observed between the dimensions of stigma with the isolation dimension of self-compassion, which were inversely and significantly correlated. Therefore, it could be concluded that as the patients further perceived the dimensions of discrimination, disclosure, and positive aspects of stigma, they were more inclined toward isolation. Stigma is an inherent cultural element in the community, which is so strong and complex that even high self-compassion could not diminish its effects.

An inherent element of the internationalization process of medical education is the assessment of preparedness to enter the international education market. The data obtained from such assessments could lay the basis for determining the policies and orientation of university planning. The present study aimed to determine the preparedness of the faculty members of Iran University of Medical Sciences for the training of international students.

This descriptive, cross-sectional study was conducted at nine faculties and 88 departments of Iran University of Medical Sciences in Tehran, Iran during 2018-2019. In total, 900 questionnaires were distributed, and 378 faculty members completed the questionnaires. Data were collected in a self-report manner using a researcher-made questionnaire regarding the attitude and empowerment of lecturers in the training of international students. Electronic questionnaires were sent to the faculty members five times via email. Data analysis was performed in SPSS version 16 using the analysis of variance, Scheffe test, independent t-test, Fisher's exact test, and Chi-square.

The mean scores of the attitude and empowerment of the studied units regarding the training of international students were 53.14 ± 8.65 and 23.32 ± 5.17, respectively, which were considered relatively favorable. In addition, 61.4% of the studied units were not willing to cooperate in the training of international students. The main causes of willingness to partake in international training were classified as individual, professional, educational department, academic, and national categories. In addition, the causes of unwillingness were classified as individual and academic categories.

According to the results, it is essential to provide the necessary infrastructures for university internationalization, as well as programs by the university authorities to improve the attitude and ability of faculty members to collaborate in international student training.

Fatigue in patients with chronic obstructive pulmonary disease reduces their professional productivity, concentration, sex drive, and performance, leading them toward lethargy. Overcoming this issue requires the involvement of the patient and the family in the care and management of the disease. The present study aimed to investigate the effects of the family-oriented empowerment model on the fatigue level of patients with chronic obstructive pulmonary disease.

This clinical trial was conducted on 72 patients with chronic obstructive pulmonary disease and their family caregivers. The subjects were selected via convenience sampling and randomly divided into two groups of intervention and control (36 per each). The family-oriented empowerment training program was implemented in four 90-minute sessions based on the four steps of perceived threat, problem-solving, educational participation, and evaluation in groups of 10-15 participants in the presence of the family members in the form of a panel for the intervention group. The intervention group was followed-up by the research team for three months to respond to the issues, care problems, and knowledge required for care. The final evaluation was performed three months after the intervention by completing the fatigue questionnaire again. Data analysis was performed in SPSS using paired t-test, independent t-test, Fisher's exact test, and Chi-square.

At baseline, the intervention and control groups had no significant difference in terms of the mean score of fatigue (P=0.5). After the intervention, the mean score of fatigue in the intervention group was significantly different from the control group (P=0.01). In addition, the mean score of fatigue significantly decreased after the intervention compared to before the intervention (P<0.001).

According to the results, the empowerment of the family members responsible for the care of the patients with chronic obstructive pulmonary disease could decrease fatigue in the patients. Therefore, the healthcare programs of chronic patients should be focused on the caregivers of the patients in addition to the patients.

Pain management is essential in the emergency room (ER) care plan, and nurses play a key role in this regard. The positive attitude and proper performance of the healthcare staff is critical in pain management, which is an important patients' right. The present study aimed to assess the attitude and performance of nurses regarding pain management in the patients admitted to the ER.

This cross-sectional, descriptive survey was conducted on 150 nurses employed in the ERs of the hospitals affiliated to Iran University of Medical Sciences, Tehran, Iran in 2018. The eligibility criteria were the minimum of bachelor's degree/higher in nursing and six months of work experience in the ER. Data were collected using a demographic questionnaire and the questionnaire of performance regarding pain management. Data analysis was performed in SPSS version 16 using descriptive and inferential statistics.

The mean age of the participants was 31.98±5.52 years, and the majority (82.9%) had no prior training on pain management. Regarding pain management in the ER, the mean scores of attitude and performance were 57.16±5.022 and 6.02±2.53, respectively. No significant differences were observed between the mean scores of attitude and performance with the demographic characteristics.

According to the results, the nurses had moderate attitudes toward pain management, and although their self-report indicated proper performance in this regard, they had inadequate knowledge regarding the use of pain management tools. Therefore, it is recommended that proper education and in-service re-training be provided for the promotion of proper pain management in the patients and increasing the quality of care, as well as proper training on the use of pain assessment measures.

Endoscopy is known to cause significant anxiety in the patients in the clinical setting. Aromatherapy is a complementary medicine technique used to alleviate anxiety. The present study aimed to assess the effect of aromatherapy with lavender essential oil on the preoperative anxiety of endoscopy candidates in Iran.

This clinical trial was conducted at the endoscopy department of Razi Hospital in Rasht, Iran during January 2018-August 2019. The sample population included 70 patients who were selected via convenience sampling based on the inclusion criteria and randomly divided into two groups of intervention and placebo. After completing the informed consent form, data were collected using a demographic questionnaire and Spielberger state-trait anxiety inventory. One hour before endoscopy, the intervention group received aromatherapy with 10% lavender essential oil, and the placebo group received aromatherapy with placebo for 30 minutes. The anxiety inventory was completed again before endoscopy. Data analysis was performed in SPSS version 21 using statistical tests (P<0.05).

The mean age of the patients was 47.12±16.75 years, and the majority of the participants were female. After the intervention, the mean score of anxiety decreased in the intervention group compared to the placebo group, and the difference was considered significant (P=0.001).

According to the results, aromatherapy with lavender essential oil was effective in the reduction of pre-endoscopic anxiety in the patients. Considering the low cost, safety, and simplicity of this method, aromatherapy could be used as a complementary measure to reduce anxiety in patients before endoscopy.

Victims of burn injuries experience numerous psychological complications, including anxiety. Preoperative anxiety is rather common and normal, and resilience is considered to be an effective coping strategy in stressful situations. The present study aimed to assess the correlation between resilience and anxiety in the candidate burn patients for skin grafting.

This cross-sectional, descriptive-correlational study was conducted via continuous sampling and based on the inclusion criteria. Data were collected using Beck anxiety inventory and CD-RISC, which were completed 20-30 minutes before the surgery at the inpatient ward in July 2019. Data analysis was performed in SPSS version 16 using descriptive and inferential statistics in the form of tables and numerical indicators. To achieve the research objectives and answer the research questions, the analysis of variance (ANOVA), independent t-test, and Pearson's correlation-coefficient were also used.

In total, 66.2% of the patients had higher resilience scores than 50. The mean scores of resilience and anxiety were 64.57±22.25 and 12.88±10.45, respectively. A significant correlation was observed between resilience and anxiety, and the increased score of resilience was associated with decreased anxiety (r=0.81; P<0.001). Resilience was significantly correlated with education level (P<0.001), economic status (P=0.001), occupation status (P=0.02), and place of residence (P=0.035). In addition, anxiety was significantly correlated with education level (P=0.004), economic status (P=0.011), occupation status (P=0.03), and place of residence (P=0.016).

According to the results, resilience and anxiety were correlated, and higher resilience was associated with lower anxiety. Furthermore, the candidate burn patients for skin grafting had mild anxiety and moderate resilience. Therefore, resilience training is recommended for the reduction of anxiety in these patients before surgery.

Infertility is a stressful condition, which could adversely affect the mental health of couples. Although the diagnosis and treatment fertility may be a frustrating crisis affecting both spouses and causing mental distress, a sense of loneliness, disappointment, and lack of control, it seems that these issues are more apparent in women than men since the physical and mental burden of infertility and the consequences of the possible failure mostly falls on women. Women (especially in eastern communities and Iranian women) live in a culture in which having a child and fertility are revered more than other communities. Even when a woman is fertile and has an infertile spouse, infertility stress is experienced similarly since regardless of the cause of infertility, the outcome is eventually is childlessness. The social stigmas experienced by infertile women become more intense when they do not enjoy familial support, causing depression in these women. Therefore, the social support of these individuals could play a key role in their adaptation process to the issue of infertility. In Iran, several studies have been focused on the quality of life and psychological issues of infertile individuals, while most of these studies have investigated the psychological issues of infertile women without much regard for the spouses of infertile men. The present study aimed to compare infertility stress and perceived social support in infertile women and the spouses of the infertile men referring to Akbar Abadi Teaching Hospital in Tehran, Iran.

This cross-sectional study was conducted on 164 infertile women and 93 spouses of infertile men referring to the infertility clinic of Akbar Abadi hospital in Tehran during 2015-2016. After obtaining the required permit from Iran University of Medical Sciences by the researcher and co-researcher, they visited the clinic on working days for sampling. After providing the necessary explanations to the hospital authorities and conforming to ethical principles (e.g., obtaining written consent), continuous sampling was performed until the completion of the sample size. The inclusion criteria were the Iranian nationality of the couples, infertility in only one spouse, willingness to participate in the study, absence of chronic physical diseases or known mental disorders, and no consumption of the medications affecting the nervous system by the couples. The subjects were allowed to withdraw from the study at any stages. Data were collected using a demographic questionnaire, Newton infertility stress inventory, and the functional social support questionnaire, which were completed in a self-report manner or with the help of the researcher, enquiring the subjects, and review of their medical records. Data analysis was performed in SPSS version 16 using descriptive and inferential statistics, including Chi-square and independent t-test at the significance level of P<0.05.

No significant differences were observed between the two study groups in terms of age (infertile women: 31.24±5.68 years; spouses of infertile men: 30.79±5.19 years), duration of marriage (infertile women: 7.29±4.81 years; spouses of infertile men: 7.54±4.13 years), duration of infertility (infertile women: 4.52±4.01 years; spouses of infertile men: 4.66±3.45 years), education level, occupation status, and economic status. In addition, 63.6% of the infertile women and 77.3% of the spouses of infertile men had primary infertility, while no significant difference was observed between the groups in this regard. No significant differences were denoted between the groups in terms of the scores of the subscales of infertility stress, including social concerns, sexual concerns, communicational concerns, and concerns regarding the lifestyle without a child, with the exception of the subscale of the need for parenthood (P=0.038). In addition, the total score of infertility stress had no significant difference between the study groups (P=0.043). The comparison of the mean perceived social support in the infertile women and spouses of infertile men indicated no significant difference in this regard. 

Although it seems that regardless of the male or female cause of infertility, women experience stress in case of infertility, the overall stress and stress induced by the need for parenthood were higher in the infertile women compared to the spouses of the infertile men. According to the results, the spouses of the infertile men were as stressed as the infertile women in many subscales of infertility. This could be due to the fact that even when the male gender is the cause of infertility, diagnostic and therapeutic procedures are often imposed on women, which increases their concerns compared to their spouses. In the face of infertility stress, women react through anxiety, stress, depression, and grief. One of the major causes of such stress in these women is the fear of divorce and loss of the ability of motherhood. Since pregnancy and the motherhood role are exclusive to women, social expectations are higher in the case of women compared to men, and the fear of the stigma of infertility is more severe in women. It could be stated that due to cultural components and the pre-defined social expectations, the foremost expectation and predicted role for married men and women is to have a child, and lack thereof is frowned upon in the Iranian culture. This shows that in the Iranian culture, the inability to have a child is synonymous with the absence of a fruitful life. Although social support could diminish the stress of infertile individuals, they may still feel the emptiness of their childless life in private, which in turn adversely affects marital relations. Furthermore, it seems that having a child is more important to women than men, and men are able to cope with a childless life more easily than women. Regardless of the cause of infertility, the findings of this study indicated that social support in both the infertile women and spouses of infertile men was similar.

A history of suicide attempt is the most important risk factor for repeated and successful suicide. Seeking help is essential to access to proper mental healthcare services, and appropriate help-seeking could protect individuals against the risks of suicidal thoughts and behavioral progress in this regard. In addition, seeking help from a professional or personal source that could facilitate access to professional psychological help mitigates or eliminates the immediate risk of successful suicide in those with suicidal thoughts or manifesting suicidal behaviors. The level of help-seeking is higher in the areas where the suicide rate is lower. Considering the role of cultural background in help-seeking, studies must be conducted in Iran to gain insight into the intention of help-seeking for suicidal thoughts. The present study aimed to determine the intention of help-seeking from formal sources for suicidal thoughts and assess its correlation demographic factors in the poisoned patients with a history of suicide attempt prior to the current condition in Loghman Hakim teaching hospital in Tehran, Iran.

This cross-sectional, descriptive study was conducted on all the poisoned patients with a history of suicide attempt prior to the current condition, who were being discharged from the men's and women's poison wards of Loghman Hakim teaching hospital affiliated to Shahid Beheshti University of Medical Sciences in Tehran, Iran. In total, 130 patients were selected via continuous sampling from late April to late June, 2019. In addition to the demographic form (age, gender, education level, marital status, occupation status, economic status, number of suicide attempts, family history of suicide, history of receiving consultative and psychological services, history of psychiatric medication use under the supervision of a physician, and history of admission to the psychological ward), data were collected using the general help-seeking questionnaire (GHSQ) developed by Wilson et al. (2005) in Australia for the measurement of help-seeking intentions. To confirm the validity of the GHSQ, the process of translation and re-translation was utilized. Moreover, the reliability of the scale was confirmed by 15 eligible poisoned patients (not the main research units) who completed the questionnaire, and the Cronbach’s alpha coefficient was calculated to be 0.70. After obtaining informed consent and explaining the responding process of the questionnaires, the demographic form and GHSQ were completed for each research unit by the researcher based on the responses of the patients within 15-20 minutes at their bedside. Data were obtained from 130 completed questionnaires. Data analysis was performed in SPSS version 20, and descriptive statistics were used in the form of tables and numerical measures in order to describe the research units. To determine the correlations between the demographic variables and help-seeking intentions, the data were analyzed using Pearson's correlation-coefficient, independent t-test, and the analysis of variance (ANOVA) at the significance level of P<0.05.

In total, 76.9% of the participants were female, and the age of the patients was within the range of 18-57 years (mean: 26.76±9.1 years). Among the patients, 40.0% had a high school diploma, 56.9% were single, 61.5% were unemployed, and 41.5% had an average economic status. The number of suicide attempts was 2-14 times (mean: 2.91±2.3), and 11.5% of the subjects had a family history of suicide attempt. In addition, 41.5% had no history of receiving consultative and psychological services, 52.3% had no history of psychiatric medication use under the supervision of a physician, and 20.8% had a history of admission to the psychiatric ward. The help-seeking intentions for suicidal thoughts from formal sources were low, with the mean of 2.51±1.18 (achievable range: 1-7), and the most significant formal sources of help-seeking intentions were psychologists (3.78±2.65), psychiatrists (3.64±2.58), and social services hotlines (2.34±2.08), respectively. Among the demographic variables, no significant correlations were observed between help-seeking intentions from formal sources and age, gender, education level, marital status, occupation status, economic status, number of suicide attempts, history of receiving consultative and psychological services, history of psychiatric medication use under the supervision of a physician, and history of admission to the psychiatric ward. History of suicide attempt in the first-degree family members was the only demographic variable that had a significant correlation with help-seeking intentions from formal sources (P=0.021), and the mean score of help-seeking intentions from formal sources was higher in the patients with a family history of suicide attempt.

According to the results, the help-seeking intentions from formal sources for suicidal thoughts were low in the poisoned patients with a history of suicide attempt. Help-seeking is an effective coping strategy when experiencing suicidal thoughts, which facilitates access to professional psychological help and plays a key role in reducing the rate of suicide; therefore, efforts should be made to promote help-seeking. The individuals who are at the risk of suicide need interventions developed to improve mental health care, especially primary care to encourage quicker help-seeking from proper sources. In this regard, measures such as the normalizing of help-seeking from formal sources, expanding insurance coverage to cover mental healthcare services, and improving communication skills in the families of those with a history of suicide could act as the facilitators of help-seeking from formal sources, as well as the training, identification, and referral of these individuals to available professionals, such as teachers and clerics. The familiarity of these individuals with various help-seeking sources (e.g., social aid hotlines and media campaigns) to increase the level of help-seeking may also facilitate the access of individuals to proper help-seeking sources. Moreover, the barriers against help-seeking in the individuals attempting suicide must be identified and mitigated. In this study, only about half of the individuals with a history of suicide attempt had a history of visiting a professional psychologist or using psychiatric medications under the supervision of a physician, while their intention of help-seeking from formal sources was relatively low. Therefore, the prevention of suicide required investment for creating a positive image of mental health care, which must be made accessible to the highest extent possible to the individuals who need to seek help from formal sources.