Iranian Journal Of Nursing and Midwifery Research
Volume:28 Issue: 4, Jul-Aug 2023

There are various approaches in primary health care regarding the key role of nurses. This systematic review investigates the roles of nurses, as part of the family medicine team.

All published articles related to the role of nurses in the family medicine team from January 2000 to March 2022 were the subjects of this study. The eligibility criteria included original articles published in English or Persian in the last two decades. International credible scholarly databases (PubMed, Scopus, Magiran, IranMedex, and SID) were searched using keywords and syntax. Some of the keywords included “Family Health Nurse,” “Nurses in Primary Care,” “Family Medicine,” “Family Physician Care Program,” “General Physician Program,” “Role,” and “Nurse.” Data were extracted based on Sample, Phenomenon of Interest, Design, Evaluation, Research type (SPIDER) technique and reported based on the structure of Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA).

Of 147 identified publications by the search strategy, eight eligible empirical studies were included. The results showed that besides providing nursing care, nurses play vital roles in communication and teamwork, assessment, securing health services relevant to communities’ needs, education, empowerment, clinical practice, health promotion, prevention, reflective research practice, and counseling.

This study identified different roles nurses could play in providing primary health care. These findings are helpful for the replanning or reform of primary health care in countries, which aimed to expand the Family Physician Program (FPP) in their countries, including Iran.

Ostomy‑related challenges in everyday life may negatively affect patients’ Quality of Life (QL), even long after ostomy surgery. Nurses provide care interventions that may have a significant effect on the patients’ QL. Therefore, the purpose of the present study was to determine evidence of effective nursing interventions on the QL of patients with an ostomy.

A systematic review was conducted following the Preferred Reporting Items for Systematic Review and Meta‑Analysis (PRISMA) guidelines. English articles published from 2000 to 2021 were identified and retrieved from PubMed, Medscape, MedlinePlus, ScienceDirect, Web of Science, Scopus, Wiley Online Library, ProQuest, ClinicalKey, SAGE, IRCT, and Cochrane. We assessed all included studies (18 articles) using the JBI Critical Appraisal Checklist.

Interventions reviewed in the study were categorized based on intervention, content of nursing intervention, training method, and target group of the nursing intervention. The nursing interventions involved natural treatments, self‑care, and psychological support for patients. The training methods used in the studies included demonstration and lecture, mixed media presentation including PowerPoints, and Internet tools such as WeChat Applications. Some interventions were only presented to patients, caregivers, caregivers and patients together, or peer patients.

According to the results of the present study, it is suggested that a regular care plan be used with the participation of families and patients from pre‑operational to discharge along with nurses’ follow‑ups and home care to promote the QL. A combination of self‑care and psychological education can promote these patients’ QL.

The maternal sense of competence refers to the mother’s sense of ability to care for the baby. Maternal competence can affect the mother’s parenting capacities. Maternal preparation programs are aimed to increase mothers’ knowledge and improve their maternal competence. This systematic review and meta‑analysis investigated the effect of a maternal preparation program on maternal role competence.

A systematic search was conducted using the following MeSH terms: “education”, “program”, and “parenting sense of competence” in databases including PubMed, Web of Science, Cochrane Central, and Scopus, from inception till July 2022. All Randomized Controlled Trials (RCTs) published in any language were extracted. Articles were screened based on predefined inclusion and exclusion criteria. The quality of the included articles was assessed by two qualified reviewers based on the Preferred Reporting Items for Systematic Reviews and Meta‑Analyses (PRISMA).

Of the 170 published works that were retrieved in the initial stage, five articles including 647 first‑time mothers were analyzed. A meta‑analysis showed that parenting preparation program interventions increased maternal role competence in first‑time mothers as opposed to those who received routine care Mean Difference (MD) = 3.31, 95% Confidence Interval (CI) [2.07, 4.55].

The results of this study encourage health policymakers to develop

Polycystic Ovary Syndrome (PCOS) is the most common endocrine disorder among women of reproductive years. In addition to multiple physical problems, this syndrome has many psychological complications. Thus, the present study attempted to explore the psychological experiences of women with PCOS in Iran’s sociocultural context.

The study was carried out in Isfahan, Iran, using a qualitative content analysis method. The participants were selected through purposive sampling from women with PCOS, their spouses, and healthcare providers in hospitals, clinics, workplaces, universities, and physicians’ offices between September 2018 and November 2019. Data collection was performed through semi‑structured interviews until data saturation. Data analysis was based on conventional content analysis. The interviews were transcribed and coded. Afterward, categories and concepts were extracted by grouping similar codes.

A total of 13 women with PCOS, four spouses, and 13 healthcare providers participated in this study. Data analysis yielded five main categories, including the patient’s psychological reactions following infertility and its probability, psychological issues following menstrual disorders, patients’ fear and concerns about the probability of developing chronic diseases, psychological problems following the disease, and psychological problems resulting from body appearance.

The results of this study showed that women with PCOS were exposed to multiple psychological problems. Therefore, preventing and controlling the psychological consequences of PCOS and its complications requires healthcare providers’ support and comprehensive and long‑term planning to promote the mental health of these women.

Breast Cancer (BC) is one of the most common cancers in the world, including in Iran. Chemotherapy as one of the basic treatments for BC leads to many side effects such as fatigue. This study aimed to examine the effect of a combined exercise program on the intensity of fatigue in patients with BC undergoing chemotherapy.

This clinical trial study was conducted on 64 patients with BC undergoing chemotherapy referring to the Seyyed al‑Shoada and the Al‑Zahra clinics from January to April 2022. Eligible patients who met inclusion criteria were recruited by the convenience sampling and then assigned randomly to intervention and control groups. The combined exercise program in the intervention group was done for 8 weeks as three sessions a week (34 sessions) each for 35–40 min. Piper’s Fatigue Scale was completed for both groups before and after the intervention. Data were analyzed using descriptive and inferential statistical methods.

The results showed that the mean score of fatigue intensity in both control and intervention groups had a statistically significant difference after the intervention (p </em>= 0.004). The mean fatigue intensity score in the intervention group decreased significantly from mean (SD) 8.17 (1.88) to 5.56 (1.74).

Based on the results, a combined exercise program can reduce fatigue in patients with BC. Therefore, nurses can utilize exercise programs and practices as a subset of complementary medicine alongside other treatment methods, which can effectively promote cancer patients’ quality of life by reducing their fatigue.

The global spread of the new coronavirus has increased the necessity of innovations to increase the quality of health care. This study was intended to examine the impact of tele‑medicine on health anxiety and pregnancy‑related anxiety in pregnant women during the COVID‑19 epidemic in Iran.

This quasi‑experimental study was performed between March and May 2020. Sampling was done using multi‑stage random sampling method. A total of 104 pregnant women were in two groups (intervention: n = 52, control: n = 52). Data were collected using a demographic and obstetric information questionnaire, the Health Anxiety Questionnaire, and Van den Bergh’s Pregnancy‑Related Anxiety Questionnaire. The intervention group received counseling services for 2 months by researchers through telephone conversations, text messages, and applications such as WhatsApp, Telegram, and Instagram. In addition to routine pregnancy care, they could contact the researchers by phone and receive the necessary advice in case of any questions, ambiguities, or problems. The control group included pregnant women who received only routine pregnancy care.

After the intervention, health anxiety scores of pregnant women in the control group were significantly higher than those of the experimental group (t98 = 13.54, p < 0.001). Also, the mean (SD) scores of pregnancy‑related anxiety in the control group were significantly higher compared with the intervention group (t98 = 3.80, p < 0.001).

Using tele‑medicine, especially during the COVID‑19 pandemic can reduce unnecessary referrals of pregnant women to medical centers and their risk of developing the disease, on the one hand, and by reducing women’s anxiety, however, it can improve psychological consequences.

Depression is the most important postpartum mental disorder that can lead to irreversible damage to family health if not addressed, including inability to provide maternal care, impaired mother–child relationship, impaired growth, and development of the child, to marital problems, and sometimes the risk of suicide and infant death. The aim of this study was to investigate the relationship between self‑compassion and body image with postpartum depression.

In this study, 150 pregnant women in the third trimester and 6 weeks postpartum completed the Short Form Self‑Compassion Questionnaire (SCS‑SF), Multidimensional Self‑Body Relationships (MBSRQ), and Edinburgh Postpartum Depression Inventory (EPDS). Depending on the type of study, descriptive statistics such as mean, median, and standard deviation were calculated for quantitative, frequency, and relative frequency variables. Kolmogorov–Smirnov test was used to evaluate the normality of the distribution of scores in each questionnaire. Data were analyzed using parametric proportional statistical tests (paired t‑test, Pearson correlation, and linear regression) at the level of significance less than 0.05.

Based on the findings, the relationship between self‑compassion and postpartum depression was not significant. Self‑kindness had a significant positive relationship, and self‑judgement had a significant negative relationship with depression (p </em>< 0.01). Body image had a significant predictive effect on postpartum depression (p </em>< 0.05).

Negative body image as a risk factor for postpartum depression should be considered by healthcare providers and used in the prevention and treatment of postpartum depression.

Considering the threats in the operating room during the COVID‑19 pandemic, the optimal care and safety of the operating room nurses should be maintained when performing surgery on an acute respiratory patient. It seems necessary to design a tool to measure the caring behaviors of operating room nurses. Therefore, the present study was conducted with the aim to design a valid and reliable tool for measuring the caring behavior of operating room nurses during the COVID‑19 pandemic.

In this sequential, exploratory, mixed‑method study, the designing and psychometric evaluation of the caring behaviors of operating room nurses questionnaire during the COVID‑19 pandemic were performed in qualitative and quantitative phases from August 2021 to July 2022 in Aja University of Medical Sciences, Iran. In the qualitative phase, the concept of caring behaviors of operating room nurses was explored through interviews and a literature review based on online searches. In the quantitative phase, validity (face, content, and construct), and reliability of the questionnaire were evaluated.

The findings supported 21 items in the 5 factors of caring behaviors related to attitude toward patients, knowledge of surgical care, virus prevention principles, self‑care knowledge, and self‑care performance, which explained 35.92 of the total variance. Scale‑Content Validity Index/Average and Cronbach’s alpha were calculated to be 0.93 and 0.89, respectively.

Given its desirable reliability and validity, simple scoring, and ease of use by operating room nurses, the Caring Behaviors of Operating Room Nurses Questionnaire is applicable and its use is recommended.

Medical errors are numerous in medical activities. Considering the sensitivity and importance of the medical group’s professions, the emergence of an apparently simple error can cause the death of an individual or even a group of individuals. The present study aims the evaluation and reduction of human error using a system human error reduction and prediction approach System Human Error Reduction and Prediction Approach (SHERPA) in the nurses of Baqiyatallah hospital’s chemotherapy ward in 2019.

A cross‑sectional study was conducted in the chemotherapy ward using the SHERPA technique. Then, the duties were determined in detail using Hierarchical Task Analysis (HTA). The errors were identified using the SHERPA checklist, and the risk outcomes and intensities were finally evaluated.

Based on the study findings, there are 109 possible errors for 48 sub‑duties. The most frequent errors fall in the functional area (54%) and the least frequent errors pertain to the area of selection (3%).

In order to reduce the errors and increase the quality of the services and safety of the patients, errors can be identified by using the SHERPA technique; after identifying these errors, using this technique, it is possible to prevent the recurrence of the identified errors by careful planning. Considering the fact that the most frequent error was found in the functional domain, modern protocols can be codified in this area, and standards can be observed for putting the problems of this section atop of the priority list and reducing the errors and increasing safety of the patients.

Using natural oral supplements is one of the methods of complementary medicine that has been widely welcomed in the last decade Since studies have reported contradictory results for effectiveness of herbal medicines during menopause and no other more effective herbal medicine has been suggested yet, the researchers of this study decided to compare the fennel and Evening Primrose Oil (EPO) and their effect on menopause problems and sex hormones.

The present study was a triple‑blinded, controlled clinical trial with 125 participants randomly assigned to. An intervention group received fennel, another intervention group received evening primrose oil, and the placebo group received placebo twice daily for 8 weeks. Pre‑intervention and post‑intervention results were obtained using hormonal assay and the Menopause Rating Scale (MRS).

In this study, the mean follicle‑stimulating hormone (FSH) and estradiol levels changed significantly in the fennel and EPO groups compared to placebo (p </em>< 0.001). The difference in the mean FSH score between the fennel group and EPO group was not significant (p </em>= 0.304), but the difference in the mean estradiol level between these groups was significant (p </em>= 0.043). Moreover, there was a significant difference in the mean MRS score between the intervention groups before the intervention (p </em>< 0.05). However, the difference in the mean MRS score between the fennel and EPO groups was not significant after the intervention (p </em>= 0.322).

Consumption of fennel and EPO can significantly change FSH, estradiol, and psychological menopausal symptoms in postmenopausal women.

Non‑pharmacological interventions in clinical practice, such as Nature‑Based Sounds (N‑BS), can be an efficient way to reduce stress in patients with Myocardial Infarction (MI). This study was an attempt to investigate the effect of N‑BS on stress and physiological parameters in patients with MI.

This double‑blind, randomized clinical trial was conducted on 80 patients with MI from two selected hospitals. Using headphones, the subjects in the intervention group listened to 30 minutes of N‑BS twice a day for 3 days. The control group, on the other hand, wore headphones playing no sound. The data were collected using the Persian version of the Depression, Anxiety, and Stress Scale. The significance level was set at 0.05.

The repeated measure analysis showed that the within group effect is statistically significant for Systolic Blood Pressure (SBP) (F = 113.32, p </em>< 0.001), Diastolic Blood Pressure (DBP) (F = 67.22, p </em>< 0.001), Heart Rate (HR) (F = 28.52, p </em>< 0.001), respiration rate (F = 36.41, p </em>< 0.001), and stress (F = 102.82, p </em>< 0.001). The reciprocal effect was statistically significant for SBP (F = 11.76, p </em>< 0.001) and stress (F = 5.31, p </em>< 0.001).

N‑BS can provide an effective, inexpensive, and non‑invasive method of reducing stress in patients with MI. Nurses can incorporate N‑BS intervention into the daily care of patients with MI in order to reduce their stress and lower their SBP and HR.

Maternal serum sample screening in the first and second trimesters has been commonly used to identify women who are at risk of fetal trisomy 21. In addition, these serum markers are associated with adverse perinatal outcomes. Hence, the present study was conducted to determine the relationship between false positive screening results of Down syndrome and adverse pregnancy outcomes. 

This prospective, two‑group, cohort study was conducted on 608 pregnant women who had undergone fetal contingent screening. They were selected through convenience sampling in the twentieth week of pregnancy and were followed up until delivery. The raw Odd Ratios (OR), Relative Risk (RR), and adjusted OR of adverse pregnancy outcomes were calculated in the false positive and true negative groups.

The adjusted OR of developing preeclampsia was 1.98 (95% CI: 1.14–3.42), and its RR was 2.13 (95% CI: 1.34–3.38) times higher in the false positive group. Moreover, the adjusted OR of Small for Gestational Age (SGA) was 2.80 (95% CI: 1.76–4.47), and its RR was 2.28 (95% CI: 1.54–3.36) times higher in the false positive group. The adjusted OR of Low Birth Weight (LBW) was 3.34 (95% CI: 1.97–5.64), and its RR was 2.65 (95% CI: 1.72–4.11) times higher in the false positive group. In addition, no significant difference was observed between false positive and true negative groups in terms of preterm birth.

Women with a false positive fetal screening test result are more likely to suffer from preeclampsia, SGA, and LBW and require planned prenatal care.Keywords:

Cardiovascular diseases can affect sleep quality. The use of non‑pharmacological methods to improve the sleep quality of heart failure patients is essential. Therefore, this study compared the effects of the Benson relaxation technique and foot reflexology massage on sleep quality of those patients.

In this clinical trial study, 93 patients with systolic heart failure referred to Javad Al‑Aeme heart clinic in Torbat Heydarieh were selected with purposive sampling method and divided into the foot reflexology massage, Benson relaxation technique, and control groups using the balanced blocking randomization method. The Benson relaxation technique and the foot reflexology massage were performed for 20 and 30 minutes three days per week for four weeks, respectively. The control group only received routine care. Sleep quality was measured by the Pittsburgh sleep quality index and then compared among the groups before and after the intervention. The data were analyzed using ANOVA, Tukey’s post hoc </em>tests, paired t </em>test, and Chi‑square at the significant level of p </em>< 0.05.

After interventions, the mean (SD) quality of sleep significantly increased in both intervention groups (Reflexology: pre‑intervention 10.80 (3.40), post‑intervention 6.60 (3.10), Benson relaxation: pre‑intervention 15.50 (2.40) post‑intervention 12 (2.60), compared to the control group (pre‑intervention 10.50 (1.90) post‑intervention 9.40(1.70) (p </em>< 0.001). There was no significant difference between the two intervention groups (p </em>= 0.53).

The interventions improved the quality of sleep in patients with systolic heart failure. Therefore, these methods can be used as a suitable complementary treatment to improve the quality of sleep by nurses and midwives.

The majority of cardiac disorders resulting from ventricular dysrhythmias are fatal. The Implantable Cardioverter Defibrillator (ICD) is one of the most common treatments of ventricular dysrhythmias. Despite the benefits of ICD in preserving life, patients with ICD experience adverse physical, psychological, and social consequences. This study investigated the effects of the continuous care program on self‑efficacy in patients with ICD.

The present study was a randomized clinical trial. Based on the inclusion criteria, 80 patients attending an educational cardiovascular center in Tehran during 2017–2018, were randomly assigned to two intervention and control groups (40 in each). The intervention included the continuous care program, an educational session, and a follow‑up program undertaken for the patients receiving the ICD. The control group received routine care. Self‑efficacy was then measured by ICD (SE‑ICD and OE‑ICD) questionnaires and compared between the two groups. 

The results showed no difference between the two groups before the intervention (p </em>> 0.05). However, there was a significant difference in the mean self‑efficacy score between the two groups after the intervention, being significantly higher in the intervention group (t77 = 4.9, p </em>< 0.001).

The results of the present study indicated that providing a continuous care program can increase self‑efficacy in patients with ICD and can be used as an effective model in the nursing care of patients with ICD.

Sexual and Reproductive Health (SRH) and access to related services are the most important issues and are part of reproductive health rights. Therefore, this study was designed and conducted to explain the perceived barriers and needs in accessing sexual health services for Iranian couples.

We conducted this study on 14 subjects at the Navab Health Center in Isfahan and Behsa Counseling Center in Tehran from November 2015 to December 2016 by common qualitative content analysis approach through semi‑structured interviews.

The results show that sub‑subcategories “Therapist’s Individual Traits” and “Specialized Skills of Therapist” formed “Need for Access to a Professional Therapist” subcategory and sub‑subcategories “Provide specialized problem‑based treatments” and “Rapid and Timely Therapy of Sexual Problems” formed the “Need for Timely and Comprehensive Access” subcategory and these two subcategories formed the main category of “Need to access a specialized, comprehensive and timely sexual health services system.” Furthermore, sub‑subcategories of “Failure to Prioritize Sexual Matters” and “Lack of sexual awareness” formed the “Individual Challenges of Search for Sexual Health Services” subcategory, and sub‑subcategories of “Sexual Problems are a Taboo” and “Lack of awareness of the existence of sex therapists and sexual health service centers” formed “Sociocultural Challenges to Access Sexual Health Services” subcategory. Two subcategories formed the main category of “Obstacles to Access Efficient and Proper Sexual Health Services.”

The explored couple’s experiences demonstrated that the need to receive timely and comprehensive specialized sexual health services because of the obstacles to access is not provided.

Neonatal problems and adverse outcomes may be minimized by up to 90–75% when preterm delivery is diagnosed early and managed properly. This study aimed to determine the association of maternal plasma lipid indices with the occurrence of spontaneous preterm labor.

This matched pair case–control study was performed on 80 pregnant women referred to a teaching hospital in Tehran for childbirth in 2019. The lipid profile was assessed in women with spontaneous preterm labor and term birth. According to age, Body Mass Index (BMI), pregnancy number, employment status, and educational level, the women in each group were paired. Data were analyzed using an independent‑samples t‑test, Mann–Whitney U‑test, Chi‑square, linear regression, and conditional logistic regression.

Mean serum levels of total cholesterol, triglycerides, and low‑density lipoprotein were all significantly higher in the case group compared with the control group (p < 0.05). The conditional logistic regression test confirmed that this association remained significant even after adjusting the effect of potentially confounding factors such as maternal age and body mass index. In addition, in linear regression the increased levels of triglyceride, total cholesterol, and low‑density lipoprotein were found to be associated with 3.33‑fold (1.32.–5.32 95% CI, p </em>< 0.001), 2.94‑fold (1.60–3.14 95% CI, p </em>= 0.002), and 2.46‑fold (1.31.–2.91 95% CI, p </em>= 0.006) increased risk of preterm labor, respectively.

High triglyceride, total cholesterol, and low‑density lipoprotein serum levels may be linked to an increased chance of spontaneous preterm labor, which might be considered a risk factor for this pregnancy problem.

Professional socialization of nurses is the process of transferring knowledge, skills, techniques, attitudes, and values among nursing professionals in order to enhance their capacity consistently. The objective of this research was to study the professional socialization of nurses in humanized care in 2 phases: in a nursing study phase, and in a nursing professional phase. 

The study was implemented in the form of a qualitative study by using an in‑depth interview technique for the data collection. The informants of the study were 12 professional nurses who were granted the Award of Ratchaphiphat Role Model of Best Moral Practice.

During the nursing study phase, it was found that the professional socialization of nurses operated through course content, teaching management, extra‑curricular activities, the interaction between nursing instructors and students, interaction among peers, observation of nursing instructors, and observation of nurses. On the other hand, in the nursing professional phase, professional socialization is performed through orientation, on‑the‑job training, supervision, ethical and moral promoting activities, and interaction with and observation of colleagues.

Based on the findings, some recommendations were proposed as guidelines to develop nursing educational management for promoting humanized care in the development of nursing students and professionals.

It is well known that caregivers are at risk of suffering from diseases, including chronic ones, which might increase the burden of the healthcare worker.

A cross‑sectional study was conducted in Jordan on 143 caregivers who were randomly selected to participate in self‑administered Quality of Life in Life‑Threatening Illness—Family Carer Version (QOLLTI‑F) questionnaire. The variables were tested using simple linear regression analyses in the SPSS.

Male Jordanian caregivers who provide unpaid care, reported lower quality of life than their female counterparts (p </em>= 0.028), (p </em>= 0.077), respectively. A high statistically significant result was found between unshared and shared care (p </em>= 0.009). Statistically significant results were determined between single caregivers compared with those who were married or divorced (p </em>= 0.894 and p </em>= 0.041, respectively).

This study concludes that gender, care status, type of care, and marital status are direct predictors of quality of life among Jordanian caregivers.

I read the article by Kaur et al</em>. about lactation and coronavirus disease 2019 (COVID‑19).[1] This study has important implications, but there is no mention of maternal health problems and midwifery challenges during the pandemic. Among different fields of medicine, some, like clinical midwifery specialists, are more susceptible to COVID‑19 dangers. The increased vulnerability arises from various variables. For instance, every pregnancy has some risk of difficulties, and medical care during pregnancy has its own uniqueness that sets it apart from many other healthcare sectors.