Background and Purpose: Anxiety is a common problem associated with invasive medical procedures, especially in patients undergoing coronary angiography. As an intensifier at cardiovascular reactions, anxiety poses significant risk to the health of patients undergoing angiography. Researchers believe that use of Benson's relaxation technique could reduce anxiety in different patients. This study aimed to evaluate the effect of Benson's relaxation technique on the anxiety of patients undergoing coronary angiography. Methods: This randomized clinical trial was conducted on 70 patients who were candidates for coronary angiography in Mazandaran Heart Center in Sari, Iran in 2014. Patients were selected via randomized sampling and divided into two groups of intervention (n=35) and control (n=35). Data collection tools included demographic questionnaire, Spielberger's State-Trait Anxiety Inventory (STAI), and hemodynamic variables recording sheet. Data analysis was performed in SPSS V. 16 using Chi-square, dependent and paired T-test, and Mann-Whitney U test. Results: Both study groups were homogenous in terms of age, gender, marital status, education level, disease history, and health insurance status. Use of Benson's relaxation technique significantly decreased anxiety in the intervention group (P=0.0001). However, no significant difference was observed in the systolic blood pressure, respiratory rate and heartbeat parameters between the study groups (P=0.0001). Conclusion: According to the results of this study, use of Benson's relaxation technique before coronary angiography reduced the level of anxiety in the patients. Therefore, this complementary approach could be used as an effective healthcare measure without any side effects to provide mental support for patients before invasive procedures, such as angiography.

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Background and Purpose: Pain perception with arteriovenous fistula (AVF) cannulation is a major concern among patients undergoing hemodialysis. This study aimed to compare the efficacy of cryotherapy and placebo in the reduction of AVF puncture-related pain in hemodialysis patients. Methods: This randomized clinical trial was conducted on 50 patients undergoing hemodialysis selected via random sampling. Patients were randomly divided into two groups of intervention and control. Patients in the intervention group received cryotherapy using ice cubes wrapped in latex gloves, which were placed on the back of the hands without AVF (between the index finger and thumb). The same process was performed on the patients of the control group by using wooden cubes as placebo instead of ice cubes. Pain perception of the patients was recorded during two consecutive hemodialysis sessions using a visual analogue scale. Data analysis was performed in SPSS V.13 using Chi-square and independent T-test. Results: With cryotherapy, scores of AVF puncture-related pain significantly reduced from 5.9±0.96 in session one (routine care) to 3.2±1.71 in session two of hemodialysis. However, no significant difference was observed between the two sessions in patients of the control group (P=0.07). Conclusion: According to the results of this study, cryotherapy, as a non-pharmacological and complementary approach, could be effective in the prevention of the pain associated with AVF cannulation. Therefore, it is recommended that nurses apply this method before AVF cannulation in order to alleviate pain intensity in hemodialysis patients.

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Background and Purpose: Stress has adverse effects on the quality of sleep and professional life in nurses engaged in intensive care units (ICUs). This study aimed to evaluate the relationship between the qualities of work life and sleep in nurses employed in the ICUs of Mazandaran province in Iran. Methods: This cross-sectional, descriptive-correlational study was conducted on 180 nurses employed in the ICUs of teaching hospitals affiliated to Mazandaran University of Medical Sciences, Iran in 2015. Participants were selected via stratified random sampling. Data collection tools included demographic questionnaire, Walton's Quality of Work Life (QWL), and Pittsburgh Sleep Quality Index (PSQI). Data analysis was performed in SPSS V. 18 using descriptive and inferential statistics (independent T-test, one-way ANOVA, Pearson's correlation-coefficient, and logistic regression analysis). Results: In this study, ICU nurses were dissatisfied with most of the dimensions associated with the quality of work life. Moreover, 49 participants (27.2%) had poor quality of work life, while 119 (66.1%) and 12 cases (6.7%) had moderate and high quality of work life, respectively. Also, 69 (38%) and 111 nurses (61.7%) were reported to have good and unfavorable sleep quality, respectively. A significant, inverse, linear correlation was observed between the quality of work life and sleep quality (P=0.012). Conclusion: According to the results of this study, quality of work life and sleep quality were moderate and unfavorable in the majority of ICU nurses, respectively. Moreover, sleep quality had a significant correlation with the quality of work life.

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Background and Purpose: Colorectal cancer (CRC) is one of the most highly prevalent and life-threatening digestive tract cancers. CRC and its treatment are associated with numerous complications in the patients. Orem's self-care model is a theory on clinical improvement and reducing fatigue in patients with CRC. This study aimed to investigate the effects of Orem's self-care theory on the nutrition status and fatigue of CRC patients. Methods: This quasi-experimental study was conducted on 70 patients diagnosed with CRC in the teaching hospital of Imam Reza in Kermanshah, Iran in 2014. Samples were randomly divided into two groups of experimental and control. Data were collected using the food frequency questionnaire (FFQ) and Brief Fatigue Inventory (BFI). After data collection, a self-care training program was implemented based on Orem's self-care theory. Results: Self-care training intervention in the experimental group improved the consumption patterns of fruits (P=0.002), vegetables (P=0.001), and dairy products (P=0.001). Moreover, general fatigue of CRC patients in the experimental group decreased after the intervention (P=0.0001). Conclusion: According to the results of this study, Orem's self-care model could reduce the clinical symptoms and fatigue of patients with CRC. Therefore, it is recommended that this model be applied to enhance the self-care behaviors and clinical conditions of CRC patients.

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Background and Purpose: Professionalism refers to the professional character and manners of an individual, which encompasses different attributes and a lifestyle reflecting responsibility and commitment. Effective communication between physicians and nurses enhances the quality of patient care, reduces medical errors. Over the years, there have been repeated admonitions to improve nurse-physician communication, which is influenced by several factors. This study aimed to evaluate the effect of professionalism on the professional communication between nurses and physicians. Methods: This qualitative study was conducted using the phenomenological approach developed by Husserl. Semi-structured interviews (n=15) were performed on eight nurses and seven physicians engaged in the hospitals of different cities in Iran in 2014. Participants were asked to describe their experiences regarding the professional communication between nurses and physicians. All interviews were recorded and transcribed, and data analysis was performed using Colaizzi's method. Results: Four main themes emerged from data analysis, including professionalism, communication patterns, confounders, and communication usefulness, the most important of which was professionalism. In this study, we focused on professionalism and its subthemes, including autonomy, dignity and respect, responsibility and preparedness. Conclusion: According to the results of this study, professionalism plays a key role in establishing efficient professional communications. Therefore, it is recommended that structured communication interventions be implemented in clinical environments in order to improve the quality of nurse-physician communication.

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Background and Purpose: Spiritual health is one of the most critical health dimensions with remarkable influence on the life of individuals. Religion and spirituality play a pivotal role incoping with stressful events in life. This study aimed to evaluate the relationship between spiritual health and quality of life in patients with multiple sclerosis (MS). Methods: This cross-sectional study was conducted on 223 patients at Mazandaran Multiple Sclerosis Association (MMSA), Iran in 2015.Participantswere selected via convenience sampling. Data collection tools included Paloutzian's spiritual well-being questionnaire and Multiple Sclerosis Quality of Life (MSQOL-54) scale. Data analysis was performed in SPSS V.18 using ANOVA, T-test, and Pearson's correlation-coefficient. Results: In this study, the majority of MS patients (71.7%, n=160) had average spiritual health, and mean score of quality of life was 50.2±12. Moreover, significant correlationswere observed between the total score of quality of life with dimensions of existential health (P<0.0001, r=0.97), religious health (P<0.0001, r=0.95), and total score ofspiritual health (P<0.0001, r=0.97). Conclusion: According to the results of this study, spiritual health and religious beliefs could improve the quality of life in MS patients. Spiritual health is inherent to the quality of life of patients suffering from chronic diseases, such as MS. In Iran, ideational and religious doctrines remarkably influence people's lives. Therefore, provision of culture-based and meaning-orientated care and adopting a wholesome attitude towards different aspects of MS could help medical professionals to offer the required services for these patients.

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Background and Purpose: Ethical climate is hinged upon organizational culture, rules, and policies; nurses' perception of this concept varies according to the ward they are working on and the new rules of the treatment system. This can exert adverse impact on their care method and performance. Thus, this study aimed to determine nurses' perceptions of the ethical climate governing the hospital environment. Methods: This descriptive, cross-sectional study was conducted on 168 nurses working in a teaching hospital. The data were collected through census method, using a demographic form and Olson's Hospital Ethical Climate Survey (HECS). For data analysis, descriptive (percentage, frequency, mean, and standard deviation) and inferential statistics (independent t-test and ANOVA for the establishment of the relationship between ethical climate and demographic factors, as well as Friedman's test for ranking the factor) were used. Results: Mean ethical climate scores of nurses for managers, hospital, physicians, patients, and colleagues factors were 3.87±0.71, 3.39±0.68, 3.00±0.67, 3.68±0.57, and 3.82±0.54, respectively. The total mean score of ethical climate was 3.5±0.51. The comparison among the mentioned factors indicated that managers (P=0.000) factor acquired the highest score. In addition, organizational ethical climate did not show any significant association with gender, marital status, education level, working shift, and employment status, whereas there was a statistically significant relationship between job title and income (P=0.000). Conclusion: The highest score of ethical climate belonged to managers/ factor, while the minimum score was related to physicians. Regarding the role of ethical climate in the improvement of nurses' performance, planning for enhancing the ethical climate seems to be mandatory.

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Context: Nursing process is the systematic method of thinking used by nurses to develop an individualized plan of care for patients. Effective use of the nursing process depends on a nurse's familiarity with the standardized nursing language. Aim: This study evaluates the utilization of nursing process on the day of admission and within 24 h of patient admission in a teaching hospital. Setting and Design: Descriptive and Retrospective design was utilized. Materials and Methods: Systematic sampling technique was adopted to evaluate 959 patients' records from 2014 to 2016 in 2 medical and 2 surgical wards over 3 months period using a self designed checklist. Statistical Analysis Used: Data collected was analyzed using SPSS version 21 and presented as frequencies and percentages. T test was used to test the significant difference between variables with P value set at ≤ 0.05. Results: Only 24.9% of the medical records contained the nursing process form. On the day of admission, <25% of the charts included a complete record of nursing assessment, nursing diagnoses, nursing intervention, and the evaluation. The highest phase of nursing process recorded is nursing diagnosis followed by patient assessment. At 24h postadmission, no significant increase was noted in the phases of nursing process recorded. There was a significant difference between the frequencies of documentation of nursing diagnosis and the nurses' area of practice (P = 0.001). Conclusions: Nursing process utilization remained poorly incorporated into the activities of nurses in this institution. Therefore, continuing professional education on nursing process and supervision should be mandated.

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Context: Blood-borne infections are a serious problem of health systems. Most of these infections are caused by sharp injuries. Aims: This study was conducted to determine the frequency of sharp injuries and its related factors among high-risk wards staff. Setting and Design: This cross-sectional study was conducted on high-risk wards staff at educational hospitals of sari in 2018. Materials and Methods: In this study, 306 high-risk wards staff who were working in educational hospitals of sari district for more than 1 year completed a self-administered questionnaire. Statistical Analysis Used: Data were analyzed using descriptive statics, independent T- test and Chi –square. Results: All participants had a history of sharp injuries during their work experience, and in the last year, from the 306 participants in this study, 250 (81.7%) had at least one Needle Stick Injuries (NSI) event. in 66.7% of cases in the surgical technologists, suture needles were reported to cause NSI. While, 61.1% of nurses, 61.4% of anesthesia personnel and 45.5% of physicians, reported syringe needles as the main cause of injury. Suture and stitch needle was the most important cause of injury. The result shows that there is no significant relationship between work experience and gender with NSI rate. Conclusions: The results of this study indicate a high prevalence of NSI in personnel of high-risk wards, especially in the operating room. Due to the excessive use of needles and needle stitches in these areas, the incidence of them is high. It is recommended that safety measures be taken in the use of sharp equipment to reduce the complications in case of an accident.

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Background and Purpose: Distress is an important issue with significant effects on nurses and patients in the nursing profession. This study aimed to investigate the effects of mindfulness-based cognitive therapy (MBCT) on the distress tolerance of nurses with job burnout. Methods: This quasi-experimental study was conducted with a pretest-posttest design and a control group. Study population consisted of 202 female nurses employed at Fatemeh Zahra Hospital (heart center) of Sari, Iran in 2015. Collected data were indicative of job burnout in 70 participants. In total, 30 nurses were selected as eligible subjects and equally divided into two groups of intervention and control. Pretest was performed on both groups. Nurses in the intervention group received eight sessions of training (two hours each) twice per week, while the control group had no intervention. Both groups were evaluated after the intervention (posttest). Data were collected using Maslach Burnout Inventory (MBI) and Simons and Gaher's Distress Tolerance Scale (DTS). Data analysis was performed in SPSS version 21 using analysis of covariance. Results: In this study, use of MBCT was observed to positively affect the distress tolerance of nurses with job burnout. Conclusion: According to the results of this study, factors such as prompt decision-making, job difficulty, long working shifts, and stressful environments were significantly involved in the psychological and physical stress of nurses, and MBCT could effectively enhance distress tolerance in the participants.

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Background and Purpose: Professional autonomy in nursing is defined as working in a self-determined environment and making decisions based on professional judgment. This study aimed to evaluate professional autonomy and its association with individual factors in nurses employed at teaching hospitals affiliated to Kerman University of Medical Sciences in the southeast of Iran in 2013. Methods: This was a descriptive analytical study, and required data were collected by quota sampling using self-administered questionnaires, which were completed by 385 nurses at four teaching hospitals in Kerman, Iran. Data analysis was performed using inferential (ANOVA) and descriptive statistics (mean and frequency) in SPSS V. 18. Results: In this study, a significant correlation was observed between professional autonomy and age (P>0.001), gender (P=0.04), work experience (P>0.03), education level (P>0.02) and attitude of nurses. Moreover, a positive correlation was found between the mean scores of professional autonomy and nursing experience (r=0.559). Conclusion: According to the results of this study, general attitude of nurses towards professional autonomy was relatively positive. In addition, professional autonomy was observed to increase with higher education level and job satisfaction. Hierarchical team decision-making may restrict professional autonomy in nurses. Therefore, it is recommended that nursing skills and professional autonomy of nurses be improved through appropriate methods.

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Context: Patient's rights are one of the most fundamental rights that should be considered by the health-care providers, especially nurses. On the other hand, moral distress in nurses can lead to problems in the provision of health services for patients. Aims: This study aimed to determine the correlation between nurses' moral distress (NMD) and patients' satisfaction with the observance of the patients' rights charter (PRC). Setting and Design: In this descriptive-analytic study, 82 nurses were selected using purpose-based method, and 200 patients were selected in quotas in proportion to the number of beds available in the general and special wards in 2 months. Materials and Methods: Data collection tools consisted of demographic information form, the moral distress scale-revised, and a researcher-made questionnaire on patient satisfaction with the observance of PRC. Statistical Analysis Used: Data were analyzed using descriptive statistical in SPSS version 16. Results: The mean score of moral distress in nurses was11 ± 33 that 59 (72%) of them had moderate distress level and the mean score of satisfaction with the observance of the charter of patients' rights was 71.6± 18.2. It was found that 120 (60%) of the patients had a satisfactory moderate level of the observance of their rights charter. There was a reverse statistically significant positive correlation between NMD and satisfaction with the observance of the PRC (P < 0.05). Conclusion: In the present study, it was found that there is a moderate correlation between the patients' satisfaction with the observance of the PRC and the NMD.

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Context: Lifestyle recognition is important because of its ability to prevent diseases and promote the health of the body and mind. Aims: The aim of this study was to determine the lifestyle and its related factors in elderly in Babol health centers. Settings and Design: This study was a descriptive-analytic study that was carried out on the elderly population of Babol health centers in 2018. Materials and Methods: The sample size was 500 elderly people over 60 years of age who were selected by systematic random cluster sampling method and entered the study. The research tools were the demographic questionnaire, the Iranian elderly lifestyle questionnaire. Statistical Analysis Used: Data were Analyzed by SPSS 21 software using descriptive statistics, Pearson's correlation coefficient test, one-way ANOVA, and independent t-test. Results: The findings of this study showed that the mean ± standard deviation score of healthy lifestyle in the elderly was 155.73 ± 16.28. Of included population, 243 (48.6%) indicated moderate lifestyle and 257 persons (51.4%) had a desirable lifestyle. The Chi-squared test showed that men had better lifestyle than women (P < 0.001), also elderly lifestyle was significantly associated with gender,education, income level, marital status, living arrangement, housing status, and age (P < 0.001). Conclusion: Regarding the study results, some demographic factors must be addressed in intervention program, aimed at life style promotion in elderly people.

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Background and Purpose: Diabetes has adverse effects on the quality of life of patients. Roy's adaptation model could be used to enhance quality of life among diabetic patients. This study aimed to evaluate the effects of Roy's adaptation model in nursing practice on the quality of life in patients with type II diabetes. Methods: This quasi-experimental study was conducted on 60 diabetic patients randomly divided into two groups of experiment and control (N=30) at Hamadan Diabetes Research Center. Data were collected using Diabetes-Specific Quality of Life Scale (D-39) in five dimensions, which was completed before and after intervention in both groups. Educational care programs were executed based on Roy's adaptation model only for experimental subjects in five sessions during one month. Data analysis was performed using independent and paired t-test in SPSS. Results: At the beginning of the study, both groups were matched in terms of demographic characteristics and quality of life dimensions (P>0.05). Comparison of mean scores of quality of life areas between the two groups before and after intervention was indicative of a significant difference in the aspects of diabetes control, energy and mobility and social support (P<001). However, there was no significant difference in the dimensions of stress, anxiety and sexual activity (P>0.05). Conclusion: According to the results of this study, use of Roy's adaptation model has positive effects on some dimensions of quality of life in patients with type 2 diabetes; these domains were diabetes control, energy and mobility, and social support. However, further studies with longer durations are required as to investigate the efficacy of this model in the areas of anxiety and sexual activity.

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Background and Purpose: Surrogacy is a new assisted reproductive technology requiring to be perceived based on the real experiences of surrogacy patients regarding its legal issues so that legislators are able to enact appropriate laws for such patients' safety. This study pursues the goal to examine the experiences of commissioning mothers and surrogates confronting legal issues. Methods: This paper is part of the findings of a larger study conducted over 20 months from October 2011 to June 2013 using the grounded theory approach to explain the process of becoming a mother in commissioning mothers. The experiences of mothers using gestational surrogacy have been analyzed through the conventional content analysis method and then reported in terms of the legal issues of surrogacy. Overall there have been 20 participants including 11 commissioning mothers and 4 surrogates. For incorporating the resources, 5 fertility clinic personnel have also been interviewed. Totally 25 unstructured in-depth interviews have eventually been performed. Data have been collected via purposive sampling method within Royan Institute, and then due to the inadequate number of samples, sampling continued in other surrogacy treatment centers. Results: Commissioning mothers and surrogates suffer a great amount of stress at the time of childbirth, and lack of legal support imposes plenty of problems on them. Participants' experiences revealed a common theme of “legal constraints” with three dimensions as “inefficiency of current laws”, “receiving inadequate educational support services” and “stress and frustration”.s Conclusion: Results indicate disagreeable legal settings for surrogacy leading to a high level of stress imposed on the clients using these technologies. The treatment team should inform the families about the entire process ahead of them before they make their final decision so as to enable them to enter the process fully aware.

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Background and Purpose: Social support is considered as a facilitator of health behaviors in women. This study aimed to evaluate and compare the status of social support and its associated dimensions in pregnant and non-pregnant women. Methods: This analytical study was conducted on 310 pregnant and non-pregnant women referring to the health-care centers of Zarqan city in Shiraz, Iran in 2011. Participants were selected via convenience sampling. Data collection tools included demographic questionnaire and Social Support Appraisals (SS-A) scale. Data analysis was performed in SPSS V.16 using descriptive (frequency, percentage, mean, and standard deviation) and inferential statistics (Chi-square, T-test, and Pearson's and Spearman's correlation-coefficient). Results: In non-pregnant women, mean of the total social support was 40.08±2.80, and mean scores of support from friends, spouse, family and others were 12.08±1.33, 14.02±1.56, 14.53±0.96 and 13.54±1.09 respectively. Among pregnant women these values were 39.52±2.85, 11.72±1.59, 14.54±1.12, 14.38±1.06 and 13.4Ш.18, respectively. The total support and support from friends were significantly higher in non-pregnant women compared to pregnant women (P = 0.05 and P = 0.03, respectively). On the other hand, support from the spouse was significantly higher in pregnant women compared to non-pregnant women (P = 0.01). Moreover, a significant correlation was observed between the total scores of social support and employment status of spouse among pregnant women (P<0.01). Also, significant associations were found between social support and employment status of spouse (P<0.01), mother' availability (P<0.05), and education status (P<0.05). Family support in pregnant women had a significant relationship with the employment status of spouse (P<0.05), father's availability (P<0.01), and mother's availability (P<0.05). In addition, there was a significant correlation between the social support from others and employment status of the pregnant women (P<0.05). Conclusion: According to the results of this study, there were significant differences in the total scores of social support and mean scores of support from the spouse and friends between pregnant and non-pregnant women. It seems that physical and psychological changes during pregnancy largely influence the perception of expecting mothers towards social support.

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Background and Purpose: Nurses are frequently exposed to anxiety-related problems. In fact, anxiety and stress can negatively affect nurses' mental health and performance. Therefore, in the present study, we aimed to investigate the effect of emotional intelligence training on employed nurses in Sabzevar, Iran in 2014. Methods: In this experimental trial, 135 nurses working in Sabzevar hospitals were enrolled and randomly assigned to intervention and control groups. The subjects were evaluated, using a demographic questionnaire, Bar-On's emotional quotient inventory, and Spielberger's State-Trait Anxiety Inventory (STAI). The intervention group was trained in six sessions by an expert. In the final session, the questionnaires were completed by the participants and analyzed. For statistical analysis, t-test and non-parametrical tests were performed. P-value less than 0.05 were considered statistically significant. Results:Based on the findings, 80% of the samples were female. The mean age of the participants was 32.11±6.68 years. Before the intervention, the difference between the two groups was insignificant (P>0.05), while after the intervention, a negative relationship was found between the STAI score and emotional intelligence in the two groups. Also, the difference between the groups regarding STAI scores was significant (P<0.003). Following the intervention, the emotional intelligence scores were higher in comparison with the pre-intervention period in the intervention group. Also, after the intervention, anxiety decreased in the intervention group in comparison with the pre-intervention period (P<0.001). Conclusion: The present results showed that emotional intelligence scores could improve as a result of training, while the STAI scores significantly decreased.

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Background and Purpose: Heart disease death rates have increased worldwide.Family-oriented empowerment model improves the quality of life in the patients with chronic diseases. This study aims to determine the effect of family-oriented empowerment model on the life quality of the patients undergoing coronary artery bypass graft. Methods: A quasi-experimental study was performed on the patients undergoing CABG in both experimental and control groups before and after the surgery. Samples were put in the groups with a random arrangement and family-oriented empowerment model was applied for the experimental group. Firstly, Mac New Quality of Life Questionnaire was completed for both of them. The four-stage model of threat perception, problem solving, collaboration and training was carried out for the experimental group. One month later, the tools for both groups were completed and the data were analyzed by Mann-Whitney nonparametric test, sign test and SPSS17 software. Results: The mean score of the control group before and after implementing the model was 137.5 ±11.6 and 143.7 ± 9.6 (p = 0.001), respectively. They were 133.4 ±13.3 and 148.2 ±10.5 (p = 0.00), respectively in the test group. Conclusions: These empowering models will lead to improved life quality by developing the inherent capacity of the individuals to take responsibility in life and help to make rational decisions and evaluate them.

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Context: Work–family conflict (WFC) is a consequence of imbalance and incompatibility, which influences the health and family relationship of nurses negatively and creates challenges for the individual and the organization. Aim: To explain the nurses' view on the stressful effects of conflict between work and family on their lifestyle. Setting and Design: This qualitative investigation was a conventional content analysis and conducted by the use of purposive sampling selecting 25 nurses. Material and Methods: Unstructured interview was performed, and data were analyzed using inductive content analysis. The credibility and objectivity of the data were repeatedly checked by incorporating the data-gathering process, variety of participants and monitoring the participants in the investigation. Statistical Analysis Used: Data analysis was conducted by Graneheim and Lundman approach. The unit analysis in this study was the whole interviews, and the meaning units were distinguished in the statements and texts of the interview in the form of “sentence” or “paragraph” from which the open codes were extracted. Then, the categories, main categories, and themes were abstracted. Results: The final findings consist of two main themes: (i) the predisposing factors/the sources of WFC and (ii) coping/stress management and obstacles that each of which is formed by some categories. The core of the nurses' efforts for eliminating WFC is creation of balance between different factors. Conclusion: Thus, resolving the problem is possible to use in access to resources and proportional circumstances. We propose that, in different societies, qualitative study be conducted on to explore preventive strategies and policies.

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Context: There is considerable empirical evidence about the psychosocial vulnerability of children of parents with mental illness (COPMI). Nonetheless, these children's experiences and needs have still known poorly. Aims: This study was conducted to explore the mental health needs of COPMI. Settings and Design: The grounded theory approach was deployed. Material and Methods: Semi-structured interviews were held with 17 participants who had been recruited purposively and theoretically from a psychiatric teaching hospital located in Qazvin, Iran 2008–2010. Statistical Analysis Used: The data were analyzed using Strauss and Corbin method (1998). Results: After relating the main concepts of the study, the “COPMI need theory” was formulated. This theory explains children's needs, changes of needs in the cycle of parents' illness, the process of fulfilling the needs, and outcomes-driven from need fulfillment. Conclusions: Based on findings, recommendations were provided to mental health professionals who for dealing with families and children of patients with mental disorders.

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Context: Pressure ulcers are among the main postoperative complications which isassociated with an increased length of hospitalization. Determining risk factors of postsurgical pressureulcers is crucial for developing prevention and treatment strategies. Aims: This study aimed to investigate the incidence rate of pressure ulcer and related risk factors after general surgery. Settings and Design: This descriptive cross-sectional study was carried out in three hospitals in Mazandaran province in 2016. Materials and Methods: The sample size was 191 surgical patients undergoing general surgery by using census method. Data were collected in pre-, intra-, and post-operative period using demographic and clinical questionnaires and also, through the Braden Scale for Predicting Pressure Ulcer Risk. Statistical Analysis Used: Descriptive statistics, t-test, Chi-square, and univariateand multivariate logistic regression were used to analyze the data. Results: The incidence rate of postoperative pressure ulcers in patients was 17.8% (34 out of 191 patients). Based on the multivariate logistic regression model, significant correlations existed between the incidence of pressure ulcers and the following variables: age over 70 years old (P = 0.003), history of hypertension (P = 0.035), history of heart diseases (P = 0.029), Braden score <15 (P = 0.017), type of surgery (P = 0.003), and type of anesthesia (P = 0.015). Conclusions: Since it is critical to consider the incidence of postoperative pressure ulcers among patients, further measurements are required to identify high-risk people and use preventive protocols by nurses at pre-, intra-, and post-operative levels. Moreover, it requires extra attention in patients over 70 years, those with a history of hypertension and heart diseases, and those undergoing emergency surgery and spinal anesthesia.

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Context: Several researchers emphasized to develop cost-effective and easy interventions in this field as communicating about the relationship is the first step of healing. Aims: This study was aimed to evaluate the effectiveness of cognitive behavioral counseling based on film therapy on the communication skills of females with low sexual function. Setting and Design: In this clinical trial study, fifty subjects selected among females referred to health centers of Gonbad-e Kavus City-Iran. Materials and Methods: Samples randomized through permuted block randomization into two intervention (N=25) and control (N=25) groups. The intervention group participated in eight sessions of cognitive behavioral counseling (CBC)-based film therapy while the control group did not receive any intervention. All participants assessed by demographic, Arizona Sexual Experience Scale and Jerabeck Communication Skills Scales in pre and post intervention stages. Statistical Analysis Used: Data is analyzed using descriptive& independent t-test. Results: Findings showed that the two groups did not differ significantly in terms of age, education, and duration of marriage. The control (65.65 ± 6.75) and intervention groups (66.18 ± 7.32) were not significantly different in terms of communication skills before the intervention. However, in the postintervention phase, there was a significant difference between the control (66.04 ± 7.29) and intervention (74.95 ± 6.12) groups in term of communication skills (P < 0.05). Conclusion: Based on the findings of this study, CBT based on film therapy can improve communication skills among females with low sexual function in all aspects. Therefore, it is recommended to use this therapeutic approach to improve couples' relationships with low sexual performance.

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Context: Cancer pain in a complicated situation for patients with breast cancer. Researchers suggested to use complementary and alternative method in order to reduction pain and side effects in these patients. Aims: This study was aimed to investigate the effectiveness of mindfulness integrated with cognitive behavioral therapy (MiCBT) on perceived pain and pain self-efficacy in patients with breast cancer. Settings and Design: In this clinical trial study, a semi-experimental method was used. Patients with breast cancer were recurred from cancer clinic of a hospital of Mashhad University of Medical Sciences. Material and Methods: Twenty-four patients with breast cancer selected through purposive sampling method and randomly assigned with permutation blocks in two groups of intervention (n = 12) and control (n = 12). The groups were assessed by demographic questionnaire, Perceived Pain Scale, and Pain Self-efficacy Scale before, immediate, and 1 month after the intervention. Participants in the interventional group received MiCBT for 8 weeks. Statistical Analysis Used: Data were analyzed using descriptive methods and multivariate analysis of covariance. Results: The results showed that the interventional group had a significant decrease in perceived pain (P > 0.05). The pain self-efficacy of patients significantly increased in comparison to the control group in posttest and follow-up stage (P < 0.05). Conclusion: According to the results, it can be concluded that using integrated therapy with mindfulness has been effective in reducing pain and enhancing pain self-efficacy in breast cancer patients. Therefore, it can be an adequate complementary therapy for patients with breast cancer.

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Context: Research revealed resilience can decrease the effects of stress and improve quality of life among cancer patients. The role of positive factors such as psychological well-being and social capital is separately studied in cancer. Aims: The aim of the present study was to determine the relationship between the psychological well-being and social capital with resilience among cancer patients. Setting and Design: This descriptive correlational study conducted on 163 cancer patients were selected patients referring to Touba Specialized Clinic in Sari from May to December 2018. Materials and Methods: The data collection tools included Demographics Questionnaire, Riff's Psychological Well-being Scale (-2002), Onyx-Bullen's Social Capital Questionnaire (2000), and Connor-Davidson's Resilience Scale (2003). Statistical Analysis Used: SPPS 20 and descriptive and inferential statistical methods (Mann–Whitney, Kruskal–Wallis and linear regression, Spearman correlation coefficient,) were employed. P < 0.05 was considered as the level of significance. Results: The results revealed that the mean (standard deviation) of the psychological well-being, social capital, and resilience were 69.71 ± 5.49, 118.60 ± 8.51, and 78.48 ± 8.68, respectively. The study showed a positive and significant correlation between psychological well-being and resilience (r = 0.797; P = 0.001), and between social capital and resilience (r = 0.716, P = 0.001). The findings revealed that psychological well-being and social capital explained 70% of the resilience variation. Conclusion: The results showed that psychological well-being and social capital have high relationship with cancer patients' resilience and it suggested through developing appropriate interventions on psychological well-being and social capital, it is possible to improve the cancer patients' resilience.

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Background and Purpose: Heart failure (HF) is a chronic, debilitating disease, and physical limitations and progressive symptoms of which associated with this condition can reduce quality of life (QOL). Patient education regarding heart HF is one of the main components of self-care. In this respect, peer education is significant in improving health and creating a learning environment. This study was performed to determine the effect of peer education on QOL in HF patients. Methods: In this quasi-experimental study performed during 2016, 60 HF patients affiliated to Tehran University of Medical Sciences were randomly divided into intervention and control groups (n=30). After preparing the peer group, four peer-to-peer training sessions were conducted during one month. The Persian version of Ferrans and Powers' Quality Of Life Questionnaire was used for data collection, which was completed by both groups before, just, and one month after the intervention. SPSS version 21 was employed for data analysis. Results: No significant difference was observed between the two groups in overall QOL score and its domains before the intervention (P=0.31). The mean scores of QOL immediately after the intervention were 126.2±6.7 and 163.1±1.6 in the case and control groups, respectively. The mean scores of QOL one month after the intervention were 134.5±0.7 and 169.9±2.3 in the case and control groups, respectively. After the intervention, paired t-test showed that peer education had a significant relationship with QOL of the HF patients (P<0001). Conclusion: Based on this study, peer education intervention can be a beneficial educative-supportive approach, which might enhance QOL in HF patients.

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