Child abuse is one of the most challenging social problems worldwide. Failure to report child abuse may lead to the aggravation of the situation and increase the probability of further abuses. This study aimed to determine the challenges of child abuse reports by healthcare professionals. This narrative review study was conducted through searching the databases such as Google Scholar, PubMed, Web of Science, Scopus, and ProQuest. The inclusion criterion was studies in Persian and English languages which published in scientific journals between 1978 and 2017 and also refer to reporting child maltreatment. Studies which, despite referring to a child abuse, did not refer to the barriers to the reporting of child abuse were discarded from further analysis. 56 papers were used to write the present paper. The results of this study organized into four categories: individual barriers (knowledge of healthcare professionals, their attitudes and beliefs, their inadequate experiences, and uncertainty of the diagnosis), interpersonal barriers (fear of disconnecting therapeutic relationships and violation of privacy and secrecy principles), organizational barriers (poor communication and weak legal processes for reporting), and situational barriers (victims' characteristics and available evidence). Given the reporting of child abuse by healthcare professionals is affected by multiple factors such as individual, interpersonal, organizational, and situational factors, so considering a comprehensive and collaborative program for this public problem in all levels is important.

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Context: Students may develop academic burnout due to various factors, especially in stressful fields. This may cause educational and occupational negative impacts. Aims: The present study was an investigation of the relationship of motivation, self-efficacy, stress, and academic performance with academic burnout among paramedical and nursing students. Setting and Design: This descriptive-analytic study was conducted in Qom University of Medical Sciences. Materials and Methods: In the present study, 264 nursing and paramedical undergraduate students were selected through simple randomization. Demographic questionnaire, Maslach Burnout Inventory, Academic Stress Questionnaire (ASQ), Academic Self-efficacy Questionnaire (ASQ), and Academic Motivation Scale were used for data collection. The average of university course grades was used as the academic performance scale. Statistical Analysis Used: Data were analyzed by linear regression analysis and descriptive statistics including mean, standard deviation, and frequency. Results: The mean score of academic burnout was 28.52 ± 15.84. The results of regression analysis in univariate model showed that all subscales of academic performance variables, i.e., academic motivation, academic self-efficacy, and academic stress of students, were related to academic burnout (P < 0.05). It was also found that internal motivation, no motivation, and assurance of self-ability to manage family and work were the most important factors in burnout, and 50% of variance changes was determined in academic burnout (r = 0.71, r² = 0.50). Conclusion: Based on the results of this study, internal motivation, amotivation, and family work management were identified as the most important decreasing factors on academic burnout. Therefore, promoting academic motivation; recognizing and applying the skills of family–work management; and recognizing the factors affecting stress, motivation, self-efficacy, and academic performance cause students to be protected against academic burnout.

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Heart failure is one of the most common cardiovascular disorders, and as a chronic and progressive disorder, it can disrupt with interpersonal and social relationships, reduce physical activity, and in fact, impair self-care. Therefore, it is necessary to improve the self-care behavior of the patients with heart failure with effective interventions. There are several ways to improve self-care behavior, and educational interventions are one of these methods. Review of educational interventions causes promotion in self-care behaviors of patients with heart failure. The aim of this study was reviewing the educational intervention for improving self-care behaviors in patients with heart failure. The present study is a narrative review study that uses a search in databases such as Google Scholar, Cochrane, Science Direct, ProQuest, Springer, SID, Magiran, IranMedex, Web of science, Scopus, and PubMed from 2000 to 2018. Search for articles using Keywords: heart failure, self care, education and training. All articles with educational intervention and clinical trial in Persian and English and articles with full-text of individual or group training in the database of internal and library were included in the study, and unrelated articles with just abstract were excluded from the study. Seventy-one articles were finally included, after removing repetitive and nonrelated items. Initially 340 articles were obtained and after reviewing the articles for inclusion criteria, finally 71 articles were included in the study. Educational interventions were divided into four groups: face-to-face teach-back training and home visitation by follow-up phone call, group training, and e-learning. The results of this study showed that four abovementioned educational methods significantly improved self-care behaviors in patients with heart failure. According to the findings of this study, it is recommended to improve self-care behaviors in patients with heart failure Based on the findings of the study, it is recommended to use one-to-one face-to-face, teach back, home visits with telephone follow-up, group training, and e-learning to improve self-care behaviors in patients with heart failure.

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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: Urinary tract infection (UTI) is the most common hospital-acquired infection. Around 80% of UTIs are associated with urinary catheters. Aims: The aim of this study was to review and to describe epidemiology and approaches for the prevention and management of catheter-associated urinary tract infection (CAUTI) in intensive care unit (ICU) patients. Settings and Design: A narrative review of studies was undertaken. Materials and Methods: A review of PubMed, Google Scholar, Medline, and CINAHL databases were conducted to identify peer-reviewed, English language, and studies published between 1999 and 2018. Related papers were reviewed with using standard keywords. The research was conducted on epidemiology and management of CAUTI in the ICU. Of the 186 English publications, 36 were duplicates. Statistical Analysis Used: Quality assessments, data extractions, and analysis were completed on all included studies. Results: The prevalence of UTI in the ICU is directly related to the widespread use of urethral catheter (32.2%). Guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections for CAUTI. Conclusions: Further studies are needed due to the importance and high prevalence of these infections. We recommend the opportunity to increase any strategy able to reduce the incidence of infections related to urinary catheterization and its consequences in ICUs.

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Health assessment skills lead to enhancement of nurses' self-confidence at work. The aim of the present study is to investigate the challenges that nurses face in conducting health assessments in Iran and another country. This study was conducted in integrated review study based on Russell's method. The inclusion criteria were; related to the objectives of the study, English or Persian writings, published during the past 35 years and access to their full text. The nonscientific articles as well as the articles that lacked a specific name or transparent data were excluded from the study. Health assessment, nurse, history taking, and physical examination were used as keywords. We used Persian and international databases such as SID, Magiran, Iranmedex, Google Scholar, Medline, Scopus, Elsevier, PubMed, and Science Direct. Finally, 20 articles were included in the study. the scattered data were summarized for data analysis and interpretation purposes. All of the data reviewed, obtained, compared, and finally, classified into six groups. The most important challenges in the use of these skills in order are Individual -motivational, professional, environmental, educational, cultural, and communicational factors as well as factors that are related to patients and their culture. The results showed that the challenges that nurses face in performing clinical health assessment skills are mostly shared in Iran and across the world. Although all of the factors have been involved in execution of these skills, the health assessment skills are significantly dependent on the need for them as felt by the nurses themselves.

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Context: Nursing is a high-risk occupation, and intensive care units (ICUs) are one of the most sensitive hospital wards. Aim: This study aimed to determine the level of occupational hazards among nurses in the ICUs. Setting and Design: This descriptive-analytical study was conducted on a total of 281 nurses in the ICUs of tertiary care centers in Golestan and Mazandaran Universities of Medical Sciences in 2017. Materials and Methods: Data were collected using a five-dimensional occupational hazard questionnaire. Statistical Analysis Used: Data analysis was performed in SPSS software (version 16) and descriptive and inferential statistics were considered statistically significant (P < 0.05). Results: In this study, 75.1% of the nurses were female and 50.9% of the participants were within the age range of 26–35 years. The total mean and standard deviation of occupational hazards was 3.20 ± 0.66. In addition, the mean values and standard deviations of chemical, ergonomic, biological, psychosocial, and organizational, as well as physical hazards were reported to be 2.43 ± 1.06, 2.6 ± 0.82, 2.63 ± 0.91, 3.38 ± 0.7, and 3.38 ± 0.86, respectively. According to the results, significant differences were observed between occupational hazards and variables of gender, marital status, educational level, and work experience (P = 0.0001). Conclusion: Occupational hazard level was moderate among nurses in the ICUs, and most of the damages were related to the physical dimension. In addition to holding educational workshops in tertiary care centers by the related officials, proper preventive plans must be designed to reduce occupational injuries.

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Context: Depression is one of the most common psychiatric disorders, and poor sleep quality is a risk factor for it. Aims: This study aimed at determining the effect of aromatherapy with lavender essential oil on sleep quality of patients with major depression. Settings and Design: This single-blinded randomized clinical trial in Psychiatric Clinic in Yahya Nejad Hospital, Babol, Iran, during 2019. Materials and Methods: Eighty major depressive patients with sleep disorder were recruited from those referred to Psychiatric Clinic in Babol City, Iran. They were assigned into intervention and control groups (forty participants in each group). The intervention group inhaled lavender essential oil and the control group received almond oil as placebo. Sleep quality of the participants was measured before and after the intervention. Statistical Analysis Used: Data analysis was performed employing statistical tests including Chi-square, Kolmogorov–Smirnov, ANCOVA, independent t-test, and paired t-test. Results: The intervention and control groups were homogeneous in terms of demographic characteristics and the mean score of sleep quality before the intervention (P > 0.05). The patients in the intervention group had a better quality of sleep comparing to that in the control group, and the difference was statistically meaningful (P = 0.001). Conclusion: Aromatherapy with lavender essential oil has positive effects on sleep quality in depressed patients. It can be used as a noninvasive complementary method to improve sleep quality in patients with major depression.

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Context: Parents have an important role in sexuality education for children. Aims: The present study aimed to review the role of parents in nurturing and sexuality education for children from the perspective of Islam and scientific resources. Setting and Design: This narrative review was done in 2018. Materials and Methods: To this narrative study, the Persian and English articles in the databases of PubMed, Magiran, Barakat Knowledge network system, SID, UpToDate, Cochrane Library, Scopus, Google Scholar, CINAHL, and Web of Science were searched. The following keywords were used for search: sexuality training, sexuality education, sexual health, guidelines, packages, Islam, parents, father, mother, and children. Inclusion criteria were studied design (articles, grey documents, packages, and guidelines) introduced in the field of sexuality education for children aged 0–12. From 80 studies retrieved, 18 articles were reviewed. Statistical Analysis Used: We employed content analysis method to extract our findings. Results: The results of this study organized into three categories; (1) Parents are introduced by Islamic and scientific resources as the first educators of sexuality for children, (2) All resources highlighted that values and cultural features of each family are explained to children by their parents, and (3) Islamic and scientific resources put an emphasis on the effectiveness parent role on the promotion of sexual health in children and establishment of a healthy society. Conclusion: These issues indicate the necessity of attention to nurturing and sexuality education and considering the fact that the Islamic community requires to be shaped through its own teaching principles. Accordingly, Iranian society is in need of guidelines for parents' readiness in line with their own culture and religion.

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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: Children's pain in hospital settings has not yet been managed well. Although nurses play an important role in pain management, its extent is limited with respect to clinical nurses in Iran. Aims: This study was conducted to explore the experience of nurses' barriers to pain management in pediatric units. Settings and Design: This qualitative study was conducted at two teaching hospitals in Amirkola Children's Hospital in Babol and Children's Medical Centers in Tehran, Iran. Data were collected from 19 nurses, using unstructured and deep interviews during 2014–2015. Material and Methods: Sampling was purposeful with maximum variation. Data analyzed by conventional content analysis method simultaneously data collection based on five steps of Granheim and Lundman (2004). To ensure about the accuracy and reliability of data, four criteria namely credibility, confirmability, dependability, and transferability, were used according to Lincoln and Guba's criteria. Before the interviews, participants were ensured about the confidentiality of their information and voluntarily nature of the study. In addition, written informed consents of the nurses were obtained. Results: Data analysis extracted five themes of barriers to pain management, including: Inappropriate organizational structure, interruption in pain relief activities, inadequate competency of the nurses, individual characteristics of child and parents, and inefficacy of companions. These themes indicated the barriers to pediatric pain management based on research conditions and experience of nurses in the pediatric ward. Conclusions: Therefore, modification of organizational structure, elimination of causes of delay in pain relief measures, promotion of nursing competencies, paying attention to child and parents' characteristics, and improvement of companions' effectiveness should be prioritized to achieve an optimal pain management

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Context: Assisted reproductive technology (ART) is generating different views among women, especially in developing countries, and this has contributed to the low turnout in the utilization of the technology in the area. Aims: This study examined the knowledge and perception of ART among women that attended a tertiary health facility. Setting and Design: This cross-sectional study was conducted on women that attended the Obstetrics, Gynaecology, and Fertility clinics in the University of Benin Teaching Hospital, Benin City, Nigeria, 2018. Materials and Methods: This study was conducted among 348 women through stratified probability sampling method, and a self-structured questionnaire with open-ended and Likert scale questions used as instrument was administered. Statistical Analysis Used: Data collected were analyzed using descriptive statistics and one-way analysis of variance (ANOVA) at 0.05 significant levels. Results: The perception of ART had a huge mean of 3.99 (0.50). The result also revealed 73.0% awareness level of ART. Hypotheses testing brought out the mean comparison of perception of ART based on educational level using one-way ANOVA, which showed F = 0.071 and P = 0.552. Conclusion: There is a high awareness level but low knowledge about ART; therefore, appropriate policies and programs must be put in place to educate the populace on the importance and success rate of ART.

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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: Leukemia is the most common pediatric cancer. Diagnosis and treatment of childhood cancer may have adverse psychological effects on children and their families. Aim: We examined the effectiveness of positive thinking education on anxiety, depression, and quality of life of mothers of children with leukemia. Settings and Design: This randomized control trial has been conducted during August-September 2017, on 30 mothers of children with leukemia who randomly allocated into two groups using 30 random numbers produced by computer software and assigned to intervention (n = 15) and control (n = 15) groups. Materials and Methods: Data collection tools included depression, anxiety, stress scale-21, and MOS 36-Item Short-Form Health Survey quality of life questionnaire. Statistical Analysis Used: The normality of data distribution examined using the Kolmogorov–Smirnov test. Then, data were analyzed using descriptive methods (mean, frequency, and percentage), Chi-square, and independent t-test. Results: There were no statistically significant differences between the study groups in depression, anxiety, and quality of life variable at baseline (P > 0.05). However after the intervention, results showed significant differences between the study groups in all the three variables in posttest compared to the pretest. The mean scores of depression and anxiety respected, in the intervention group were significantly lower than the control group (P < 0.001) and (P < 0.004). Furthermore, significant differences were found between the study groups in quality of life score (P < 0.05). Conclusion: Positive thinking training reduced anxiety and depression and increased the quality of life of mothers of children with leukemia.

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Context: Preterm babies require special care, including immediate hospitalization after delivery. Mothers of preterm babies may be required to stay in a hospital for a longer period and may be anxious about the treatment outcome and health of their babies. These may be stressful for most parents. Aims: The purpose of the study was to explore the challenges of mothers with preterm babies during hospitalization in a tertiary institution in Nigeria. Setting and Design: The qualitative study was carried out at the special care baby unit (SCBU) of the University of Abuja Teaching Hospital using a phenomenological approach. Materials and Methods: Data were collected through semi-structured interviews from 12 mothers with their preterm babies on admission. Only mothers who met the inclusion criteria were interviewed. Statistical Analysis Used: Content analysis was used to analyze the data. Results: Six themes emerged from the challenges the mothers faced, namely limited access to baby, strange SCBU environment, inadequate spousal support, high costs of treatment, lactation problems, and informational challenges. Conclusion: The results of the studies showed that mothers of preterm babies face enormous challenges when caring for their hospitalized preterm babies such as need to emotional and financial supports and educational needs. The health team should help mothers overcome these challenges by strengthening the support structures that exist. Mothers who are able to overcome their challenges can become collaborators in the provision of care, while the babies are on admission.

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Context: Awareness of types of triage methods in different situations and locations is one of the most important needs of the medical staff, especially due to the high number of patients, and is necessary for nurses in the emergency department. Aims: This study aimed to determine the level of awareness of nurses working in the emergency department. Setting and Design: In this descriptive cross-sectional study, conducted in 2017, the study population was all nurses working in the emergency departments of educational hospitals affiliated to Ahvaz University of Medical Sciences, who were included by the census method (n = 73). Materials and Methods: The data collection tool included a questionnaire on individual characteristics and an assessment of the emergency department personnel's awareness level of triage systems in Iran. Statistical Analysis Used: Data were analyzed using descriptive-inferential statistics in the SPSS version 16. Results: Totally 47 female nurses (64.4%) and 26 male nurses (35.6%), with a mean age of 30.37 ± 3.83, participated in the study. The results showed that 64 nurses (87.7%) had poor awareness, 9 nurses (12.3%) had a moderate awareness about different methods of triage, and the mean score of total knowledge of nurses was poor (20.75 ± 8). There was a significant statistical relationship between knowledge score and marital status, employment status, and teaching methods of triage principles (P < 0.05). Conclusion: Due to the employed nurses' knowledge low score, it is necessary to organize training courses of the triage.

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Context: The evidence suggests that the communication skills of the emergency department personnel are not optimal, and the employees are not prepared to deal with the violent behaviors of patients and their relatives. Aims: This study aimed to determine the effect of anger management training on controlling the perceived violence and aggression of nurses in emergency departments. Setting and Design: This quasi-experimental study was conducted on 112 nurses in emergency departments of educational healthcare centers of Gorgan, Iran, in 2017. Materials and Methods: Nurses were randomly divided into test and control group. In the test group, training of anger management skills was carried out in person, followed by 2-month virtual training, including short messages related to the skill of anger management delivered via Telegram. No specific measure was obtained in the control group. The subjects filled out an anger management skill questionnaire before and after the intervention. Statistical Analysis: Data were analyzed using paired t-test, Wilcoxon test, and Mann–Whitney U-test with P < 0.05. Results: The mean ages of the subjects in the test and control groups were 30.25 ± 3.02 and 28.58 ± 4.16 years, respectively. The comparison of exposure level to verbal violence in the control group was low in the beginning of the study, which had a significant increase at the end of the investigation (P = 0.001). There was a significant difference between the level of exposure to physical violence in the test group before and after the intervention (P = 0.007), whereas no change was observed in the control group (P = 0.91). Only in the test group, there was a reduction in the level of exposure to sexual anger, and the difference was statistically significant (P = 0.006). Conclusion: According to the results of the present study, running workshops and following the trainings via the internet reduced the score of exposure to physical and sexual aggression in nurses.

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Context: Guided self-change (GSC) is theory-driven based on cognitive-behavioral change models such as transtheoreticlal model (TTM) and can be applied with nicotine replacement therapy (NRT) for behavioral change of smoking in chronic obstructive pulmonary disease (COPD) smokers. Aims: This study aimed to investigate the individual GSC, NRT, and GSC-NRT on smoking cessation of COPD patients. Settings and Design: This randomized clinical control trial study was carried out in Imam Khomeini Hospitals in Mazandaran province in 2016–2017. Materials and Methods: Three- group block randomized controlled trial, comparing GSC (n = 20), NRT (n = 20), and GSC-NRT (n = 20) in smoking cessation and other related variables COPD smokers with follow-up to 29-week. Statistical Analysis Used: Descriptive statistics, Chi-square, and repeated measures ANOVA test were used to analyze the data. Results: The GEE model revealed that GSC reduced the odds of quitting smoking rate compared to the NRT group (odds ratio = 0.31, 95% confidence interval: 0.022–0.545, ES = 0.20). Furthermore, the TTM questionnaire, the Fagerstrom test for nicotine dependence, and spirometry variables were evaluated in the three groups. The recovery in nicotine dependency, the exhaled carbon monoxide and spirometry variables was more pronounced in the GSC and GSC-NRT groups than in the NRT over 29 weeks after the treatments. Cons (PV = 0.009, ES = 0.52), pros (PV = 0.04, ES = 0.12), experiential process (PV = 0.005, ES = 0.18), counterconditioning (PV = 0.04, ES = 0.12), stimulus control (PV = 0.004, ES = 0.19), environmental-reevaluation (PV = 0.0001, ES = 0.30), and habitual craving (PV = 0.004, ES = 0.19) were significant across the three groups. Conclusion: The interventions in the GSC and combined GSC-NRT groups were significantly more effective than in the NRT group in TTM variables, and GSC and combined GSC-NRT were equally effective in smoking cessation rate.

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Context: Chemotherapy induced nausea vomiting and fatigue are prevalent problems following chemotherapy and pharmacologic methods are moderately efficient in alleviating them. Acupressure is a substitute approach. Aims: This paper sought to determine the effectiveness of acupressure application in relieving nausea vomiting and fatigue among children with acute lymphoblastic leukemia in compression with a placebo treatment. Settings and Design: In this single blind, randomized, placebo controlled clinical trial, 120 hospitalized school age children with ALL, randomly divided into experimental and placebo groups. Subjects rated the intensity of nausea and fatigue by visual analog scales. Material and Methods: In the experimental group, finger acupressure on p6 and ST36 (true points) and in the placebo group on SI3 and LI12 (sham points) was applied. Symptoms of nausea and fatigue intensity immediately and an hour postintervention evaluated. Then variable of nausea vomiting and Fatigue was also measured 12 h postintervention by the instruments of Adapted Rhodes Index of Nausea and Vomiting for Pediatrics by Child and Fatigue Scale Child, Respectively. Statistical Analysis Used: Data were analyzed by SPSS version 16.0. Results: Significant differences were observed between two groups based on the fatigue and nausea intensity immediately and an hour postintervention with confidence interval 95% and P < 0.001. Conclusions: Applying one time acupressure may reduce the intensity of nausea immediately postintervention and fatigue and nausea at one hour post treatment. Hence, acupressure could be recommended as a helpful, nonpharmacologic method for some cancer related fatigue and chemotherapy induced nausea vomiting management.

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Context: Failure to adhere to drug therapy in patients with high blood pressure can endanger their lives. Aims: The aim of this study was to determine the effectiveness of smartphone-based medication reminder application on medication adherence of patients with essential hypertension. Settings and Design: This clinical trial study was conducted in Yazd Cardiac Research Center. Material and Methods: Seventy-eight patients with essential hypertension were assigned to intervention (39 patients) and control (39 patients) groups using a random sampling method. In the intervention group, the DaroYab 2.1.0 was installed on the patient's smartphone. The control group received routine care. Data were collected using demographic characteristics form and Morriskey's medication adherence scale (MMAS-8). The MMAS-8 completed prior to and 3 months after the intervention. Statistical Analysis Used: Data were analyzed using IBM SPSS, American multinational technology company, Armonk, New York and nonparametric tests including the Wilcoxon test and Mann–Whitney U-test. Results: The mean age of the 78 patients who completed the study was 46.6 ± 7.98 years. All of the participants had a history of drug forgetfulness and 92.5% of them had poor medication adherence before the intervention. Three months after the intervention, the ratio of good medication adherence and medication adherence scores was significantly improved in the DaroYab software group (P < 0.001). Conclusions: Considering the positive impact of DaroYab as a simple, practical, and inexpensive drug reminder, on medication adherence it is recommended that health-care providers introduce this application to of hypertensive patients and encourage them to use it.

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Context: Brain injury can cause coma and organized auditory stimulation (OAS) is thought to be associated with improvements in the level of consciousness. Aims: Determine of the effect of OAS on levels of consciousness in comatose patients with head injury Setting and Design: This study was a randomized clinical trial and conducted from July 2012 to February 2013 in the Panje Azar Hospital of Gorgan, Iran. Materials and Methods: The patients from critical care units were enrolled and randomly allocated into two groups, each group 20 patients. The intervention group underwent OAS using a nurse's voice who tried to call the patients' attention to their place, time, identification, family, and profession. This stimulation was conducted thrice daily for 10 days, and patient consciousness was measured by the Glasgow Coma Scale (GCS). Statistical Analysis Used: We used mean and standard deviation, Chi square, t test, and repeated measures to analysis of data. Results: The level of consciousness increased in both intervention and control groups, but the increase in the intervention group was more than the control group (P < 0.01). A significant difference in GCS between the intervention and control groups was observed on day 10 (P < 0.001). Repeated measures ANOVA showed significant differences within groups including time effect, interaction of time and intervention (P < 0.001). Conclusion: The level of consciousness of patients improved following an organized OAS by the nurses. Therefore, OAS likely will be a useful and applicable intervention for patients in Intensive Care Units.

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Context: Anxiety is an unpleasant emotion and inhaling Jasmine Essential Oil (JEO) may decrease anxiety before laparotomy. Aims: Determining effects of inhaling JEO on anxiety and blood cortisol levels in patients undergoing laparotomy. Setting and Design: The setting was 5th Azar Hospital in Gorgan (Iran) and the study was a single blind parallel, randomized, controlled clinical trial that was conducted in 2016. Materials and Methods: The subjects (84 patients) were randomly allocated in two intervention and control groups. The intervention and control group inhaled two drops of JEO and two drops of distilled water respectively for 60 min. Blood cortisol and anxiety levels were measured immediately after intervention by ELISA kit, and the Spielberger's State Anxiety Inventory, respectively. Statistical Analysis: The data were described with mean, Median, Interquartile Range (IQR) and analyzed using t-test, Chi-square, Wilcoxon signed-rank, Mann–Whitney U and correlation coefficient tests. Results: The mean score of anxiety in JEO group before and after intervention was 50.90 ± 7.71 and 36.42 ± 6.62 (P = 0.001), respectively and median (IQR) of the cortisol was 160.7 (60.88) and 93.15 (52.38), respectively (P = 0.001). In the control group, cortisol (IQR) level increased (124.1 (67.42) to 127.9 (62.42), P = 0.02) and the mean anxiety score decreased slightly (P = 0.43). Median and IQR of difference cortisol level before and after in the intervention and control group were significant (P = 0.001). Conclusion: Our findings suggest that aromatherapy with JEO may have beneficial effects on preoperative anxiety in patients undergoing laparotomy.

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Context: Ambulation improves blood flow, wound healing and reduces postoperative complications. Aims: To assess the effectiveness of early ambulation on the level of anxiety, co-operation and to correlate the anxiety level with co-operation among postoperative patients in the experimental and control group. Settings and Design: Pre- and post-test control group design was adapted for the present study. The participants were selected based on simple random assignment technique using the lottery method from the selected hospital at Puducherry. Materials and Methods: A total of 120 participants were selected for the study, 60 patients were allotted for the experimental group and initiated early ambulation. After 15 h of postoperative period, the patient was ambulated for two times a day for a distance of 30–40 feet, continuously for 5 postoperative days. Sixty samples were allotted for the control group who receives regular postoperative instructions. Modified STAI-Y-1 scale is used to measure the level of anxiety and observation checklist was used to monitor the co-operation for postoperative care before the initiation of early ambulation as pretest and after 5 postoperative days as posttest. Statistical Analysis Used: The data were analyzed using SPSS v. 16 (Chicago, Illinois, USA), statistical tests including frequency, percentage, and Chi-square. Results: Both the groups had severe anxiety levels (100%) and were noncooperative to postoperative care in the pretest. In posttest, the majority (85%) of the client shows mild anxiety, 15% shows no anxiety and most (88%) of the clients were fully cooperative for postoperative care in the experimental group. Whereas in the control group, 90% of the clients shows severe anxiety and were noncooperative. Conclusions: Early ambulation is very effective in reducing postoperative anxiety, thereby the patient was very cooperative for care. Therefore, nurses can teach the importance of early ambulation to patients with laparatomy surgeries

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Context: Because family members of cardiac surgery patients play a significant role in the patient's recovery, it is important to address their needs during hospitalization and after discharge. Aims: We aimed to investigate the impact of family support program on depression, anxiety, stress, and satisfaction in the open-heart surgery patients' family members. Setting and Design: This is a randomized clinical trial with two intervention and control groups. The study was conducted at the Teaching Hospital Heart Center in Sari, Iran. Materials and Methods: Ninety family members participated in this randomized controlled study, who were divided into an intervention group receiving support program from a research team and a control group receiving routine care. Statistical Analysis: In this study, Shapiro–Wilk, Mann–Whitney U, Friedman, and Chi-square test were used. Results: The family members in both groups had significantly lower depression, stress, and anxiety at 24 h before and 14 days after discharge. The total score of depression, stress, and anxiety statistically significantly improved in the intervention group compared to the control group. However, their satisfaction of nursing care increased (P < 0.001). Conclusions: This study () revealed that significant effects with regard to reduced feelings of depression, stress, and anxiety also improved the family members' satisfaction in the intervention group.

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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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