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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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: 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: The most common opportunistic infection among Human Immunodeficiency Virus (HIV) reactive patients is tuberculosis (TB). TB has an impact on the prognosis of the disease. However, developing countries have not paid much attention to the problem. Aims: The study was conducted with the aim of determining the level of TB/HIV co-infection and associated factors. Setting and Design: A cross sectional study design was used in Wolaita Sodo Teaching and Referral Hospital from March 15 to May 15, 2017. Materials and Methods: Three hundred and seventy three patients were selected using simple random sampling. Statistical Analysis Used: Frequencies and proportions were computed. Logistic regressions were carried out and associations were considered statistically significant at P < 0.05. Results: The study revealed that 17.4% of the patients were co-infected with HIV and TB. Educational status (adjusted odds ratio [AOR] =0.472 and 95% confidence interval [CI] =0.253, 0.883), drug dependency (AOR = 2.366 and 95% CI = 1.129, 4.957), World Health Organization stage (AOR = 3.031 and 95% CI = 1.326, 6.930), and baseline CD4 (AOR = 0.351 and 95% CI = 0.153, 0.803) were predictors of the TB/HIV co-infection. Conclusion: Educational status, drug dependency, WHO clinical stage, and baseline CD4 count were found as significant predictors of co-infection. Therefore, health education about the lifestyle modification, counseling, and close monitoring of pharmacological therapy adherence is recommended.

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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: 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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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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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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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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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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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: 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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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: 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: 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: 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: 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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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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Context: Despite the emphasis on the preconception care, the majority of people are not aware of how environmental and lifestyle factors influence reproductive and fetal health. Aims: The objective of this study was to determine knowledge and attitude of women in reproductive age about preconception health in the context of free and universal access to preconception health care. Setting and Design: A cross-sectional study in public health centers. Materials and Methods: This study was performed using a convenient sample of 400 women presenting to public health centers in Abhar, Iran. Knowledge and attitude were assessed using researcher-made questionnaire. Questionnaire went through validity and reliability process. Statistical Analysis Used: Data were analyzed using SPSS version 19. The knowledge and attitude scores among subgroups according to demographic characteristics were studied using ANOVA test. Results: Over two third (68.8%) of women had adequate knowledge about preconception care. Sixty nine percent had positive attitude towards preconception care. Education and age were significantly associated with knowledge and attitude. Conclusion: Despite the relatively high level of knowledge, nearly half of the women perceived preconception health optimization as difficult that may lead to not engaging in preconception health behaviors. The younger women and those with fewer years of education should be focus of preconception health program.

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Context: Considering the psychological component of multiple sclerosis (MS) in intervention could play a key role in patient compliance with their physical condition. Aims: This study examines the effectiveness of acceptance and commitment therapy (ACT) based on the fear of death in patients with MS. Setting and Design: The present study is a quasi-experimental study with a pretest, posttest, and control group. Material and Methods: The study population included 57 patients with MS who were members of MS association in North Khorasan Province, Shirvan city in 2016. Using the available sampling method, 30 samples were selected by random assignment and included in experimental and control groups (15 per group). The instrument used in this study was Templer fear of death questionnaire. The experimental group received eight sessions of therapeutic intervention. Statistical Analysis Used: Analytical and statistical analyzes are done by SPSS21.due to the nature of the plan and the two groups (control and test), the statistical method of analysis of covariance, and the effect size were used. Results: The results of covariance analysis showed that treatment based on acceptance and commitment has a significant effect on the fear of death in patients with MS (P < 0.001). In addition, the level of fear of death in the pretest stage was also significant on the fear of death in the posttest (P< 0.001). Conclusions: According to the results, it is expected that ACT maintains its effects in the long run with features such as: Encouraging people to live in the present moment, mindfulness, commitment to the pursuit of worthwhile goals, and an emphasis on process rather than the outcome.

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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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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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