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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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: Communicating with intubated patients is one of the main challenges for nurses. Aims: This study aimed to evaluate the effect of education on function and communication skills of nurses with intubated patients. Setting and Design: This quasi-experimental study with pretest–posttest design was carried out. Statistical Analysis Used: The data analyzed using Mann–Whitney test Wilcoxon, and Spearman's correlation coefficient at significance level less than 0.05 and study power of 80%. Material and Methods: The research instruments were the nurse–patient relationship checklist and communication skill questionnaire. Results: The mean ± standard deviation of communication function and verbal and nonverbal skills of nurses showed a significant difference (P = 0.039 andP < 0.001). Conclusions: The training of communication skills with intubated patients to the nurses improves their function and communication skills.

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Pregnancy and postpartum period may be accompanied with maternal anxiety and depression, each of which causes unfavorable outcomes in the mother and the infant. The maternal–fetal/neonatal interaction called attachment may influence these mental states. The present research has been performed with the goal to review the effect of maternal–fetal/neonatal attachment on perinatal anxiety and depression. This narrative review study has been done on the interventional studies in Persian and English published in 2006–2018 through searching the databases such as Google Scholar, Science Direct, Magiran, PubMed, Scientific Information Database, and Scopus and the keywords, such as anxiety, depression, and maternal–fetal/neonatal attachment. At the end, 14 articles have been included in the study. The findings have been organized into two categories: maternal–fetal attachment (10 papers) including three categories such as (1) paying attention to the fetus made up of two subcategories as relationship with the fetus and mental imagery, (2) awareness raising, and (3) relaxation techniques covering three subcategories as relaxation, exercise, and music and maternal–neonatal attachment (4 papers) including two categories such as (1) physical touch with infant and (2) pregnancy period training. Maternal–fetal/ neonatal attachment increase using various interventions can reduce pregnancy- and postpartum-induced anxiety and depression. Although regarding the mutual attachment and physiological health relationship, it is not possible to state which of these two variables get improved initially by the interventions and finally the expected result, i.e., the above factors' improvement is achieved. Thus, training attachment enhancement techniques to pregnant women's care providers are recommended.

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Context: E-learning is one of the most important and favorable topics in the scientific society, which attempts to facilitate the complexity aspects of human beings' learning. Aims: This research aimed to investigate the mediating role of emotional well-being on the effect of metacognitive learning and self-directed learning on e-learning level in universities' managers. Settings and Design: The present study was a cross-sectional research. Material and Methods: The research methodology was descriptive-correlational and in particular structural. The statistical population of this research was 478 university managers (including medical sciences and marine sciences in Islamic Azad University) in Mazandaran province in 2019, and 260 individuals were selected as the sample size in an available method. Pintridge and DeGrott Metacognitive Learning Strategies Scale (1990), Cheng's Self-Directed Learning Scale (2007), Watkins et al.'s E-learning Scale, and Keyes' Emotional Well-Being Scale (2003) were used. Statistical Analysis Used: The collected data were analyzed using structural regression equations by SPSS 18 and Amos 23 software. Results: The findings showed that the research model is fitted and 63% of the e-learning variables could be explained by metacognitive learning, self-directed learning, and emotional well-being (P ≤ 0.001). Furthermore, emotional well-being had a mediating role in the effect of metacognitive learning and self-directed learning on the level of e-learning (P ≤ 0.001). Conclusions: The results of this research can provide practical implications for improving psychological status, emphasizing the mediating role of emotional well-being on the impact of metacognitive learning and self-directed learning on e-learning level in universities' managers.

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Context: Cyberspace covers many aspects of humans' life, and the tendency to cyberspace can be influenced by cognitive and emotional aspects. Aims: The purpose of the present study was to investigate the mediating role of emotional processing in relation to self-efficacy on tendency to virtual networks in gifted students. Settings and Design: The present study was a correlational research with structural equation modeling. Materials and Methods: The statistical population of the present study was all 300 gifted students of Sampad High School in the 11^th course of experimental field in the academic year of 2019 in Gorgan city, 300 students of which were selected as samples through census method and evaluated by virtual network questionnaire of Mojardi et al., emotional processing questionnaire of Baker et al., and self-efficacy questionnaire of Sherer et al. (1982). Statistical Analysis Used: The collected data were analyzed using structural regression equations using SPSS 18 and Amos 23 software. Results: The results showed that there is a significant negative relationship between self-efficacy and emotional processing with the tendency to virtual networks (P ≤ 0.01). Self-efficacy (β = −0.267, P ≤ 0.002) and emotional processing (β = −0.221, P ≤ 0.000) had a significant negative effect on tendency toward cyberspace. The research model was fitted and confirmed and 0.38 of the variance of tendency to virtual networks was explained by self-efficacy and emotional processing, and emotional processing had a mediating role in the relationship self-efficacy with tendency to virtual networks. Conclusions: Changes in tendency to cyberspace can be explained directly based on self-efficacy and indirectly based on emotional processing in gifted students, and this study has practical implications for school counselors.

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Context: The lengthy process of treatment in burns units requires the patient to be hospitalized in the intensive care unit (ICU) for a few days up to several months. Aims: The present study was conducted to investigate the effect of planned family presence at the patient's bedside in BICU on the family's anxiety. Setting and Design: The present randomized controlled clinical trial was conducted on the family members of patients hospitalized in the BICU in Sari from March to May 2016. Materials and Methods: Selected through nonrandom sampling and randomly divided into a control and an intervention group (n = 30 per group). In the intervention group, one patient family member visited the patient for an hour each day from the 4^th to the 8^th day of admission. The control group received only the routine services of the unit, which meant keeping out all family members from the BICU. Statistical Analysis Used: The Spielberger State-Trait Anxiety questionnaire was filled out in both groups on days 3 and 8 after the intervention. The data analysis were performed using SPSS version 21 (IBM). Results: Comparing the means of the two groups after the intervention using the independent t-test showed a statistically significant difference (t = 1.51,P < 0.001). Conclusion: The regular planned presence of family members at the patient's bedside in the BICU can effectively reduce anxiety in the family members and thus improve the care procedure.

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Context: It is thought that social support plays a key role in ensuring adjustment for women as a result of failed infertility treatment. Social support and infertility issues are discussed in the literature. However, a relationship between infertility treatment failure and adjustment to infertility was not detected in studies. Aims: The purpose of this study was to examine the relationships between the perceived social support and adjustment to infertility in women with unsuccessful infertility treatments. Settings and Design: This was a cross-sectional, descriptive-analytic study performed in a university hospital in Eastern Turkey between September 2016 and September 2017. Materials and Methods: The study participants consisted of primary infertile women admitted to the clinic with at least one failed treatment experience. Two hundred and six infertile women were included in the research sample by convenience method. A demographic data form, the Multidimensional Scale of Perceived Social Support, and the Fertility Adjustment Scale were used. Statistical Analysis Used: Data were analyzed using in descriptive statistics (mean, standard deviation, and frequency). The Pearson's correlation was used andP < 0.05 was considered to be statistically significant. Results: There was a significant positive correlation between the perceived social support from family, friends, and significant others and adjustment to infertility (r = 0.17,P < 0.05; r = 0.35,P < 0.01; and r = 0.23,P < 0.01, respectively). Conclusions: There was a significant positive correlation between the adjustment to infertility and perceived social support from the family, friends, and the special someone of the women undergoing failed infertility treatments.

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Context: Pain management is one of the main clinical challenges that health-care jobs encounter with it. The nurses play a pivotal role in providing pediatric pain management. Aims: This study was conducted to determine nurses' strategies for managing pain in pediatric units in Iran. Settings and Design: This qualitative study was conducted with a content analysis approach at one teaching hospital in Amirkola Children's Hospital in Babol, Iran. Materials and Methods: Data were collected from 16 nurses, using semi-structured interviews during the year 2015–2016. The inclusion criteria were the nurses with at least 3 years of work experience in children's departments. Sampling was purposeful with maximum variation. Immediately after each interview and recording, the content was transcribed using Word software. Interviews were individually conducted in the hospital nurses restroom. Statistical Analysis Used: Data analyzed by conventional content analysis method simultaneously data collection based on five steps of Granheim and Lundman. To ensure the accuracy and reliability of data were used according to Lincoln and Guba's criteria. Results: The data analysis showed that the main them was nurses' undeveloped clinical judgment. The contents included sixth subthemes such as “incomplete investigation of the presence and severity of real pain,” “priority to pain pharmacological actions,” “inadequate understanding of nurse to the time and lack of analgesics,” “nurse's inadequate attention to the conditions of the use of nonpharmacological and pharmacological interventions,” “inappropriate assignment of nonpharmacological pain to the mother,” and “incomplete evaluation and record of pain relief.” Conclusions: Nurses use the strategy of underdeveloped clinical judgment to manage pain in pediatric units. Due to this determined fact, it is necessary to design a practical model for improving the clinical judgment of nurses in pediatric pain management.

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Context: One of the main factors associated with the death of chronic renal failure patients is dialysis adequacy. Aims: The present study aimed to investigate the relationship between filter type and blood flow rate with dialysis adequacy in hemodialysis patients referring to educational hospitals of Mazandaran University of Medical Sciences in 2016. Setting and Design: This correlational study was performed in 2016 in educational hospitals of Mazandaran University of Medical Sciences. Materials and Methods: This study was performed on 185 hemodialysis patients. Sampling was done using simple random sampling. The inclusion criteria included at least 6 months of hemodialysis history and two sessions of dialysis per week. Demographic data, as well as information on the filter type and blood flow rate, were collected using a questionnaire. Dialysis adequacy is generally measurable by two methods of urea reduction ratio (URR) and K or urea clearance, T or time of dialysis, and V, or volume of urea distribution in the body (KT/V) (K or urea clearance). Statistical Analysis Used: Data were described with mean, standard deviation, and frequency and analyzed using Chi-square and Fisher's exact tests. Results: Out of a total of 185 patients, 101 patients were male and 84 were female, with a mean age of 57.2 ± 0.7 years. The dialysis adequacy in high-flux and low-flux filters was, respectively, 79% and 1.5% based on the KT/V index and 70.6% and 0% according to the URR index. A statistically significant relationship was found between the filter type and blood flow rate with both KT/V and URR criteria (P < 0.001). Conclusion: It is recommended to use high-flux filters with high blood flow rate to improve dialysis adequacy in patients with hemodialysis. However, other factors affecting dialysis adequacy should be considered.

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