Journal of Holistic Nursing and Midwifery
Volume:28 Issue: 1, Winter 2017

Road accidents are a major cause of health problems in the world, and lifestyle stress is one of the most important factors in the occurrence of these events.
The aim of this study was to determine the association between life stress and road accidents.
A case-control study was conducted in Hamadan in 2013. The sampling method was carried out in two stages: the first stage involved simple randomization, and the second stage was convenient sampling. The sample size consisted of 103 people who referred to the car accident insurance centers (case group: regarding road accidents), and 206 people who referred to the police stations (control group: no accident). The measurement tool was a two-part self-reporting questionnaire that included information regarding demographic and lifestyle stress. The data was analyzed by the Chi-square test and Logistic regression based on age and sex. The significance level of all the tests was considered as less than 0.05.
The results indicated that life stresses (financial problems, family arguments, occupational problems, and night shifts), and stresses during driving (retaliatory or angry reactions during driving, fear of possible damage during driving, and poor road conditions) have a significant difference between the two groups (p = 0.05), such that the odds of road accidents caused by lifestyle stress in the case group was about three times more than the control group (P = 0.001, OR = 2.958, 95% CI = 1.66–5.26).
The results of this study demonstrated the role of lifestyle stress as a contributing factor to road accidents; so, it can be concluded that reducing the level of these stresses may prevent such accidents.

Patient training can be effective in preventing and controlling disease complications. Providing patient and family trainings is particularly important for improving compliance with a treatment diet.
The present study aimed at “determining the effect of two training methods (family-centered and patient-centered) on the frequency of hospitalization and clinical symptoms of patients after acute myocardial infarction”.
This clinical trial was performed in the Heart Care Unit of one of the hospitals in Arak, Iran between October and March 2014. Here, 60 patients who had experienced their first heart attack were randomly selected and divided into two groups: patient training and family training. Thereafter, for the intervention group, each patient was trained with an active member of the family through a computer in three fields of food, medicine, motion in three sessions of 30-45 min, and in the control group the same training content was given only to the patient (without the family). At the time of discharge, the checklist of patient's clinical symptoms and the number of re-admittance was given to patients to be marked if they occurred. Three months after the intervention, the incidence of clinical symptoms and re-admission in the two groups were compared and evaluated. Finally, data was analyzed using Chi-square and independent t-test.
The two groups were significantly different in terms of demographic characteristics including age, gender, history of smoking and alcohol, occupation, familial history of cardiovascular disease, education, sport, and underlying diseases. The findings showed that the frequency of clinical symptoms including chest pain (P = 0.0001), Exertional dyspnea (P = 0.004), Orthopnea (P = 0.033), Paroxysmal Nocturnal Dyspnea (P = 0.03), Heart palpitations (P = 0.015) and the frequency of re-admittance (P = 0.015) were significantly lower in the family-based training group than patient-centered.
According to the results of this study, implementation of training programs with the presence of families plays an important role in following the plan, subsequently improving the treatment outcomes and reducing the cost of treatment for patients. Therefore, it is recommended that family-centered training interventions be conducted.

not following safety tips during mobile radiography can bring about risks for nurses in ICU wards.
the study aimed to determine the status of personal protection against radiation and its associated factors in nurses working in ICU wards of health care-educational centers affiliated with Guilan University of Medical Sciences in Rasht, Iran.
in this cross-sectional analytical study, the knowledge and performance of 142 nurses in ICU wards were examined in terms of personal protection against radiation as well as the protective equipment and facilities available through census. The data collection instruments included a research-made questionnaire and checklist. The questionnaire consisted of two sections: the first dealt with personal-occupational information, while the second section included 11 four-option questions related to knowledge about protection against radiation. For data analysis, descriptive and inferential statistical indices (mean, standard deviation, Mann-Whitney, Kruskal-Wallis, and logistic regression) were used.
the findings indicated that 64.1% of samples were women, 62.7% were married, and 90.1% had bachelor’s degree. Considering employment status, 52.1% were permanent employed, while 86.6% were in turn taking nurses. A total of 41.5% of samples had a working background of less than 5 years, and 97.9% of them had not participated in any course for protection against radiation. The results also indicated that most samples (62.7%) had poor knowledge about personal protection against radiation, and only 37.3% of samples had medium knowledge, and finally none of them had favorable level of knowledge. None of the ICU wards were equipped with necessary and sufficient equipment, among which only lead divider was sufficiently available in all wards. Regarding the protective performance of samples, the results showed that 100% of samples had a poor performance. There was a significant relationship between the knowledge of protection against radiation and gender (P=0.01), being married (P=0.041), and education (P=0.016). A significant relationship was also observed between the protective performance of samples and gender (P=0.011), training method (P=0.006), and age (P=0.005).
Considering the poor knowledge of the studied samples and inadequacy of equipment regarding protection against radiation, and in response to poor performance, training nurses and equipping the ICU wards seem to be essential.

The experiences of learners in the educational system are not just limited to the overt curriculum. Other factors also play a significant role in shaping student learning in the form of hidden curriculum. Students’ views on this issue can help design a suitable curriculum.
The purpose of this study was to determine the viewpoint of nursing students about the hidden curriculum on learning.
This is a descriptive-analytic cross-sectional study. The sample size of this study comprised 300 nursing students of the Guilan University of Medical Sciences’ Faculty of Nursing (students of the 2nd to the 8th semesters) who were selected using the random sampling method. The research instrument included a researcher-made questionnaire consisting of two parts of the socio-demographic characteristics and 34 statements about students’ views regarding the effect of hidden curriculum on learning. Data analysis was performed using descriptive statistics and the binomial test.
The results of this study on the effect of the hidden curriculum on learning showed that the subjects agreed on the impact of the program in 25 statements (P=0.038) and selected disagreement options only in nine statements. According to responses of the research subjects, the reasons why the hidden curriculum was effective on learning based on students’ viewpoints are: Good student-professor relationship (88%), a chance to interact with experienced professors (82%), student humiliation (80%), equipping classes with up-to-date electronic teaching aids (80%) and attention to the peer group as a model of behavior (53%).
The findings of this study confirm the profound effect of the hidden curriculum on learning. Considering the importance of the formal curriculum, more attention to the hidden curriculum can boost knowledge among students.

Aggression is a major trait that occurs in adolescence. Family is the first institution in which a person joins, therefore family functioning is a significant factors in the development of aggressive behaviors in adolescents.
The aim of this study was to determine the relationship between family functioning and aggression in students aged 14-18 years in Rasht.
The present research is a cross-sectional analytical study. The research population consisted of 500 students aged between 14 and 18 years, studying in the first to the third grade of high school in public and non-public schools in Districts 1 and 2 of Rasht, who were selected using random cluster sampling. Data were collected using demographic questionnaires, the Buss–Perry Aggression Questionnaire, Family Assessment Device (FAD) Scale, and analyzed by descriptive and inferential statistics including Kruskal Wallis, Mann Whitney, and Spearman correlation test.
The results showed that there was a significant relationship between family functioning score and total aggression score (P= 0.0001). There was also a significant relationship between aggression and role, control of behavior, emotional response and emotional involvement (P= 0.001) as well as communication dimensions (P= 0.05). Also, there was a significant relationship between aggression and having a separate room (P= 0.011), father's education (P= 0/007), father's occupation (p = 0.04), and family income status (p = 0.041).
The findings of this research showed that children of families functioning appropriately are more likely to develop aggression than those in families functioning properly.

Ministry of Health and Family Welfare of India is constantly Functioning to provide optimum health care to achieve Sustainable Development Goals (SDGs) by updating health infrastructure.
To study the readiness and challenges of peripheral health facilities regarding skilled health workforce to provide Emergency Obstetric Care (EmOC).
A descriptive phenomenological type of qualitative research study was done in all peripheral health facilities (seven) in Deoli block of Wardha District (Maharashtra, India) from February-July 2014. Key informant interviews of Emergency Obstetric Care (EmOC) service providers at different level (facility, block and district level) were conducted by using stratified purposive sampling, to obtain their perspective regarding facility preparedness for health workforce in terms of their availability and skilfulness (training) and barriers if any to provide EmOC. Written informed consent of participants to conduct and audio recording of interview session was obtained. Thematic analysis of data was done where in appropriate, significant and evocative remarks from service providers were used for analysis. Themes that were emerged out after discussion with all providers (participants) were presented. Comments were presented in text form with quotes to highlight the study findings whenever appropriate.
Service providers shared key concern about medical officers who have recently completed graduation and recruited for one-year bonded service but mostly desire for further education and show minimal involvement in service. Trained contractual Medical Officers left over service after completion of bond. Usually single Medical Officer remains available in most of the Primary Health Center (PHCs). Stakeholders discussed the difficulties about retention of specialist in rural hospital. Insufficient trainers and training pattern are significant challenges; suggested to shift from theoretical to practical skill and trainees’ selection for improving outcome.
Contractual staff is the current option to address health workforce issue. After building up capacity of such staff, their consistent availability is challenging for district stakeholders too. Training for EmOC was provided at the district level, but to develop practical skill among trainees more hands on practice was essential. This requires significant policy level interventions.

Workplace violence is one of the problems faced by health care workers. Pre-hospital emergency staff is exposed to workplace violence, according to their working conditions. Understanding the nature of workplace violence plays a fundamental role in its prevention and management.
This study was conducted to determine the frequency of workplace physical violence against pre-hospital emergency staff and its relationship with some demographic variables.
This descriptive analytical cross-sectional study was performed on 130 pre-hospital emergency medical staff, selected on the basis of random sampling in the Guilan province in 2014, using a standard questionnaire on violence against health care staff, developed by the International Labour Organization, the Nursing High Council, the World Health Organization, and the International Public Service in 2002. The data analysis was performed using descriptive statistics, Chi-square and Fisher exact tests, as well as Logistic regression.
The results showed that 34.51% of the subjects experienced physical violence in the past year. The findings also showed that there was a significant relationship between the incidence of physical violence and marital (p = 0.008), age (p = 0.04), and higher work experience variables (p = 0.04).
There is a prevalent workplace physical violence against pre-hospital emergency staff, causing individual and organizational complications. This issue should be addressed by emergency managers and preventive measures should be taken to improve the safety of the staff and the productivity of the organization.

Looking at the role of midwives and the need to invest in this profession in order to achieve development objectives.
The aim of this study is to review the characteristics of midwifery care presentation models in the world as well as in Iran and investigate its challenges in the country.
Materials and This study is a review done in 2016. First, all papers published in Persian and English until 2016 were searched in online databases . Overall, 20 English papers, one Persian paper, and several related websites were used for accurate explanation, interpretation, and search of every care model. During investigation of papers, emphasis had been placed on introduction, results, and discuss ion of the characteristics of midwifery care models. The challenges relating to the design and application of these care models in Iran have been discussed and some solutions have been offered.
Although there are various definitions about Models of midwifery care , the boundary between midwifery care models and care models in which midwives are present is clear. Today, midwifery care is going through a transfor mation and redefinition process there has been changes in response to women’s needs to he lp the development of the midwifery profession. Midwifery - led care models have various advantages for mothers and babies; they bring about a high level of satisfaction among pregnant women, reduction of undesirable outcome for mothers and babies, and empow erment of women.
The prerequisite for promotion of mothers and babies’ health is giving women the rights to informed choose for choice of child birth and delivery methods . So, design and implementation of midwifery care models must correspond with the culture, beliefs, and knowledge native to each region and with constant protection of security and cultural safety of mothers during childbirth.

Pregnant women are highly vulnerable to air pollution, which has a significant impact on the health of the pregnant women and their fetus.
The present study aimed at determining the factors affecting the behavior of pregnant women in Arak, Iran toward avoiding exposure to polluted air.
In this analytic cross-sectional study, 208 pregnant women who were referred to health centers in Arak city were selected using multistage random sampling method. The data was collected by a researcher-made questionnaire, completed after determining its validity and reliability. This questionnaire included demographic characteristics of the mother, knowledge and the behavior of some of the mothers toward avoiding exposure to polluted air, and was scored on 100 points. Data were analyzed using Pearson and Spearman correlation coefficients, one-way analysis of variance (ANOVA) and T-test.
The mean age of mothers was 26.48 ± 4.77 years, mean gestational age was 14.88 ± 5.9 weeks, and mean knowledge score was 40.56 ± 16.91. There was a positive and significant correlation between knowledge and mother’s age (r = 0.279), husband’s age (r = 0.222), and number of smokers in the family (r = 0.178) and a negative and significant correlation with gestational age (r = -0.168) (p = 0.05). Also, there was a significant association between educational level of mother and husband, husband’s job and income with knowledge and behavior (p = 0.05).
According to the results of this study, mothers’ knowledge was less than average. It is thus suggested to develop and implement educational programs for pregnant women advanced in age and during the end of pregnancy to improve their behavior toward avoiding polluted air.

Family-centered education of patients with diabetes mellitus can play an important role in controlling the disease and reducing its complications.
The present study aims to determine the effect of family-based telephone follow-up about self-care in patients with type 2 diabetes mellitus in Uromia.
The present clinical trial study investigated 60 patients with diabetes. These 60 patients were randomly enrolled and divided into control (n = 30) and intervention (n = 30) groups. The intervention group received family-centered follow-up for three months. The data collection tool was demographic, the diabetes self-care questionnaire was completed through in-person interviews before and after intervention in both groups. Data were analyzed using descriptive and inferential statistics (Chi-square, T-test, and Mann-Whitney test).
The results of this study showed that after the family-based telephone follow-up, the mean self-care scores and the dimensions (nutrition, physical activity, blood glucose control, foot care, and self-care) were significantly different between the intervention and control groups (P = 0.001). However, there was no significant difference between the mean scores of adherence to the medication regimen after the intervention between the two groups.
Family-oriented follow-up by a nurse can have important effects on self-care and its dimensions (nutrition, physical activity, blood glucose control, and foot care) in patients with diabetes. Therefore, it is recommended that nurses follow up and educate the family members of patients to participate in diabetes care.