Journal of Holistic Nursing and Midwifery
Volume:32 Issue: 4, Autumn 2022

Due to stressful work conditions, nurses are constantly exposed to various emotions and stressors such as anger and moral distress that threaten their mental health. On the other hand, self-esteem is one of the personality traits essential for people's mental health and improving their performance.

The present study investigates the relationship between anger, moral distress, and self-esteem in nurses.

This analytical correlational study was conducted on nurses working in the hospitals affiliated with the non-profit organization of Mazandaran Social Security Insurance from August to November 2018. Two hundred nurses were selected for this study via stratified random sampling. The study data were collected using the Cooper-Smith self-esteem inventory, Hamric moral distress scale, and state-trait anger expression inventory. The collected data were analyzed using the Mann-Whitney and Kruskal-Wallis tests, and path analysis was used for testing the conceptual model. 

The mean±SD age of the nurses was 36.24±5.37 years. The mean ±SD anger, self-esteem, and moral distress scores were 113.68 ± 15.04, 26.61 ± 3.49, and 65.66 ± 35.88, respectively. The results of the path analysis model suggested an inverse causal relationship between self-esteem and moral distress (P<0.05). This model also indicated a significant inverse relationship between self-esteem and anger (P=0.01).

As the results show, the nurses' self-esteem can mitigate the adverse effects of moral distress and anger. These results show the significant psychological interventions in controlling anger and promoting self-esteem and reducing moral distress among nurses.

Distress is the most perceived behavioral state manifested by pregnant women and can directly or indirectly increase the risk of experiencing prenatal complications.

The present study was conducted to determine the effectiveness of the Adlerian group counseling approach on a mother's distress and self-care during pregnancy.

This randomized controlled trial was conducted on 79 eligible pregnant women referred to seven community health centers in Karaj City, Iran, from March 2018 to December 2019. The eligible women were assigned to the intervention (n=40) and control (n=39) groups using the block randomization method. The intervention group (gestational age of 22-32 weeks) received the Adlerian group counseling approach, while the control group received routine individual counseling. The study data were collected using the quality of prenatal self-care questionnaire and prenatal distress questionnaire at three time points; baseline, after, and one month after the intervention or routine counseling. The study data were analyzed by the Chi-squared test, Fisher exact test, and independent t test, as well as repeated measures analysis of variance.

The mean ± SD ages of the intervention and the control groups were 23.39±2.85 and  23.39±2.85 years, respectively. After the intervention, the results of repeated measures analysis of variance showed a statistically significant difference between the intervention and control groups regarding the changes in the mean scores of prenatal distresses (P=0.0001) and four domains (physical health, behavioral assessment, healthy relationships, and social health) of self-care (P=0.0001). 

The Adlerian group counseling approach effectively improved prenatal distress and self-care during pregnancy.

Social capital has potential effects on reproductive health and childbearing behaviors. However, there is limited information about its relationship with childbearing.

This study aimed to explore female healthcare providers' experiences of childbearing based on the social capital theory.

This qualitative study was conducted from July 2018 to February 2019 on 15 female healthcare workers in healthcare centers in Babol City, Iran. The participants were purposively recruited with maximum variation respecting their age, work experience, educational level, and occupation. The study data were collected through 15 semi-structured interviews and analyzed using directed qualitative content analysis.

The participants were female healthcare providers working in hospitals or healthcare centers of the University of Medical Science. Their mean±SD age and work experience were 35±8.25 and 10±7.5 years, respectively. The extracted codes during data analysis were grouped into three predetermined main categories, namely structural social capital (social learning and conformation to social norms), cognitive social capital (social beliefs and values with three subcategories, namely religious beliefs, gender preference, and social stigma), and relational social capital (support and trust). The most critical factors affecting participants' childbearing behaviors were trust in their support systems and conformation to social norms.

The different dimensions of social capital can affect childbearing behaviors. Therefore, social capital should be considered when designing population and reproductive health policies.

Research has shown that many pregnant women in Iran do not exercise during pregnancy. However, exercise, especially endurance exercise during pregnancy, is associated with good maternal and fetal outcomes.

The study aimed to examine the effect of squat exercises on fatigue and the life quality of pregnant women admitted to health centers in Hamadan City, Iran.

The study was a randomized controlled clinical trial conducted from September 2019 to February 2020 on 100 pregnant women in two groups of 50 each. The pregnant women were randomly using blocks of four divided into two groups according to the inclusion criteria. The samples filled out the fatigue questionnaire multidimensional symptoms fatigue inventory-short form (MSFI-SF) and SF-36 life quality questionnaire at the beginning of the study. Eight group sports sessions were held for women in the intervention group, and routine care was administered to the control group. The obtained data were analyzed using the independent t test, Mann-Whitney U test, Chi-square test, and analysis of covariance (ANCOVA) at a significance level of 0.05.

The mean ± SD age of participants was 28.24 ± 5.39 years in the intervention group and 27.78 ± 5.58 years in the control group. The mean scores of fatigue and life quality in all dimensions in the post-intervention stage (after adjusting for before-the-intervention scores, income, and housing status) were significantly different between the study groups. The mean fatigue score in the intervention group was lower, and the quality of life was better (P=0.001) than in the control group. The effect size of different domains of quality of life varied from 1.51 (energy fatigue) to 3.50 (physical function). The effect size of fatigue was 2.81 (95%CI: 3.36- 2.25, P=0.001).

Based on the results, squat exercises are recommended to reduce fatigue and increase the life quality of pregnant women in health centers.

The use of medicinal plants (MP) is increasing among the general population and patients with cardiovascular diseases (CVD). Simultaneous use of MP and cardiac medications can cause drug interactions and serious complications.

This study aimed to determine the frequency of MP use and its related factors among patients with CVD.

This cross-sectional study was conducted on 200 patients with CVD in 2018. The patients were consecutively recruited from the cardiac care clinic in an Educational and Medical Center in Kashan City, Iran. The study data were collected using an MP use questionnaire, the related factors of the MP use questionnaire, and the belief and attitudes about herbal medicine inventory. For data analysis, the logistic regression analysis was performed.

The mean ± SD age of the participants was 56.91±10.64 years. Their mean ± SD time passed from CVD diagnosis was 8.30±9.07 years. The frequency of MP use over the past year was 90.5% (95% CI; 86.4%–94.6%). The significant related factors of MP use were female gender (OR = 4.80, 95% CI; 1.43–16.1, P = 0.011), positive family history of MP use (OR = 8.84, 95% CI; 2.62–29.86, P = 0.0001), and knowledge about herbal medicine (OR = 1.93, 95% CI; 1.13–3.30, P = 0.017).

MP use is highly prevalent among patients with CVD. MP-related counseling services should be provided to patients with CVD.

The negative experience of childbirth has many consequences for the mother and the baby. This study analyzed the relationship of childbirth experience with mother-infant bonding and the child's growth and development.

In this cross-sectional study, the participants were 216 eligible women selected from all health centers in Zanjan City, Iran (36 health centers), using the census method. Data collection tools were as follows: childbirth experience questionnaire 2.0, postpartum bonding questionnaire, anthropometric indices checklist, and developmental age and stages questionnaire. The Pearson correlation test was used to determine the relationship of variables in univariate analysis, and a general linear model was used in the multivariate analysis.

The mean ± SD of the participants was 29.0 ± 5.7 years. Less than half of the studied women (40.3%) had a diploma, and most wanted pregnancy (94.9%). The mean ± SD scores of the childbirth experience and postpartum bondings were 2.6 ± 0.5 (score range: 1-4) and 6.6 ± 2.7 (score range: 0-125), respectively. Regarding child development, the highest mean score was in the domain of problem-solving (56.8 ± 5.7), and the lowest was in the domain of communication (50.1 ± 8.3). The results of the Pearson correlation test showed that the childbirth experience had a significant inverse correlation with the mother-infant bonding (r = -0.23, P = 0.001) and a significant direct correlation with fine motions (r = 0.18, P = 0.007). The results of the general linear model after adjusting the socio-demographic and obstetrics characteristics showed that the postpartum bonding score was lower in women with a more positive childbirth experience, which was also an indication of a better bonding (B= -2.92, 95% CI; -4.85 to -0.98, P = 0.003). Besides, the fine motor score was higher in women with a positive childbirth experience (B= 3.11, 95% CI: 0.733-5.487, P = 0.011).

Considering the correlation between the variables of childbirth experience and mother-infant bonding and child development in the domain of ​​fine motor, health providers must do their best to create positive childbirth experiences for the women to improve the mother-infant bonding and child development domains.

The challenges and difficulties of working in intensive care units put pressure on healthcare professionals, especially nurses. To support nurses working in intensive care units (ICUs), developing supportive climates in organizations may drive nurses towards increasing work engagement levels and other related factors.

This study aimed to determine the relationship between organizational support and the work engagement of nurses working in ICUs.

This correlational cross-sectional study was conducted on 140 nurses working in two governmental hospitals in Amman City, Jordan, from January to August 2021. The participants were selected with a simple random sampling method, and study data were collected using a 3-part questionnaire: demographics, the survey of perceived organizational support scale with 8 items, and the Utrecht work engagement scale with 9 items. Descriptive statistics, the independent t test, the Spearman correlation test, and hierarchal multiple linear regression analysis were performed to determine the contribution of perceived organizational support on nurses' work engagement. The significance level for all tests was set to be less than 0.05.

About 53.6% of participants were male, 55% worked in medical-surgical intensive care units, and 45% were in cardiac care units. The results showed that the mean ± SD scores of perceived organizational support and work engagement were 29.53 ± 6.71 and 3.71 ± 0.88, respectively. Also, results showed no significant differences in perceived organizational support and work engagement based on nurses' socio-demographics or work-related factors. Finally, there was a significant positive weak correlation between perceived organizational support and work engagement (r= 0.23, P=0.002). The linear regression model showed that perceived organizational support could predict work engagement (R2 = 0.039).

Perceived organizational support among nurses working in ICUs is one of the important factors in increasing work engagement. Findings have several implications for nurses in different settings. Jordanian health policymakers must take action to improve nurses' perception of organizational support and consequently increase nurses' work engagement.

One of the contributing factors in ectopic pregnancy is genital infection. The self-treatment of genital infections is a common practice that results in infectious diseases, microbial resistance, and no patient recovery.

This study aimed to determine the relationship between the self-treatment of genital infection and ectopic pregnancy.

This case-control study was performed on 373 women in 2018. Samples included 180 normal pregnant women (the control group) and 193 women with ectopic pregnancies with histories of genital infections (the case group). The samples were selected by a convenient sampling method. The study data were collected by a researcher-made questionnaire containing demographic questions and 36 questions about self-treatment of genital infections, drug type, and reasons to use self-medication. Descriptive statistics, the Chi-square test, and the logistic regression model were used to analyze the obtained data.

In the present study, 373 eligible people were included. The mean ± SD age of women with ectopic pregnancies (the case group) was 33.37 ± 4 years and of women with normal pregnancy (the control group) was 33.21 ± 3.18 years. The frequency of ectopic pregnancy in women over 35 years was higher than that in women with normal pregnancies. The frequency of individuals who used self-medication to eliminate the vaginal infection in the control group and the case group were 76.7% and 48.9%, respectively.
The frequency of individuals who used traditional methods (washing the vagina with ice or baking soda was 64.39% with the highest percentage), and 115 women (35.6%) used chemical methods (vaginal douching with the highest percentage). Self-medication was independently associated with higher odds of ectopic pregnancy (OR = 2.227, 95%CI; 1.316-3.769, p= 0.003).

The results of this study show that self-medication for vaginal infections can be a risk factor for ectopic pregnancy. Therefore, the community should be educated to avoid the self-medication of genital infections.

Medication adherence plays an important role in preventing the worsening of cardiovascular disease. Some factors associated with medication adherence are still unknown.

This study aimed to determine the factors related to medication adherence in patients with coronary artery disease.

A cross-sectional analytical study was performed on 367 cardiovascular patients by consecutive sampling. The patients were referred to the specialized cardiology clinic in Rasht City, Iran, from January 2019 to June 2020. A data collection form and questionnaires of cardiac anxiety, anxiety depression and stress, and medication adherence were used. The obtained data were analyzed by the Chi-square test, Fisher exact test, Kolmogorov-Smirnov test, Mann-Whitney U test, and logistic regression model. The significance level was considered less than 0.05.

Most samples were men (61.85%). The mean ± SD age of the samples was 59.9 ± 10.9 years. About 20.7% had high adherence, and 78.75% had moderate adherence. Factors related to medication adherence included employment or being retired (OR=4.0, 95%CI; 1-16.6, P=0.054), income level (OR= 5.1, 95%CI; 1.6-16.6, P=0.007), supplemental insurance (OR= 0.217, 95%CI; 0.07-0.66, P=0.007), living alone (OR= 10.187, 95%CI;1.980-52.404, P=0.005), living with spouse and children (OR= 3.776, 95%CI; 1.580-9.023, P=0.054), history of hyperlipidemia (OR= 3.2, 95%CI; 1.2-8.4, P=0.019), history of stent implantation (OR= 2.9 95%CI; 1.2-7, P=0.016), depression (OR=0.74, 95%CI; 0.66-0.83, P=0.0001), anxiety (OR= 1.3, 95%CI; 1.1-1.4, P=0.0001), avoidance (OR=0.69, 95%CI; 0.56-0.86, P=0.0001), attention (OR= 1.5, 95%CI; 1.2-1.8, P=0.0001), and medication complexity (OR= 2.7, 95%CI; 1-6.8, P=0.04).

According to the identified related factors, it may be possible to decline anxiety and depression symptoms by improving the related factors and follow-up of care programs. As a result, cardiovascular patients are helped by preventing readmission, cardiac event, and mortality.