Iranian Journal Of Nursing and Midwifery Research
Volume:20 Issue: 6, Nov-Dec 2015

Qualitative research focuses on social world and provides the tools to study health phenomena from the perspective of those experiencing them. Identifying the problem, forming the question, and selecting an appropriate methodology and design are some of the initial challenges that researchers encounter in the early stages of any research project. These problems are particularly common for novices. This article describes the practical challenges of using qualitative inquiry in the field of health and the challenges of performing an interpretive research based on professional experience as a qualitative researcher and on available literature. One of the main topics discussed is the nature of qualitative research, its inherent challenges, and how to overcome them. Some of those highlighted here include: identification of the research problem, formation of the research question/aim, and selecting an appropriate methodology and research design, which are the main concerns of qualitative researchers and need to be handled properly. Insights from real‑life experiences in conducting qualitative research in health reveal these issues. The paper provides personal comments on the experiences of a researcher in conducting pure qualitative research in the field of health. It offers insights into the practical difficulties encountered when performing qualitative studies and offers solutions and alternatives applied by these authors, which may be of use to others.

Eating Disorder Symptoms are among the most common disorders in perinatal period and are influenced by various environmental and psychosocial factors such as anxiety disorders. So, the aim of this study was to determine the relationship between Eating Disorder symptoms and Obsessive Compulsive disorder in primigravida women. This cross‑sectional study was carried on 213 in primigravida women referring to Mashhad health care centers, selected through a two stage sampling method (cluster‑convenience) in Mashhad in 2013. Demographic and prenatal characteristics Questionnaire, Eating Disorder Examination Questionnaire (EDE‑Q)(26Q) and Maudsley Obsessive Compulsive Questionnaire (30Q) were completed by the subjects. The statistical analysis was performed with various statistical tests such as Pearson correlation coefficient, t‑test, one‑way ANOVA and linear regression. Significance level was considered as P < 0.05. Based on the findings 94.6% of the subjects had Obsessive Compulsive disorder, and 18% had Eating Disorder Symptoms. In addition, there was a poor positive correlation between the rate of Eating Disorder Symptoms and Obsessive Compulsive. There was a correlation between the Eating Disorder Symptoms and Obsessive Compulsive in pregnant women. It is recommended to eliminate or decrease Eating Disorder Symptoms and Obsessive Compulsive among Iranian pregnant women through preventive measures.

Midwifery profession is required to bring solutions to problems and a midwife is expected to be an assertive person and to develop midwifery care. This study was planned to examine the relationship between assertiveness and problem‑solving skills of midwives. This cross‑sectional study was conducted with 201 midwives between July 2008 and February 2009 in the city center of Sivas. The Rathus Assertiveness Schedule (RAS) and Problem Solving Inventory (PSI) were used to determine the level of assertiveness and problem‑solving skills of midwives. Statistical methods were used as mean, standard deviation, percentage, Student’s T, ANOVA and Tukey HSD, Kruskal Wallis, Fisher Exact, Pearson Correlation and Chi‑square tests and P < 0.05. The RAS mean scores and the PSI mean scores showed statistically significant differences in terms of a midwife’s considering herself as a member of the health team, expressing herself within the health care team, being able to say “no” when necessary, cooperating with her colleagues, taking part in problem‑solving skills training. A statistically significant negative correlation was found between the RAS and PSI scores.The RAS scores decreased while the problem‑solving scores increased (r: ‑0451, P < 0.01). There were significant statistical differences between assertiveness levels and problem solving skills of midwives, and midwives who were assertive solved their problems better than did others. Assertiveness and problem‑solving skills training will contribute to the success of the midwifery profession. Midwives able to solve problems, and display assertive behaviors will contribute to the development of midwifery profession.

Pregnancy may be accompanied by serious physiological and psychological changes as it is a stressful period in a woman’s life. So, this study was conducted to determine the effect of progressive muscle relaxation on pregnant women’s general health. In this clinical trial, 60 primigravida women admitted to the prenatal clinic of selected hospitals in Iran constituted the study population. Using purposive sampling method, the level of general health of the women was measured with General Health Questionnaire‑28 (GHQ‑28). Then, the samples were randomly divided into control and experimental groups. Three 1.5–2 h relaxation training sessions were held for the experimental group. After 8 weeks, the level of general health of both groups was measured again. Finally, the collected data were analyzed using Chi‑square and paired t‑test (P < 0.05). Total mean score of general health of the experimental group and the control group before the intervention was 35.83 (6.92) and 29.46 (8.3), respectively, and after the intervention, the respective scores were 20.2 (5.61) and 27.85 (8.24). Although after the intervention both groups showed an increased level of general health, the difference in general health between before and after intervention was significant in the experimental group (P < 0.001). Furthermore, comparison of variations in mean scores of general health level before and after intervention in the two groups showed a significant difference (P < 0.001). Given that the results showed the effectiveness of progressive muscle relaxation on pregnant women’s general health, the prenatal clinics can include a training program for progressive muscle relaxation in the routine training programs for pregnant women.

Labor is a stressful situation that may have an adverse impact. Aromatherapy is a method to control anxiety and stress of women. This study was conducted to investigate the effect of aromatherapy using essential oil of orange on women’s anxiety during labor. In this clinical trial study, 100 women during labor were randomly assigned to two groups: intervention group and control group. The women in the intervention group were exposed to orange essential oil, but the women in the control group were exposed to distilled water. The women’s anxiety was assessed using the Spielberger inventory. Moreover, physiological parameters such as systolic and diastolic blood pressure, respiration and pulse rates were assessed in all the women before and 20 min after the intervention. The data were analyzed by Chi‑square, Wilcoxon, paired t‑test, and Mann–Whitney U test. Data were evaluated with the SPSS 16 program. The significance level of P < 0.05 was considered. The level of anxiety of women in both intervention (P = 0.03) and control (P = 0.003) groups reduced after the intervention. However, the reduction was more in the intervention group (difference in anxiety scores after the intervention in comparison to before intervention = −3.08) in comparison to the control group (score = −1.14). No significant change was found in the physiological parameters of women in the intervention group after the intervention. Aromatherapy is a noninvasive and effective method to help women overcome their anxiety during labor. Orange scent can be useful in childbirth units to help women who are experiencing stress in labor.

Clinical competency is one of the most important requirements in nursing profession, based on which nurses are assessed. To obtain an effective and improved form of clinical competency, several factors are observed and monitored by the health educational systems. Among these observed factors, spiritual intelligence is considered as one of the most significant factors in nurses’ success and efficacy. In this study, it is aimed to determine the spiritual intelligence status and its relationship with clinical competency. The descriptive–correlational research was carried out on 250 nurses in Mashhad educational hospitals, selected by multi‑stage sampling. Demographic, clinical competency, and spiritual intelligence questionnaires were used for data collection and 212 questionnaires were analyzed. About 53.3% of nurses obtained above average scores in spiritual intelligence. Clinical competency was evaluated by both self‑evaluation and head nurse evaluation methods. Most nurses (53.8%) were having good level of clinical competency based on self‑evaluation, 48.2% were at average level based on head nurse evaluation, and 53.3% were at average level based on overall score. A significant correlation was found between spiritual intelligence and clinical competency. In this study, the positive significant correlation between nurses’ spiritual intelligence and their clinical competency is investigated. Because of the positive effects of spiritual intelligence on nurses’ clinical competency and quality of care, it is recommended to develop nurses’ spiritual intelligence during their education and by way of continuous medical education.

Non‑medical utilization of pre‑implantation genetic diagnosis (PGD), like sex selection, is increasing, therefore it is necessary to follow‑up the health and outcome of fertilization and newborn’s birth followed PGD. The aim of this study was to evaluate the outcome of fertilization after sex selection by PGD and the relation between the age of parents and the outcome of fertilization. This was a retrospective descriptive correlative study conducted on 218 couples in Isfahan. Samples were selected through convenience sampling. The rate of chemical and clinical pregnancy and abortion, the frequency of success in achieving the desired sex, and the mean of gestational age and weight of newborns were gathered through reviewing medical files and phone interviews. Data was analyzed using independent t test and Pearson correlation test. The rate of chemical and clinical pregnancy was 30.7% and 30.3% respectively, the rate of abortion was 26.9%, the frequency of success in achieving the desired sex was 100%, and the mean of gestational age and weight of newborns was 3260 (616) kg and 37.7 (2.07) weeks respectively. There was no significant relation between the age of parents and the rate of abortion, the rate of chemical and clinical pregnancy and newborn’s gestational weight. But there was a significant relation between the age of men and gestational age of newborns (P = 0.04). PGD method was 100% successful in achieving the desired sex, but relatively high rate of abortion could indicate the effect of PGD on the embryo development process.

During women lives, frequently face the challenge of calcium reduction and absorption. Decreased calcium absorption followed by a decrease in estrogen at premenopausal ages, low average per capita calcium intake among women, wrong nutritional behavior, and household income reductions and make them more susceptible to osteoporosis and related complications.The aim of this study was to evaluate the relationship between the health belief model constructs and consuming calcium‑rich foods in menopausal age women. This study was descriptive‑correlation study. The questionnaires were completed by 210 menopausal women who had referred to health centers. The research data were analyzed using: Frequency distribution, mean score, Pearson correlation coefficients and multivariate regression. Significant levels of P < 0/05 were considered. The mean and standard deviation of the scores for perceived susceptibility and severity of the threats of consumption and complications of inadequate intake were respectively: (62.1 and 38.9, and 60.2 and 39.9) and (59.6 and 37.9 and 56.3 and 36.5).The relationship between the number of units of calcium intake with perceived susceptibility and severity calcium intake and Complications caused by the inadequate intake of calcium were (P < 0.001, r = 0.581, r = 0.651) and (P < 0.001, r = 0.634, r = 0.567). The obtained results indicate that perceived threat is the prognostic factor for the intake of calcium‑rich foods and the increase of perceived threat in the health promotion programs may be associated with the increase in the consumption of calcium‑rich foods in the women of premenopausal age.

The improved physical action following administration of supplements to bodybuilders was supported by changes in laboratory parameters. Despite the fact that these supplements are sometimes associated both advantage and side effects, this study were conducted for the purpose of evaluating the possible effects of some commonly used supplements in bodybuilders on the hematological and biochemical parameters. In this study, we included 40 male bodybuilders as cases and 40 controls in the age group of 20‑40 years. They used different kinds of supplements for 1 year. In general, all the supplements used were classified into two groups: hormonal and non‑hormonal. Laboratory tests were requested for evaluation of hematological and biochemical parameters. In an equation model, we found that weight (P = 0.024), duration of bodybuilding (P < 0.001), and duration of hormone supplement consumption (P < 0.001) were loaded significantly on the latent variables, demographic and dietary supplement, respectively. The relationship between dietary supplement and biochemical and hematological parameters was significant (P = 0.01) and some of these parameters including creatinine (P = 0.023), blood aspartate aminotransferase (AST) (P < 0.001), alanine aminotransferase (ALT) (P < 0.001), and red blood cell distribution (RDW) (P = 0.046) had a significant role than others. In a multivariate regression model, we found that WBC (P < 0.001), platelets (P < 0.001), blood urea nitrogen (BUN; P < 0.001), creatinine (P < 0.001), AST (P = 0.005), and ALT (P = 0.001) were higher in athletes than in controls. It is strongly advised that there should be some concerns about possible supplement‑induced changes in the laboratory exams for bodybuilders. The available supplements are unchecked and not approved by the US Food and Drug Administration (FDA). More studies should be designed for a better and precise administration of each supplement in athletes.

Nutrition pattern is one of the important factors predicting menstrual distress, which varies among different cultures and countries. The purpose of this study is to determine the relationship between food frequency and menstrual distress in high school girls from Mashhad. This cross‑sectional study was conducted in 2012 using a two‑stage sampling method on 407 high school female students from Mashhad who met the inclusion criteria. Subjects completed questionnaires of demographic characteristics, food frequency, and Menstrual Distress Questionnaire (MDQ) during three phases of the menstrual cycle (a week before bleeding, during menstrual bleeding period, and a week after menstruation). The collected data were analyzed by statistical tests such as Pearson correlation coefficient test, independent Student’s t‑test, and one‑way analysis of variance (ANOVA). Results showed that 87.7% of the students were at moderate economic status, 82.2% were exposed to cigarette smoke, 94.8% had mothers without university education, and 9.4% had working mothers. About 71% of the students reported minor pre‑menstruation distress, 81% reported minor distress during bleeding, and 39% reported minor post‑menstruation distress. In addition, the mean (SD) values for sweet–fatty foods, salty–fatty foods, fast foods, and caffeine were 3.6, 3.3, 1.3, and 10.2 per week, respectively. In addition, Pearson correlation coefficient test showed no significant correlation between total menstruation distress and food frequency (P > 0.05). With regard to the inappropriate food frequency and high intensity of menstrual distress among high school students and as health care and educational efforts for prevention and health promotion in society are among the duties of health workers, the results of this study can help the officials involved in education to emphasize on nutrition and the menstrual health of students.

Renal failure is a major public health problem in the world. These patients experience high levels of psychological tension, anxiety, and depression, which leads to their lowered quality of life, increased health care costs, and early mortality. Due to medication side effects in these patients, non‑medicational methods are more in demand now. This study aimed to investigate the effect of hope therapy on depression, anxiety, and stress among the patients undergoing hemodialysis. This is a clinical trial. Fifty patients undergoing hemodialysis were selected. Patients were assigned to two groups of hope therapy and placebo. Intervention of hope therapy was administered for 60–90 min during dialysis sessions once a week for eight sessions. In the placebo group, non‑specific intervention was administered with the same number of sessions. Depression, Anxiety, and Stress scale (DASS)‑21 questionnaire was completed at the end of the last session and 4 weeks later. Data were analyzed by paired t‑test, repeated measures analysis of variance (ANOVA), and least significant difference (LSD) post hoc test through SPSS 18. There was a significant difference in mean scores of depression, anxiety, and stress in hope therapy group before, immediately after, and 1 month after intervention (P < 0.05), while there was no significant difference in mean scores of depression, anxiety, and stress before and immediately after intervention in the placebo group. Changes in mean scores of depression, anxiety, and stress were significantly higher in hope therapy group compared to placebo (P < 0.05). The obtained results showed that hope therapy is effective on reduction of depression, anxiety, and stress.

One of the reported obstacles to the achievement of universal access to Human Immunodeficiency Virus (HIV) prevention, treatment, care, and support programs includes stigma and discrimination from health workers, particularly nurses. Since nursing students would become future practising nurses and are most likely exposed to caring for people living with HIV/AIDS (PL WHA) during their training, it is of great importance to assess the knowledge, attitude, and practice of student nurses toward the reduction of HIV/AIDS‑related stigma and discrimination. A descriptive survey research design was used. A total of 150 nursing students were selected using the simple random sampling technique of fish bowl method with replacement. Data were obtained using a self‑administered (33‑item) validated questionnaire to assess the knowledge, attitude, and practice of student nurses with regard to HIV/AIDS‑related stigma and discrimination reduction strategies. Reliability of the tool was tested using Cronbach alpha (R) yielding a reliability value of 0.72. Data collected were analyzed with descriptive statistics of frequencies and percentages. Majority (76.0%) of the respondents were females and 82.7% were married. Respondents were found to have high knowledge (94.0%) of strategies for reducing HIV/AIDS‑related stigma and discrimination. Also, 64% had moderate discriminatory attitude, 74% engaged in low discriminatory practice, while 26% engaged in high discriminatory practice. Student nurses had adequate knowledge about strategies for reducing HIV/AIDS‑related stigma and discrimination; negative discriminatory attitude toward PLWHA and some form of discriminatory practices exist in participants’ training schools. It is, therefore, recommended that an educational package on reduction of HIV/AIDS‑related stigma and discrimination be developed and implemented for the participants.

Shivering is a common complication of general and epidural anesthesia. Warming methods and many drugs are used for control of shivering in the recovery room. The present study is a randomized clinical trial aimed to investigate the effects of two interventions in comparison with pethidine which is the routine treatment on shivering in patients undergoing abdominal surgery with general anesthesia. Eighty‑seven patients undergoing abdominal surgery by general anesthesia were randomly assigned to three groups (two intervention groups in comparison with pethidine as routine). Patients in warmed intravenous fluids group received pre‑warmed Ringer serum (38°C), patients in combined warming group received pre‑warmed Ringer serum (38°C) accompanied by humid‑warm oxygen, and patients in pethidine group received intravenous pethidine routinely. The elapsed time of shivering and some hemodynamic parameters of the participants were assessed for 20 min postoperatively in the recovery room. Then the collected data were analyzed by software SPSS (v. 16) with the significance level being P < 0.05. The mean of elapsed time in the warmed intravenous serum group, the combined warming group, and the pethidine group were 7 (1.5) min, 6 (1.5) min, and 2.8 (0.7) min, respectively, which was statistically significant (P < 0.05). The body temperatures in both combined warming and pethidine groups were increased significantly (P < 0.05). Combined warming can be effective in controlling postoperative shivering and body temperature increase.

Self‑esteem is known to be one of the most important markers of successful aging. Older people’s self‑esteem is influenced by several factors that particularly may be health related. Therefore, this study aimed to explore some important general health‑related predictors of the older people’s self‑esteem. In this study, 200 people, aged 65 years and older, who referred to health care centers were selected through stratified random sampling method. Data were collected by using Rosenberg’s self‑esteem scale and the 28‑item Goldberg’s general health questionnaire. Data were analyzed by Pearson’s coefficient tests and multiple regression analysis. Findings showed that the entered predictor variables accounted for 49% of the total variance (R2) of self‑esteem in the model (P < 0.001, F4,195 = 46.717). Three out of the four predictor variables including somatic signs, anxiety/insomnia, and depression, significantly predicted the self‑esteem. The results emphasized on the determinant role of both physical (somatic signs) and mental (anxiety/insomnia and depression) aspects of health in older patients’ self‑esteem. The significant general health‑related predictors found in the present study emphasize on some of the significant points that should be considered in planning for improving older patients’ self‑esteem.

Recent attempts have been focused on employing chemical and natural supplemental agents for treatment of cyclic mastalgia. Among various agents, the potential effects of vitamins remain questionable. In the present study, we examined the efficacy of two types of these vitamin supplements (vitamin E and vitamin B6) in improving pain severity in cyclic mastalgia. In a randomized double‑blinded clinical trial, 80 patients suffering from cyclic mastalgia were randomly assigned to receive 200 IU of vitamin E daily or 40 mg/day of vitamin B6 for 2 months. Written informed consent was obtained from all participants. Severity of breast pain was detected by the Cardiff breast pain score during one menstrual cycle before and two menstrual cycles after the intervention. Data were analyzed using t‑test, Chi‑squared test, analysis of variance (ANOVA), and regression with SPSS version 19 and P < 0.05 was considered significant. There was no significant difference in the mean of severity of cyclic mastalgia during one menstrual cycle before the intervention between the vitamin E and B6 groups (9.1 ± 2.1 and 8.4 ± 3.1, respectively), but the difference was significant during the first cycle (5.1 ± 1.6 and 5.2 ± 2.5, respectively) and the second menstrual cycle (2.3 ± 1.0 and 2.6 ± 2.0, respectively) in the two groups after the intervention. The trend of changes in pain severity score showed significant downward trend of pain severity score within the study period in both the treatment groups (P < 0.001), while these trends were similar in both groups when examined by the repeated‑measure ANOVA test. By multivariable linear regression analysis adjusted for baseline variables, we found that both the treatment regimens resulted in similar reduction in breast pain severity (P = 0.067). Both regimens containing vitamin E and vitamin B6 are similar in reducing breast pain severity in cyclic mastalgia.

Sir,Worldwide, in the health care industry, administration of injections is one of the most frequently performed procedures.[1] The World Health Organization has defined “safe injection” as one which is not only harmless to the recipient, but even does not expose the provider to any risk and does not produce any waste which can be hazardous for the society.[2] In‑fact, on an annual basis, at least 16 billion injections are administered worldwide, of which immunization related injections account for only five percent of them, while the rest being employed for various other indications (like transfusion of blood and blood products, drug/fluid administration, etc.).[1,3] As administration of an injection is an invasive procedure, thus it is crucial to maintain safety standards so as to prevent the transmission of disease or injuries.[1]….