International Journal of Community Based Nursing and Midwifery
Volume:8 Issue: 4, Oct 2020

Household labor has been indicated as a feminine role even in the present millennium,in which gender role orientations have been changed. As pregnancy is an important time for studyingthe division of household labor, this study aimed to discover the meaning of the pregnant women’sexperiences of household roles. An ethno-phenomenological study, in which van Manen approach to phenomenology wasits core and focused ethnographic approach was its supplementary component, was used to conductthis study. 25 pregnant women with maximum variation were recruited via the purposeful samplingduring 2016-2017 in Mashhad, Iran. In-depth semi-structured interviews, vignette interviews aswell as observations were used for data collection. Six-step van Manen’s descriptive-interpretivephenomenological approach was used for concurrent data collection and analysis. MAXQDA, version10, was used for data organization. Data analysis led to the emergence of an overarching theme entitled: “couples’ preservation,keeping up and protection of the household roles”. This was derived from two subthemes includingthe mother’s efforts to play the household roles and spouse confrontation with the household chores. The consequence of all endeavors of pregnant women along with their husbands developsthe experience of preserving and maintaining the importance of household roles. As pregnancy is animportant period for considering division of household responsibilities, it is necessary to design andimplement gender sensitive programs to empower pregnant women and their families as well.

Happiness is a positive feeling that is vital and significant to maintain health. Nursesare working in difficult conditions which may heavily affect their level of happiness and ability toprovide care. Job burnout is a mental reaction against some persistent source of workplace stress. Thepurpose of this study was to identify happiness and its relationship with job burnout in nurses workingat Tabriz’s educational hospitals. This descriptive-correlational study was conducted on 344 nurses working at Tabriz’s hospitalsin 2018. The subjects were selected by means of proportionate stratified random sampling. Data werecollected using three questionnaires (demographic information, job burnout with 22 items and threesubscales and Oxford happiness with 29 items) and analyzed in SPSS version16 using descriptive statistics.Statistical tests such as Pearson correlation coefficient, independent t-test, one-way ANOVA, and multiplelinear regression analysis were used to analyze the data. The age range of the participants was 23–57 years with a mean of 35.9±7.5. The mean score ofhappiness was 64.2±11.5, (score range 35 to 116), which suggests an average level of happiness amongthe nurses. There was a negative correlation between happiness and total job burnout (r=-0.29, p <0.001).This negative correlation remained significant (B=-0.15, p <0.001) even when nurses’ perception of ownhealth status (B=-5.24, P=0.01), history of illness (B=-4.47, P=0.04), job position (B=-6.61, P=0.001),and type of employment (B=3.56, P=0.03) as potential confounding factors were adjusted. Considering the reverse relationship between job burnout and happiness, it is suggestedthat managers try to improve the workplace by managing condition which could lead to job burnout,and therefore use the results to increase the happiness of nurs.

Autoimmune diseases are a main cause of primary ovarian insufficiency. This study wasdesigned to elucidate the relationship between ovarian reserve and anti-thyroid peroxidase antibodiesin women of different ages.

98 women in a cross-sectional study was conducted at the infertility Center of ShirazUniversity of Medical Sciences, Hazrate Zeinab Hospital, from September 2018 to March 2019. Womenwith infertility and thyroid-stimulating hormone (TSH) > 3mIU/L were included in the study withconvenience sampling. Data were collected by a form containing demographic characteristics, thyroidhormones, and ovarian reserve data. Participants were categorized based on the negative or positiveanti-thyroid peroxidase (anti-TPO) antibodies. According to a pilot sample, and possible dropout of20%, the sample size was determined to be 49 cases in each group. The results were compared betweengroups using SPSS, version 22. All statistical comparisons were performed using the t-test, and thedata are presented as the mean±SD. P-values less than 0.05 were considered significant.

49 women were analyzed in each group. There was no significant difference between thegroups in the mean age (P=0.42), body mass index (BMI) (P=0.34), duration of infertility (P=0.99),mean prolactin (P=0.66), TSH (P=0.17), thyroxine (T4) (P=0.87) and follicle-stimulating hormone(FSH) levels (P=0.14). Ovarian reserve characteristics: antral follicular count (AFC) and anti-Müllerianhormone (AMH) levels in anti-TPO positive group were 10.61±7.29 and 1.98±2.38, respectively, andAFC and AMH in anti- TPO negative group were 16.46±6.38 and 2.94±2.22, respectively. There weresignificant differences between the two groups on AFC (P <0.001) and AMH (P=0.04).

Patients with autoimmune thyroiditis were at higher risk for decreased ovarian reserve.They should consider their lower reproductive life span during their childbearing years.

Recovery of postnatal women with perineal injuries, especially when perineal tearis severe, occurs much later than the healthy women. There is no specific questionnaire to assessthe postnatal recovery in these women. The aim of this study was development and psychometricevaluation of a new tool to measure women’s recovery of postnatal perineal injuries questionnaire(WRPPIQ). In this validation study, which was conducted based on the method developed by DeVellis(2003), 270 women with postnatal perineal injuries who referred to healthcare centers in Mashhad,Iran, were studied between 2018 and 2020. This method consisted of steps: (1) definition of postnatalrecovery based on in-depth qualitative interview with 22 women, (2) generation of an item pool, (3)selection of the Likert scale, (4) review of the initial item pool, (5) inclusion of items from relevantinstruments, (6) conducting exploratory factor analysis, (7) evaluation of the items, and (8) optimizationof the scale length. The initially generated item pool consisted of 144 items on a 5-point Likert scale, whichreduced to 85 items following face and content validity measurement. The value of the SCVI/Avewas measured 0.901. The conduction of exploratory factor analysis resulted in 33 items and threefactors including evidence of wellness, emotional changes as well as independence and support. TheCronbach’s alpha for the three factors was calculated 0.92, 0.80, and 0.83, respectively. WRPPIQ has validity and reliability to measure the women’s recovery of postnatalperineal injuries in Iran. It is, therefore, recommended that health care providers to assess women’srecovery of postnatal perineal injuries using this newly developed questionnaire.

Sexual function is important for diabetic women because it has a special effect onthe quality of life. This study was conducted to compare the relationship of sexual function, maritaladjustment, and life satisfaction between diabetic and non-diabetic women.

This cross-sectional study was done in Kerman, Iran, from August 2018 to November 2019.The study sample included 300 diabetic women and 300 non-diabetic women. Data gathering toolsincluded a demographic questionnaire, Rosen female sexual function index (FSFI), Spanier DyadicAdjustment Scale (DAS), and Diner satisfaction with life scale. Data were analyzed through SPSS 15,using descriptive statistics, independent-t test, ANOVA, and Pearson tests. The significance level wasconsidered 0.05.

The mean scores of marital adjustment, female sexual function index, and satisfactionwith life scales in diabetic women were 90.98±23.33, 19.04±9.77, and 13.4±3.21; also, they were120.34±33.34, 27.82±10.17, and 16.3±5.89 in non-diabetic women, respectively. Statistically significantdifferences were found between the scores of marital adjustment (P=0.001), female sexual functionindex (P=0.001), and satisfaction with life (P=0.001) in diabetic and non-diabetic women. The femalesexual function index was correlated with life satisfaction and marital adjustment.

Diabetic women experience sexual dysfunction because of their special condition, whichnegatively influences life satisfaction and marital adjustment. Healthcare providers should pay muchmore attention to this issue. They can provide educational packages on sexual issues for diabeticwomen. They should also support these women and their spouses to improve their quality of life.

Cancer affects the quality of life (QoL) of patients and their families. The purpose ofthis study was to determine the effect of coping skills training on the QoL among daughters of motherswith breast cancer. In this quasi-experimental pre-test/post-test design, data were collected from 70 participants(35 in each of the control and education groups) from January 2016 to July 2017 in Imam Khomeiniand Rasole-e-Akram Hospitals in Tehran. The education group participated in a workshop and group discussion (groups of 5 to 8 participants) with the presence of a pediatric psychiatrist and two pediatricnurses, and then a follow up program was performed. The Pediatric Quality of Life Inventory version4.0 was used in this study in two stages of pre-test (before education) and post-test (four weeks later).Data were analyzed through SPSS, version 21 using independent t-test and paired t-test for comparisonof the mean scores of the two groups, with the significance level of 0.05. After the education, there were significantly improved scores of the QoL in the dimensionsof physical functioning (p <0.001), emotional functioning (p <0.001), and school functioning (p <0.001)in the study group compared to the control group. The social functioning did not show a significantchange (p <0.083). The findings of the study confirm that coping skills training can lead to the improvementof QoL in adolescent daughters of mothers with breast cancer. Healthcare professionals must providethe mothers and daughters with information about breast cancer and instruments to handle theirsituation to promote the daughters’ QoL.

High-risk pregnancy is associated with many problems which can affect marital wellbeingas well as maternal and fetal health. Yet, there is limited information about the conditions whichaffect marital well-being in high-risk pregnancy. This study aimed to explore the pregnant women’sexperiences of the conditions affecting marital well-being in high-risk pregnancy

This qualitative study was conducted from October 2018 to December 2019. Participantswere 24 women with high-risk pregnancy who were purposively selected from three public and twoprivate hospitals as well as a primary healthcare center in Mashhad, Iran. Face-to-face semi-structuredinterviews were conducted for data collection. Data were analyzed concurrently with data collectionthrough Graneheim and Lundman’s content analysis (2004). The MAXQDA program (v. 10) was usedfor data management.

Conditions affecting marital well-being in high-risk pregnancy were categorized into elevensubcategories and three main categories, namely emotional spousal intimacy in the midst of danger,husband’s commitment to manage the difficult conditions of pregnancy and sexual relationship duringhigh-risk pregnancy.

Several conditions can affect marital well-being in high-risk pregnancy. Healthcareproviders can develop and use strategies for the effective management of these conditions, therebyimproving marital well-being among women with high-risk pregnancy.

One of the current worldwide challenges is struggling with the emerging disease of COVID-19. Following the announcement of the outbreak of the disease by the World Health Organization (WHO), numerous measures have been taken in the field of education, treatment and research at the national, regional and international levels by governmental and non-governmental organizations (NGOs). Iran, like other countries in the world, has taken extensive measures in this regard. On Feb. 25, 2020, the National Headquarter for Combating Corona (NHCC) was formed.1 Immediate and necessary decisions and measures such as closing schools and universities were taken and implemented by this headquarter. The initial instructions about the COVID-19 were published by official websites, including the Ministry of Health and Medical Education (MoHME) and the Universities of Medical Sciences included information on disease symptoms, methods of the prevention, diagnosis, and treatment of COVID-19. Another concern about public health was mental and psychological health. Unknown and unpredictable future in the COVID-19 pandemic, along with misinformation and myths, has led to misunderstandings of health messages in the community. Restrictions on travel and quarantine at domestic and international airports in the spring, when most flights take place, have also raised concerns.2 On the other hand, as previous studies have shown, fear of infectious diseases with high prevalence and mortality rate is associated with other psychological challenges such as stigma, discrimination, loss, feelings of fear of getting sick or dying, and helplessness.3, 4 Therefore, following the activities of the NHCC and MoHME, booklets on stress management and coping with anxiety were published. In this regard, a phone line for psychological counseling has been opened in the Ministry of Health and universities of medical sciences. Meanwhile, children are exposed to a lot of news about the disease epidemic. Therefore, publishing some booklets for children was another measure taken by MoHME to reduce their stress and anxiety. Another activity that took place in the first weeks of the illness and after the closure of schools and universities in Iran was teaching the students by distant education using virtual content and software. This kind of education ensured the students and their family and made them calm because they did not need to attend schools, universities or dormitories. In addition to government agencies, NGOs and charity organizations have taken steps to address the physical, economic, social and psychological harms of the disease. For example, some of these groups provided the equipment and supplies needed for patients and even members of the medical team, such as masks, gloves, and gown. These charity groups have also provided financial support to people suffering from financial problems during the closure of their businesses. Despite all the measures taken in various areas at the national and provincial levels by government and non-government agencies, there are still some shortages. Because Iran is under numerous sanctions, especially in the field of health, and due to the lack of resources and equipment for healthcare services, an increase in the morbidity and mortality rate might happen in the long time.5 Although some efforts were made regarding the stress and anxiety of the public health, especially children and youth, there are some other measures which could be applied. Through online counseling, psychologists can provide training on how to deal with health issues caused by domestic conflicts, tensions between children and parents, and anxiety about illness. It is important to note that financial worries, sanctions, pressures, and deficiencies resulting from them could be associated with physical and mental disorders for people in Iranian society, especially for vulnerable, high risk groups such as low-income individuals and their families. Therefore, the support of international community and WHO, at least in lifesaving medical supplies, is essential. These kinds of lifting sanctions could decrease the tragedy and contribute to preventing the second wave of spreading the disease.

The pandemic of COVID-19 is the second one in the 21st century after H1N1 Swine Flu in 2009-2010, which infected more than 4.9 million and caused more than 327000 death as of 23 May 2020 worldwide.1 This pandemic has overwhelmed the health systems, specially hospitals, and the need for ICU beds and ventilators increased while many of patients with mild symptom of COVID-19 could be recovered at home.2 In addition, early discharge of hospitalized patient and referring for Home Health Care (HHC) would be a suitable strategy for decreasing the overload of patient in hospitals and its consequences such as nosocomial infections. On the other side, many patients who receive HHC for other conditions (usually old people with chronic disease) need special attention during the pandemic for ensuring continuation of care and prevention of COVID-19 threat. The first patient in Iran was officially reported on February 19, 2020 in Qom city. According to World Health Organization about 129 341 Iranians were infected by Novel Corona Virus and 7249 died till 23 May 2020.1 As the nurses are frontline health worker who provide services in hospitals as well as in home settings, Deputy for Nursing of MOHME published the guideline for Home care for COVID-19 patient and about 405 institute for Home Care services were active to care of patient in their homes.3 Regardless of the availability of detailed information about hospitalized COVID-19 patients by means of integrated Hospital Information Systems (HIS), there is no information about the number, characteristics and health outcomes of people who receive professional HHC in Iran during this pandemic. It is not only the problem of Iran’s Health system, but European countries have also encounter with lack of home care data.4 The history of HHC, as an industry in Iran, dates back to 1999 when the first bylaw for HHC was ratified by Health Minister. In recent years, Act on the Sixth Five-Year Economic, Cultural and Social Development Plan of Iran for 2017-2022 enforced the MOHME to expand the HHC in community and insurance coverage for HHC is on the High Council of Health Insurance’s agenda. Thus, nowadays home health care is becoming integrated in the health system of Iran more than ever. One of the problems of HHC during the COVID-19 in Iran (at least in the beginning of epidemic) was lack of appropriate and adequate Personal Protective Equipment (PPE) for the staff who worked in HHC settings directly with patients and families and raised fear of the risk of cross-infections by the staff and patients. The lack of information and data about home care in Iran’s healthcare system, lack of adequate and accurate monitoring, and inability of supervising have been among the challenges of HHC in Iran,5 which during COVID-19 epidemic became more challenging. The lack of data has weakened the ability of policymakers for evidence-based and timely decisions to combat the disease. Using Information Technology (IT) in HHC has many advantages such as gathering and sharing information, supervising and providing telenursing. The HHC teams and patients as well as policymakers can benefit from IT implementation in HHC. This issue is especially a priority in the disasters like COVID-19 pandemic when the health system needs integrated and real-time data. On the other hand, to minimize the contacts between nurses and patients aiming to decrease the cross-contamination, Telenursing can be used for frequent contact between the nurses and patients to manage the condition by telephone or video call without direct contact. According to lessons learned from COVID-19 pandemic, using IT in Home Health Care, especially implementation of Home Health Care Information System and its integration into national Electronic Health Record (EHR) and using Telenursing are among the important factors for developing the role of HHC in the health system of Iran; this could help to better manage the outbreaks. It is not a simple policy to implement and needs a national determination and plan with multi-sectoral cooperation.

The coronavirus disease 2019 (COVID-19) emerged in Wuhan, China, in late 2019. The fact that COVID-19 has caused illness resulting in death has sustained human-to-human spread, is concerning. The disease has a high mortality rate of between 3 and 15%.1 At the time of writing, the coronavirus COVID-19 is transmitted widely among populations and has affected 216 countries with more than 5,934,936 cases globally and almost 367,166 deaths.2 Rapid global spread of this new virus  is a major public health concern in the world.2 Therefore, healthcare workers, governments and managers need to co-operate to fight against COVID-19 pandemic and it has become increasingly important to address the safety and health protection of healthcare workers. Healthcare workers are under both physical and psychological pressure due to exposure to this huge infectious public health problem.3 As of 8 April 2020, 22,073 cases of COVID-19 among health workers from 52 countries had been reported to the World Health Organization(WHO)(2). The role of health workers is vital; they are at the frontline of any outbreak response. They save lives while encountering the hazards that put them at risk of infection with COVID-19 outbreak pathogen. The hazards include physical and psychological violence, long working hours, emotional reactions, fatigue, occupational burnout, stigma, shortage of personal protective equipment, concern about infecting themselves and their family members, insomnia, depression, and anxiety.3, 4 Therefore, it is imperative to ensure protection for medical staff from hazards not only to safeguard the patients, but also to ensure their health and safety. Hence, the safety and health problems of medical staff in COVID-19 outbreak have become an important public health concern.4, 5 Evidence suggests implementation of a series of safety and psychological protective measures by managers. Employers and managers in health facilities must take overall responsibility to ensure that all necessary preventive and protective measures are taken to recognize problems and hazards and assess the risks of health workers’ health and safety. They are required to provide information, instruction and training on occupational safety and health, provide adequate personal protective equipment supplies (such as N95 masks, goggles, and protective gowns) in sufficient quantity, reasonable work shift arrangements, sufficient logistical support and comfortable accommodations to healthcare staff during this COVID-19 pandemic. Employers and managers in health facilities should also provide access to mental health professionals and counselling resources to relieve the symptoms in healthcare workers who experience depression, anxiety and psychological distress and seek to recover them from occupational hazards.3-5 In conclusion, the managers and employers are suggested to be more sensitive about the health problems with which the medical staff might encounter. Therefore, implementing a series of preventive and protective measures and psychological supportive interventions to ensure the safety and health in healthcare workers could be helpful to overcome this disaster.