International Journal of Community Based Nursing and Midwifery
Volume:9 Issue: 1, Jan 2021

Adolescence is a time of risks and opportunities. This study aimed to investigate andprioritize the behavioral concerns of male adolescents. A modified Delphi study (2018-2019) was conducted in two stages. In the first stage,adolescents’ behavioral concerns were extracted based on seven qualitative interviews and a focusgroup. Then, a questionnaire was designed using the obtained data; also, two-round consensusbuildingapproach (rating and ranking) through surveys were conducted among 90students, teachersand parents covered by the Health Departments of Tehran University of Medical Sciences, who hadbeen selected using a stratified cluster random sampling method. Qualitative content analysis was usedin the first stage and descriptive statistics in the second stage to analyze the data. In the first stage, eight categories emerged, including relational challenges with parents andother adults; poor interaction with peers; lack of adaptation to conditions; emotional dysregulation;self-esteem and sense of purposefulness issues; materialistic tendencies; cyberspace issues; and nonadherenceto religious beliefs. Then 63 behavioral concerns were identified. In each round (rating/ranking), 29/27, 28/29, and 30/30, responses were received for students, parents and teachers,respectively. According to the specified scores given to different issues, ten top problems according tothe viewpoint of different groups were extracted. “lack of planning and prioritization skill”, “insufficient skill for controlling crisis”, and “lackof resilience” are the most important priority for male adolescents, teachers and parents, respectively.These findings can be used for planning programs based on the adolescents’ behavioral concerns.

The first case of Coronavirus Disease (COVID-19) was reported in Iran on February19, 2020. This study aimed to assess the characteristics and reproduction number (R) of COVID-19 inMarkazi province in Iran. This is a cross-sectional study. Confirmed cases (N=2430) in the regions covered by ArakUniversity of Medical Sciences from Feb 20 to Aug 26, 2020 were enrolled in the study. The includedvariables were clinical and demographic characteristics of COVID-19 patients. The case fatality rate(CFR), incidence rates, and R were estimated based on the daily reported data. For estimating R,generation time was assumed on multi scenarios. R was estimated by R0-package. Moreover, Chisquare test was applied. All the analyses were performed in STATA, Excel, ArcMap and R. A p-valueless than 0.05 was considered as statistically significant. The mean age of the participants was 51.78±20.58 years, and 206(8.50%) cases were amonghealthcare workers. Among the patients, 499 (20.50%) had a history of cardiovascular diseasesand 337(13.90%) diabetes type 2. The most prevalent symptoms were cough 1347(55.40%), fever1233(50.70%), and dyspnea 960 (39.50%). The highest incidence rate of COVID-19 in the study area(Delijan) was 575.35 per 100,000 persons. CFR was 205(8.40%). At the end of the study period, R wascalculated as 1.04 (CI 95%: 1.00, 1.08) in all districts of Arak University of Medical Sciences. Thehighest R (1.08, 95% CI: 1.06, 1.10) was observed in Farahan. As R is slightly high, the risk of epidemic has reduced gradually. However, observingsocial distance and related guidelines are still recommended.

The concept of birth preparedness and complication readiness (BP/CR) has continuedto generate interest in the last decade. Unfortunately, there is a paucity of published data regardingthis subject in Tanzania and the Lake Zone in particular. This study aimed to determine the factorsaffecting the level of awareness of BP/CR among Tanzanian women in the Lake Zone. Between May and June 2016, a cross-sectional study on 737 postnatal or pregnant womenwas conducted in the Lake Zone Tanzania. A systematic random sampling technique was employedto select the study participants. A structured questionnaire adopted from the Johns Hopkins Programfor International Education in Gynecology and Obstetrics (JHPIEGO) questionnaire was used tocollect the data. Data analysis was carried out through SPSS (v.21) using statistical tests includingdescriptive Statistics, Chi-square tests and Multivariate logistic regression. A significance level of 5%was considered. The odds of the occurrence of events were assessed using Odds Ratios (OR) at a 95%confidence interval (CI). The majority of women were multigravida (512=69.5%) with up to three living children(409=80%). Awareness of danger signs and BP/CR was low at 40% and 35%, respectively. Predictorsof the level of awareness on BP/CR were multi-gravidity (P=0.04), awareness of at least three dangersigns (p

Missed care is a global phenomenon, which can include many clinical conditions thatthreaten the patients’ safety in all countries and cultures, and also indicates the quality of nursing care.The nursing students’ awareness and understanding of missed nursing care is of great importance. Thecurrent study aims to explore the lived experience of postgraduate nursing students in missed care.

The current qualitative study was performed based on the interpretive phenomenologicalapproach in Tehran, Iran, in February to December 2019. A total of 10 master’s degree nursing studentswere selected through purposive sampling. A total of 10 semi-structured individual interviews wereused to collect the data. The trail version of MAXQDA-10 software was used for coding. All interviewswere recorded and codified, and the main themes were extracted from them using Dicklemann et al.’s(1989) analytical method.

Two main themes, five sub-themes, and 31 meaning units were obtained. The main themesincluded: “unfulfilled care” and “living in limbo”.

Missed care, as unfulfilled care, is accompanied with living in limbo for nursing students,and this condition is influenced by organizational and personal factors. It seems that managers canprevent missed nursing care by supervising nursing care, reducing the nurses’ workload, creating asense of commitment to work, and enforcing ethical issues among nurses.

Despite high number of visited cases, there are no certain therapeutic guidelines for mastalgia. Generally pain is associated with poor quality of life in all dimensions. The present study aimed to investigate the effect of healthy lifestyle promotion intervention on the quality of life in cyclic mastalgia. This study was a randomized controlled trial (RCT) conducted on women suffering from cyclic mastalgia at the age of 20 and older before menopausal age referred to the health centers of Karaj,Iran from September 2017 to August 2018. The participants were randomly assigned to intervention (N=40) and control groups(N=40). Intervention was carried out in two 46-minute sessions and two 90-minute sessionsfor the intervention group. The quality of life was assessed before and after the intervention in both groups using the World Health Organization Quality of Life-BREF (WHOQOL-BREF). The data were analyzed through SPSS statistical software(version 21) using independent sample t-test, Chi-square,and Paired t-test. Besides, p Before the intervention, both groups were matchedin terms of marital status, educational level, occupation, history of breastfeeding, and mean scores of quality of life (P>0.05). After the intervention, the mean score of life qualityin physical, social, environmental, and general health dimensions in the intervention group increased significantly compared to the control group(P>0.001).This difference was not statistically significant in the mental health dimension (P= 0.086). The present study indicated that healthy lifestyle promotion intervention could improve the quality of life of women with cyclic mastalgia.

Premature birth is a crisis for mothers and affects resilience. Premature babies are atrisk for developmental disorders. The Kangaroo Mother Care (KMC) can reduce maternal stress andimprove the growth of the baby. This study aimed at assessing the effect of home visit based on thecontinued KMC on maternal resiliency and development of premature infant. This randomized controlled trial conducted on 50 pairs of mothers and premature babieswith gestational age of 26-32 weeks who were admitted to Neonatal Intensive Care Unit of Om-al-Banin Hospital, Mashhad, Iran in 2019. The KMC is practiced routinely for all eligible newborns in thishospital. The experimental group continued the KMC one month after discharge at home and receivedtwo home visits. Resiliency of the mothers was assessed in admission, discharge, and one monthafter discharge with the Connor and Davison questionnaire and the development of the newborns wasassessed in two months of adjusted age with Ages and Stages Questionnaire (ASQ). Data analysis wasperformed using SPSS software version 16 and t-test, Mann-Whitney, ANOVA, Friedman, Chi-square,Fishers exact. The significance level was set at p <0.05. The resiliency score of the mothers one month after discharge was112.50±5.50 and 76.40±5.60in the experimental and control groups, which was significantly different (p <0.001). The ASQdevelopment score of the newborns in two months of adjusted age was also significantly higher in theexperimental than the control group (280.40±15.60vs223.80±22.00) (p <0.001). The results showed that the home visit program based on the continued KMC was effectivein increasing maternal resilience and the development of premature infants.

Patients with multiple sclerosis (MS) require health literacy to manage the symptomsand problems of the disease, which improves their quality of life. Health literacy is recognized asa critical indicator of health care outcomes. This study aimed to compare the effect of peer-led andlecture-based education on health literacy in MS patients. This quasi-experimental study was conducted on MS patients in Jahrom from December2018 to November 2019. 90 patients were selected using convenience sampling and then assigned intocontrol (n=45) and intervention groups (n=45). While routine education was presented to patients inthe control group, peer education intervention was held for the intervention group. The number ofsessions held for both groups was six sessions (one session per week). For data collection, MS healthliteracy questionnaire (MSHLQ) was used before and one month after the intervention in both groups.Data were analyzed through SPSS version 21 using Chi-square, Fisher’s exact test and t-test. Thesignificance level was considered p <0.05. Paired t-test showed that there was a significant difference between the mean of health literacyin the intervention group before and after the intervention (P=0.001), while this difference was notobserved in the control group (P=0.39). Independent t-test showed a significant difference in the meanof health literacy between the intervention and control groups after the intervention (P=0.001). The results showed that peer group experiences were more effective than lecture-basededucation in improving health literacy. It can be beneficial to employ as an educative-supportiveapproach in MS patients.

The coronavirus disease 2019 (COVID-19) outbreak has brought to people all over the world, in particular to patients, not only the risk of death, but also too much psychological pressure. Individuals who are quarantined at hospitals or homes might experience various adverse feelings. The potential lethality of the illness, some clinical symptoms of patients including shortness of breath and hypoxia, and devastating and sensational news, especially on social networks could lead to anxiety and fear in patients. Patients may also have feelings of guilt about potentially exposing their family members to infection. “Medical mistrust” which refers to lack of trust in medical treatments may also increase the patients’ overall sense of worry and despair. Inadequate information about the disease and insufficient transparency from authorities about the disease status could also make the patients feel anger as we can see in previous studies on outbreaks such as Ebola.1 Reduced contact with others, especially loved ones, leads to boredom, frustration, and a sense of loneliness and isolation, which is distressing to patients. Based on clinical observations and patients’ reports, worry about the health of self and that of significant others, loneliness, and lack of entertainment are the most concerns of patients quarantined at hospitals or homes. Therefore, mental health services should provide mental health care for individuals who are quarantined. On the other hand, fast transmission of virus restricts face-to-face psychological interventions. Moreover, due to heavy workloads and lack of standardized training in psychiatry or clinical psychology, mental health providers do not always know how to mitigate the psychological distress of patients.2 It would be worthwhile to develop online or smartphone-based psychoeducation to promote mental health among patients quarantined for COVID-19. Psychologists, psychiatrists, and psychiatric nurses could use the Internet and online social networks, including WhatsApp and Telegram, to share strategies by reducing stress, frustration, and sense of loneliness and isolation in patients. During the outbreak of COVID-19 in Iran, psychological services have been widely established by mental health professionals in universities and academic societies. An example of such psychological services provided by Shiraz University of Medical Sciences is psychoeducational services via WhatsApp (PSW). PSW includes various intervention strategies to minimize the potential mental health problems that might arise among individuals who are quarantined during the COVID-19 pandemic. It offers a package of interventions through instant messaging in order to offer self-help guidance to patients. PSW provides cognitive therapy through educational video clips, podcasts, texts, and audio files to teach patients to know their cognitive biases towards their disease and the likelihood of adverse events occurring to them. Furthermore, mindfulness techniques are recommended to help patients recognize their negative thoughts and emotions about the disease and reduce the intensity and impact of those thoughts and emotions on their level of stress. With these techniques, the patients are taught to try to allow any emotion they feel to just be without striving to change it or push it away.3 Relaxation techniques such as diaphragmatic breathing, progressive muscle relaxation, and imagination exercises are taught to patients using video clips and audio files. Patients are encouraged every day to practice these techniques and provide feedback on which techniques work best for them as well as adapt to their condition. The patients are informed that they don’t need to do all the techniques every day. Instead, they can choose the most effective technique for themselves and practice it daily. To target engagement, pleasure, and meaningful life for the management of hopelessness in such patients, positive psychotherapy exercises including “Positive Reminiscence”, “Three Good Things”, and “Hope, Optimism, and Posttraumatic Growth” exercises are provided. During the “Positive Reminiscence Exercise”, patients should take time to think about an event from their past that evokes positive emotions, visualize the event in detail, and focus on the pleasant feelings arising during the exercise.4 The objective of the “Three Good Things” exercise is to help patients be more aware and remember the good things and positive events that happened to them throughout the day.5 During the “Hope, Optimism, and Posttraumatic Growth” exercise, patients are encouraged to think about the times when important things were lost, but other opportunities opened.5 In addition to psychoeducational interventions, every day, the number of recovered patients from COVID-19 is sent to patients to increase hope in them. Moreover, music, humor, and riddle are sent through WhatsApp in order to entertain patients during their hospitalization. Finally, we should consider the fact that individuals who experience COVID-19 and face quarantine have various psychological demands. Thus, mental health professionals should provide psychological interventions according to their interests and needs.

Health promotion is the process of enabling people to increase control over their health and its determinants, and thereby improve their health. Through the Ottawa Charter, World Health Organization (WHO) defined health promotion as “the process of empowering individuals to increase their control and improve their health”.1 WHO and the United Nations Educational, Scientific and Cultural Organization (UNESCO) have launched a new initiative called “Making Every School a Health Promotion School” through the development and promotion of global standards for health promotion in schools. The initiative will help more than 2.3 billion students and the WHO to achieve the motto of “one billion healthy lives” by the end of 2023.2 Today, 1.2 billion adolescents in the world make up more than one-sixth of the world’s population; also, more than 80% of them are teenagers and spend one-third of their time in school.2 Highlighting the issue of health for this group, especially the adolescents, is important because their physical, mental, and social health guarantees the current and future health status of the society. Therefore, the purpose of school health is to provide, maintain, and improve the physical and mental health of adolescents and ultimately communities. Adolescents need to know how to take care of themselves and what measures to take for their health.3 Given that the WHO aims to promote health among children and adolescents, special emphasis should be placed on the implementation of health promotion programs. Teaching based on the appropriate approaches to promote health and to care for adolescents will improve the health of the community. In addition, it can help reduce the financial costs of chronic diseases and their growing prevalence.4 For this purpose, the Health and Welfare Office of the Ministry of Education in Iran in cooperation with the Education and Health Promotion Office of the Ministry of Health and Medical Education (MOHME) has signed an executive agreement in the form of a program for student health ambassadors. This program was designed to provide grounds for mobilizing students and to provide health ambassadors with a plan to make efforts to comprehensively implement biological and physical training. The program is based on the peer education approach, which is a coherent program designed to build an effective peer network to encourage students to improve their health. Accordingly, 10% of the diligent, interested, and volunteer students in the school and also at least one qualified student from each class will be selected by the healthcare provider or the coordinator. They will be provided with a self-care booklet and a healthy lifestyle. Then, the healthcare providers in each school are asked to provide the necessary information to the health ambassadors through holding special training sessions (group discussion, workshop, panel, and role play). Consequently, they should transfer health information to their peers at school. Student Health Ambassadors are referred to those volunteer students who are interested in group activities in various fields of health (physical, psychological, social, and spiritual). They should be able to play a pivotal and effective role in promoting health and self-care not only in schools, but also among their families. This is a newly established program that was endorsed in 2016-17. The “Health Ambassadors” program was developed for the elementary and secondary schools in urban and rural areas in cooperation with the Office of Health for Population, Family and School and Education and Health Promotion Office in the MOHME.5 This program is also faced with many challenges, indeed. Given the need for an educator and the establishment of an intimate and friendly relationship between the educator and the audience as the main principles of health education, it seems that the presence of a health educator or a school nurse is one of the priorities and underlying foundations of the project. Therefore, the appropriate physical and human context for health education and promotion should be provided to be used efficiently. Despite the measures taken, the “Health Ambassadors” program still seems to be in the pilot stage; however, it has been welcomed by many schools and students as a health ambassador. Developing a sense of responsibility for one’s health as well as the health of others is one of the main objectives of this program. Therefore, after evaluating and resolving its challengesas a start-up project, the “Health Ambassadors” project can have significant short-term and long-term consequences. Therefore, developing a plan such as the “Student Health Ambassadors Project” is a dynamic way of thinking in pursuit of sustainable development in society. It is noteworthy that such a proposal can be implemented in other countries as well. However, it seems that highlighting the presence of an expert in health education and promotion is one of the most important issues that should be taken into account by the executives in order to improve the implementation of the Health Ambassadors Project. Community health nurses with sufficient knowledge about the developmental stages of adolescents, principles of school health, nursing procedure, communication process, and educational methods can provide adolescents with the necessary health education in schools. Accordingly, we recommend employing community health nurses in schools to achieve more desirable results in terms of the implementation of school health programs including the “Health Ambassadors Project” in the future. Consequently, this will lead to better health education as well as the promotion of healthy behaviors.