نشریه پرستاری ایران
پیاپی 132 (آبان 1400)

Epilepsy is one of the most common chronic neurological disorders, and epileptic patients are prone to physical and psychological diseases and can experience issues such as anxiety, which affect their life quality. In general, epilepsy reduces life quality indexes and life expectancy, which has considerable economic effects on the person and the society and will ultimately lead to problems such as isolation, dependence, psychological damages and disorders, remaining single, unemployment and declining quality of life. Daily preferences and circadian rhythms are recognized as factors affecting epileptic patients’ life quality. As a mental feeling, quality of life is a psychological phenomenon that may play a role in patients’ life quality through personal traits such as daily preferences and circadian rhythms. In other words, circadian rhythms and anxiety are important issues found in epileptic patients, which can affect their quality of life. Therefore, the present study aimed to determine the relationship between life quality and circadian rhythms and anxiety in epileptic patient members of the Iranian Epilepsy Association.

This was a cross-sectional, descriptive and correlational study performed on 120 individuals who referred to the Iranian Epilepsy Association. The participants were selected by continuous sampling and based on the inclusion criteria. The sampling process continued for a period of June-August, 2020. Data were collected using a demographic characteristics questionnaire, including age, gender, level of education, marital status, occupational status, average monthly family income, and medical information related to other diseases, duration of diagnosis, and diagnosis of epilepsy in other family members. In addition, we applied the Morningness-Eveningness Questionnaire (MEQ), which comprises 19 questions about the sleep and waking times and appropriate times for physical, mental and conscious functioning after waking up. Moreover, we used the Beck Anxiety Inventory (BAI), which has 21 items about cognitive and physical signs of anxiety. Furthermore, we exploited the Quality of Life in Epilepsy (QOLIE-31-P) was exploited, which encompasses subscales of concern about epilepsy, psychological health, energy/fatigue, cognitive performance, drug effects, social performance and overall quality of life. The instruments were filled by the participants in a pre-determined location through self-report. Notably, the process took 20-30 minutes per subject. Data analysis was performed in SPSS version 16 using descriptive, inferential and correlational statistics and multiple linear regression model to determine the predictors of quality of life in patients with epilepsy.

In this study, the mean age of the subjects was 4.14 years. Regarding circadian rhythms, most participants were in an intermediate position (71.7%), which had the highest frequency compared to other circadian rhythms. However, the lowest frequency was related to the complete morningness state. On the other hand, there was no significant relationship between life quality scales and circadian rhythms. Quality of life had the highest score in the dimension of seizure anxiety with an average of 57.47 and in the dimension of social functioning with an average of 45.76 had the lowest mean score among other dimensions. Moreover, the average score of quality of life was 50.32 with a standard deviation of 23.03, which was close to the median of the instrument score- i.e., 50. There was a significant negative correlation between the quality of life and all of its dimensions with anxiety, meaning that quality of life and its dimensions decreased with an increase in anxiety (r=-0.673, P<-0.001). In addition, a significant association was observed between anxiety and variables of the level of education, occupational status, income level and hospitalization frequency. Moreover, diagnosis of other diseases (P=0.001) and five-six hospitalization times (P<0.001) were the only significant variables in the regression model.

According to the results of the study, there was a negative significant correlation between the quality of life and all of its dimensions with anxiety. It seems that effective steps could be taken toward promoting anxiety-free behaviors, which increases the life quality of patients with epilepsy, through raising awareness, considering a minimum level of education of high school diploma as a recruitment criterion, creating jobs with suitable income levels, and eliminating organizational barriers (e.g., facilitation of staff recruitment).

Paying attention to positive and negative emotions is very important and is one of the predictors of happiness and satisfaction in life. When judging the happiness and satisfaction of their lives, some people pay attention to the level of their negative and positive emotions, which indicates that their positive emotions prevail over negative ones. Nursing students experience a range of positive and negative emotions during their studies, and in the meantime, negative emotions and feelings can become more troublesome and hinder their learning. Studies show that emotions students experience in different learning environments can act as facilitators for their academic success, academic adjustment, and psychological well-being. Also, the results of studies show a significant positive relationship between students' positive emotion and their academic achievement. Students who receive compassion-based education have more hope, self-esteem, and overall mental health than their peers. The present study aimed to evaluate the effects of self-compassion training on the positive and negative emotions of nursing students.

This was a quasi-experimental study with pre-test and post-test design, which was conducted on 50 undergraduate nursing students studying at Iran University of Medical Sciences in the second semester of 2020. Inclusion criteria were being a bachelor student, not using psychiatric drugs, no stressful events such as divorce, death of loved ones, etc. in the past four months and a history of attending similar training classes. Exclusion criteria were not answering the exercises for at least 2 sessions. The students were selected through convenience sampling method and took the pretest. Then, students underwent training for eight 60-minute sessions (during one month and for two sessions each week). Some tasks were considered for the students in the interval of two sessions that were held during a week, and the students sent the answers of these exercises individually to the researcher. The students took the posttest one month after the last session. The instruments used were demographic profile and the reliable and valid Positive Affect and Negative Affect Scale (PANAS). Data analysis was performed using SPSS 16 through descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (paired t-test). In order to comply with ethical considerations, after obtaining permission from the ethics committee of Iran University of Medical Sciences, along with obtaining written consent from the samples, they were told that the information contained in the tools would remain confidential and there would be no obligation to participate in the research.The results of paired t-test showed that the positive emotions of the nursing students in the posttest with a mean score of 37.2 ± 9.5 was significantly higher than the pretest with a mean score of 21.24 ± 2.36, which indicates the superiority of the numerical indicators of positive emotion (P=0.001; t=23.388). Also, the results of paired t-test on negative emotions showed that the posttest score (12.2 ± 44.5) was significantly lower than the pretest score (20.34 ± 1.72), which indicates the superiority of the numerical indicators of negative emotion of nursing students (P<0.001; t=19.89). The results indicated that in the posttest, the scores of positive emotions increased significantly in all the time dimensions, while the scores of negative emotions decreased significantly.

The results of present study show that self-compassion-based education was effective on reducing negative emotions of nursing students, and therefore, affirm the research hypothesis that self-compassion-based education can increase the positive emotion scores and decrease negative emotion scores in the posttest. Based on the results of the research, self-compassion education can be employed as a high capability method for increasing positive emotions and reducing negative emotions of nursing students. The results of this study are useful for counseling centers of medical universities to better manage counseling for students. In the field of nursing students' education, the self-compassion training content presented in this study can be provided to nursing professors to acquaint their students with this content and these students can use this content as much as possible in their care plans for clients as self-compassion is a concept that applies to both healthy and sick groups in society. It is suggested that similar studies be performed on nursing students in other medical universities of the country and also on other fields of medical sciences to compare their results.

Cancer is a common chronic disease that leads to numerous psychological reactions in patients and affects the reactions of individuals to the physical symptoms of the disease and adherence to treatment in patients. According to forecasts, the number of new cases of cancer in 2025 will reach more than 130,000 people in Iran, which is about 35% more than the present time. The complex and longitudinal process of cancer treatment leads to many psychological complications in patients and their families and causes severe damage to their mental health and quality of family and social life. Various studies have identified several psychological factors that affect people's reactions to physical symptoms of the disease and adherence to treatment in patients. One of the psychological factors affecting health and illness is emotion. It is believed that expressing or not expressing emotion alone cannot be problematic. What causes the problem is the conflict or ambivalence that one experiences in expressing emotion. On the other hand, expressing emotions towards others has a positive relationship with social support. Those who are ambivalent about expressing their emotions toward others are more likely to miss out on the opportunity to receive support from others; while, supporting cancer patients protects them against the negative consequences of this disease and acts like a cure, and has a strong relationship with patients' psychological performance. On the other hand, one of the important issues about patients with chronic diseases which affects the effectiveness of planned therapies is the patient's adherence to treatment. In chronic diseases in which the treatment process takes a long time, adherence to treatment usually decreases; while, adherence to treatment is one of the most important factors in controlling these diseases, and poor adherence to treatment is an alarm for both patients and health care delivery systems, because from a clinical point of view, not following the treatment can reduce the beneficial therapeutic effects, increase complications, and increase hospitalization or even death in patients. The above mentioned points and review of previous researches indicate that many studies have examined psychological variables in cancer patients. However, less attention has been paid to ambivalence over emotional eexpressions in patients and following the medication and treatment regimen and cognitive-behavioral factors involved in them. Therefore, the present study aims to investigate the relationship between ambivalence over emotional eexpressions and social support with adherence to treatment in the cancer patients.

The present study is a descriptive correlational study and has employed Pearson correlation and stepwise regression methods for data analysis due to the nature of the design. The statistical population of the present study consisted of all cancer patients (based on the diagnosis of oncologist), referred to Dezful medical centers from April to June 2020. The sample of the study included 206 people (men and women) with each type of cancer selected from the mentioned population based on convenience sampling. The samples completed Demographic Characteristics Questionnaire, Ambivalence over Emotional Expression Questionnaire (AEQ), Social Support Scale (MOS-SSS), and General Adherence Scale (GAS). Statistical analyses were conducted in SPSS version 16 using Pearson correlation coefficient and stepwise regression.

Based on data, the average age of the sample was 44.90 years. The sample included 175 females (85%) and 31 males (15%). They had high school to master's degrees. In terms of marital status, 26 (12.6%) were single, 169 (82%) were married, and 11 (5.3%) were divorced. Regarding the stage of the disease at the time of diagnosis, 23 patients (11.2%) were in stage one, 95 patients (46.1%) in stage two, 73 patients (35.4%) in stage three, and 15 patients (7.3%) in stage four of the disease. Also, 37 patients (18%) reported metastatic disease and 83 patients (40.3%) reported a family history of cancer. Thirteen patients (6.3%) reported drug and tobacco use and alcohol consumption. In terms of insurance coverage and medical services, 169 (82%) of the samples were covered by insurance. Among the dimensions of ambivalence over emotional expression, the highest mean belonged to expressing negative emotions (42.59). Among the various dimensions of social support, the highest mean belonged to the emotional/information support dimension (25.53). And in general, among the three variables of ambivalence over emotional expressions, social support, and adherence to treatment, the highest mean belonged to the variables of ambivalence over emotional eexpressions (76.04), and there was a negative and significant relationship between ambivalence over emotional expressions and adherence to treatment (r=-0.184; P<0.05). However, there was no significant relationship between social support and adherence to treatment. In addition, ambivalence over emotional expressions predicted a total of 3% of adherence to treatment in cancer patients (R2=0.034).

Emotional changes that cancer patients experience during the various stages of diagnosis to treatment and even afterwards, as well as, the length and complexity of the treatment process and the complications of treatment and disease, can have significant effects on treatment adherence in patients. On the other hand, non-adherence to treatment is associated with several individual and social consequences, and imposes high costs on patients and their families. Given that nurses, as part of the treatment team, have the closest relationship with patients and their families during the treatment process, they can identify behavioral, cognitive, and emotional factors involved in poor adherence or non- adherence to treatment instructions to develop the necessary training and provide it to patients and their families. Also, according to the results of research on the high level of ambivalence over emotional expressions in cancer patients and its negative effects on adherence to treatment, nurses can have a significant role in reducing ambivalence over emotional expressions in patients by communicating and empathizing with patients and encouraging them to recognize and express their emotions and concerns and promote their self-expression. This way, the nurses can provide better treatment and higher quality of life for patients. The research had some limitations, including the limited and specific statistical community and it is suggested that this research be conducted in other cities and provinces and with different cultures in order to increase the generalizability of the research results. It is also suggested that due to the different complications and problems of different types of cancers in patients, this study be performed on different types of cancers separately and review the results.

Emotional eating is defined as the tendency to eat in response to stress or negative emotions in order to overcome negative emotions. According to research evidence, emotional eating is harmful to health. For example, emotional eating is associated with weight gain, increased risk of type 2 diabetes, metabolic syndrome, high blood pressure, and hyperlipidemia. Therefore, it is important to identify the factors that cause emotional eating to be harmful, as it helps us to get a deeper insight into emotional eating and its harms and plan more effective educational and psychological interventions to manage emotional eating. To do this, we need to analyze the experiences of people who have had emotional eating, to explore and explain this behavior from their point of view. As a result, we can identify the various psychological, social, and cultural dimensions of emotional eating. In addition, research evidence shows that emotional eating is more common in obese people than normal weight people, and women are more vulnerable to emotional eating than men. In addition to being universal, emotional eating behavior also has culture-related characteristics. According to these points, the aim of this study was to explain the harmfulness of emotional eating in young Iranian obese women.

The present study was conducted using a qualitative method and a hermeneutic phenomenological approach in 2020. Participants in this study were 17 young women aged 25 - 45 years living in Kermanshah or Karaj, with emotional eating experience and a body mass index of 30 or higher. Pregnant women were not included in this study due to their different body mass index. Participants were selected using purposive sampling method with maximum diversity approach. Data were collected through in-depth individual and face-to-face interviews. Sampling and interviews continued until the data saturation stage. The main questions asked of the participants during the interview were as follows: 1) Describe one of your emotional eating experiences and explain the thoughts, ideas, emotions and physical feelings that led you to eat at that time. 2) What other experience in your life is similar to this experience, and what does it mean to you? 3) Under what circumstances do you have the most emotional eating? And what do you think the relationship between these conditions and emotional eating means? 4) What is the difference between the times when you eat emotionally and the times when you eat normally? Also, exploratory questions were asked to analyze the deeper layers of the participants' lived experiences. Some of the exploratory questions asked in the present study were as follows: What did you mean by ....? Could you explain more? Please give an example in this regard? Data analysis began at the same time as data collection process. Dickelman's 7-step method was used to analyze the data.

In data analysis, a major theme emerged called "harmful companions" which showed that while participants experienced emotional eating, some other experiences accompanied their emotional eating, causing emotional eating to be harmful for these people. The main theme of "harmful companions" consists of seven sub-themes named lack of self-control in eating behavior, unconscious eating, body abuse, contradictory experiences, eating addiction, excessive eating of certain foods, and secretive eating. Lack of self-control in eating behavior means that emotional eaters do not have enough control over their eating behavior and their emotional eating is accompanied by fast eating, overeating, eating regardless of food quality, swallowing unchewed food, eating at the wrong time, and etc. The sub- theme of "unconscious eating" includes those experiences accompanying emotional eating that are not within the control of the conscious mind, and includes eating without consciousness, eating without will, eating involuntarily, eating without thinking, eating without purpose, unwanted eating, and eating without the right to choose. The sub- theme of "body abuse" refers to the victimization of the body, especially the gastrointestinal tract, during emotional eating experiences, and includes distracting from negative emotions by engaging the mouth and stomach through eating, replacing pain caused by filling the stomach with psychological pain of anxiety and chewing foods with clenching teeth to vent anger. The sub- theme of "contradictory experiences" includes the functions of positive and negative emotional eating and contradictions in attitude, feelings, and behavior of participants during emotional eating; Like enjoying eating but with a sense of shame for how you eat, eating pleasantly but with a guilty conscience; eating with craving but without pleasure, eating with craving but unwanted and the necessity of eating unnecessary. The sub- theme of "eating addiction" includes quasi-addictive traits found in emotional eaters, such as; mental temptation to eat, eating out of habit, physical urge to eat, psychological dependence on eating, compulsive eating, and searching behavior to find food. The sub- theme of "excessive eating of certain foods" means that although the participants' overeating included a variety of foods; in particular, they ate more sugary foods, high caffeine foods, starchy or fatty foods, and high-fat and salty snacks. The sub- theme of "secretive eating" means that participants ate secretly to avoid negative judgments and blame for their overeating, or that secretive eating was to passively eat their share of the food.

The results of this study showed that emotional eating alone is not harmful, but some other experiences that accompany it, cause it to be harmful in physical, psychological, and social dimensions. An interesting finding of this study is the sub-theme of "body abuse". This sub-theme expresses the need for people to maintain their mental cohesion even at the cost of harming their body. Another important point of this study is that; the "harmful companions" of emotional eating that emerged in the form of seven sub-themes complicate the cognition and management of emotional eating, and it is necessary to pay attention to harmful companions in psychotherapy programs to manage emotional overeating especially in women.

Nurses are the largest group of professionals among health care workers who play a significant role in the community health system. Nurses work in environments where the life and death of patients are the most important issues, so their health and well-being become important and having a happy and positive spirit can help them improve their health and that of their patients. Organizations are also increasingly aware of the importance of their employees' well-being in striving to gain sustainable competitive advantages. Over the past decade, the concept of subjective well-being (SWB) has become a popular research topic, and many researchers have examined its implications at the organizational, group, and individual levels in the workplace. Subjective well-being helps organizations to effectively engage their employees at work in an attempt to achieve a sustainable competitive advantage. Sustaining employees' subjective well-being is a difficult task. Therefore, the present study aimed to investigate the relationship between intrinsic motivation, extrinsic motivation, and amotivation with nurses' subjective well-being through the mediating role of energy in the workplace.

 This correlational study was conducted in 2020 following structural equation modeling (SEM). The statistical population of this study included all nurses at Baqai Hospital in Ahvaz. The total number of nurses in this hospital was about 200. According to the population size, all nurses were selected as the sample through census method. Among the collected questionnaires, 193 questionnaires were analyzed. The instruments used in this study were: Multidimensional Work Motivation Scale (MWMS) developed by Gagné et al., Energy Scale (ES) developed by Atwater and Carmeli, and Subjective Well-Being Scale (SWBS) developed by Diener et al. The theoretical research model and indirect effects were evaluated using structural equation modeling with partial least squares (PLS-SEM) approach in Smart-PLS3 software.

 According to the results, the scales used in the present study were reliable, and their reliability indices were estimated as follows: (Cronbach’s alpha: intrinsic motivation=0.91, extrinsic motivation=0.83, amotivation=0.77, energy=0.90, subjective well-being=0.89; composite reliability: intrinsic motivation=0.93, extrinsic motivation=0.89, amotivation=0.87, energy=0.92, subjective well-being=0.92) and convergent validity (AVE: intrinsic motivation=0.68, extrinsic motivation=0.65, amotivation=0.69, energy=0.59, subjective well-being=0.69). The discriminant validity was acceptable as well. Also, the general model of the present study had a strong and very good fit according to the goodness of fit index (GoF = 0.53). The results showed that intrinsic motivation (β = 0.43, p <0.001) and amotivation (β = -0.19, p <0.037) had significant positive and negative relationships with energy, respectively. The relationship between extrinsic motivation and energy was not significant (p > 0.05). Also, the relationship between energy and subjective well-being was positive and significant (β = 0.68, p <0.0001). Overall, intrinsic motivation and amotivation predicted 39% of energy variance, and energy predicted 46% of mental well-being. Regarding the mediating role of energy, the results showed that energy mediated the relationship between intrinsic motivation and subjective well-being (β =0.29, p <0.001) and the relationship between amotivation and subjective well-being (β =-0.13, p <0.042).

 According to the results, intrinsic motivation and amotivation affect nurses' energy in the workplace. Therefore, the researchers of the present study have several practical suggestions for managers to conserve and nurture the energy and subjective well-being of their workforce. In this regard, it is suggested that managers increase the internal motivation of employees and reduce their amotivation by increasing participation, increasing the level of authority, the possibility of career advancement, as well as determining more benefits. Creating opportunities for the growth and development of individual skills through empowerment programs, as well as facilitating success by minimizing barriers and reducing pressures and requirements, can also provide the basis for increasing employees' intrinsic motivation. Also, our findings demonstrate that energy is closely related to subjective well-being. Therefore, we recommend that HR practitioners carefully recruit resilient and enthusiastic individuals with high energy levels and an overall positive approach even in adverse and stressful conditions. Moreover, firms should make sincere efforts to promote optimal employee energy levels by formal and informal ways such as: (1) encouraging them to behave enthusiastically, (2) showing persistence even when they encounter negative situations, (3) providing a flexible work environment by allowing short breaks so that employees can relax with co-workers, and (4) holding training and energy management workshops. Here, the real challenge for management is not only to reach an optimal level of employee energy but also to maintain that level. Our study contributes to the subjective well-being literature by bringing attention to the direct and indirect mechanisms that influence the relationship between employee motivation and subjective well-being. We believe that further research in this area will better allow managers to understand how to promote employee happiness and overall well-being. There are few limitations that are needed to be considered while interpreting our research findings. The first limitation of this study is common method variance and mono-method since we utilized self-reported measures for all the study variables, which may inflate or deflate the association between study variables. Future researchers may utilize alternative data sources to reduce mono-method bias, such as manager’s appraisals for assessing employee energy level and peer/colleague rating of work motivation in order to verify our proposed model. The second potential limitation is that causality among the study variables cannot be drawn because this study is correlational. Therefore, future studies may try to examine the causation among the study variables by utilizing longitudinal and experimental study designs.

According to statistics, about 10% to 12% of babies born in developing countries are preterm. Iran is among the countries with a high incidence of preterm birth. Some babies require care in a neonatal intensive care unit (NICU). Premature birth is an emotional crisis for parents, and the hospitalization of preterm infants in the NICU is a cause of many families' suffering. Mothers of preterm infants experience emotional shock and may express feelings such as a depressed mood. Approximately, 28 to 70% of the mothers of preterm infants experience significant degrees of stress. Parents of preterm infants often suffer much psychological distress due to enduring the infant's unknown clinical conditions in the NICU, observation of aggressive treatments, and not participating in infant care. Therefore, it is essential to pay attention to the mental health of mothers of preterm infants. Previous studies have revealed limited information on the mood and mental state of mothers of preterm infants. Most studies have examined the effects of massage on the physical and psychological state of preterm infants, but few studies have investigated the effect of massage on their mothers' moods. The purpose of this study was to investigate the impact of infant massage on depressed mood of mothers of preterm infants who were discharged from the NICU.

In this quasi-experimental clinical trial which was conducted during October 2015-April 2016, 70 mothers and their preterm infants with fetal age of 32-37 weeks were assigned to one experimental and one control group. The study population was primiparous Iranian women whose preterm infants were hospitalized in the NICU for at least two days and were supposed to be discharged from the ward within the next 24 hours. A continuous sampling method was used so that on consecutive days in the morning shift, research samples were selected from eligible mothers and infants. After studying the infants' records and visiting a specialist, eligible mothers whose infants were ordered to be discharged within the next 24 hours were included in the study. The following cases were removed from the study: mothers who were not willing to continue participating in the study, early discharge of the infant with the personal consent of the parents, and the need to extend the infant's hospitalization days. To prevent the exchange of information between mothers, different groups participated in sampling every week. Code 1 or 2 was assigned to each group. Sampling was started by selecting one of the two cards marked with numbers 1 and 2 assigned to each group. Data were collected by a research assistant who was blind to the groups' assignment. In the morning shift, before the day of discharge, the depressed mood of Profile of Mood States Questionnaire (POMS) was completed by the mothers of the two groups. A depressed mood score was obtained in response to 15 questions of the depressed mood of McNair's questionnaire. In the experimental group, the intervention consisted of 8 minutes of massage consisting of two identical standard parts (four minutes each part). The first part was performed by the researcher, and the second part by the mother. To prevent friction, the researcher dripped his fingertips in almond oil and placed the baby in a prone position, and massaged the child with his palms at medium pressure for four one-minute periods. Each minute consisted of 12 movements and each movement took five seconds, from the tip of the head down to the neck and vice versa and from the upper part of the back down to the waist and vice versa. It should be noted that the two movements were performed once on the right side and once on the left side of the baby's body, and in performing the movement on the baby's back, the baby's spine was not touched at all. The mother then repeated the massage movements performed by the researcher for four minutes. The massage was repeated in two parts on the day of discharge, so that the massage was done in the first 4 minutes by the researcher and in the second 4 minutes by the mother. After the intervention, the depressed mood was re-measured. In all stages of massage, in case of infant crying, urination, or defecation, tactile stimuli were stopped and then intervention continued. The control group received no intervention.

Out of 75 mother-infant dyad participating in the study, 70 completed the study. 5 cases withdrew from the study (three and two mother-infant dyad in the experimental and control groups, respectively). Three samples were excluded from the study due to readmission (two in the experimental group and one in the control group) and two samples were removed from the study due to discharge with the personal consent of the parents (one in each group). Out of 70 mother-infant dyad, 35 remained in each group. There was no significant difference between the two groups in terms of demographic characteristics. On the day of discharge, there was a significant difference in the mean scores of depressed mood between the experimental and control group (6.37 ± 3.54 and 9.34 ± 5.27, p=0/007, respectively). In addition, on the day of discharge, the mean of depressed mood significantly decreased in the two groups (p=0/001).

The results showed that observing the infant massage and then performing this massage by the mother twice (once the day before discharge and once on the day of infant discharge) reduced the mean scores of their depressed mood compared to mothers in the control group. However, the mean score of depressed mood in both groups on the day of discharge significantly decreased compared to the previous day, which could be due to reduced anxiety of mothers in both groups when discharging their babies. Hospitalization in the neonatal intensive care unit increases parental concern, anxiety, and depression. The use of simple, inexpensive, and accessible methods, including tactile communication between mother and baby, will positively affect mothers' moods and mental states while creating numerous benefits for the baby. Undoubtedly, the mother's continuation of baby massage in the family environment as the development of healthy habits, way of thinking, and belief in improving these mothers' mental conditions under complex mental states is of great importance. Researches on maternal postpartum behaviors are related to the oxytocin and the placental corticotrophin-releasing hormone. One of the mechanisms of the effect of infant massage on the mother is its effect on the oxytocin. Oxytocin plays a crucial role in developing behaviors related to interpersonal relationships, including the emotional relationship between mother, infant, and child. Therefore, the mechanism of oxytocin action in the central nervous system and the occurrence of certain behaviors due to its effect has recently been considered by psychiatrists. Undoubtedly, identifying the mothers of infants with a depressed mood and providing support for these mothers will significantly reduce the incidence of postpartum depression. Training mothers on how to perform massage has an essential role in the mother's mental health and reduces the mother's mood disorders. Community-based health care must be at the forefront of care planning.

Spinal cord injury is usually debilitating and has many negative effects on the quality of life of people due to secondary complications. Therefore, improving the quality of life of people with spinal cord injury is one of the main priorities in the nursing profession. Also, educating self-care behaviors and obtaining information from nurses can be helpful for people with this problem. Self-care is also the most important form of primary care for chronic diseases in the health sector. The aim of this study was to determine the effect of self-care education on the quality of life of people with spinal cord injury referred to Khatam Ol-Anbia Hospital in Tehran.

The present study was a quasi-experimental study with a control group. 84 patients with spinal cord injury referred to Khatam Ol-Anbia Hospital in Tehran in the first 6 months of 2020 were selected through systematic random sampling and divided in two groups; an intervention group and a control group. The questionnaire used in this study is an abbreviated form of WHO Quality of Life Assessment Group. WHOQOL-BREF Introduction is a 26-item questionnaire that measures a person's overall quality of life. This questionnaire has four subscales and an overall score. These subscales include: physical health, mental health, social relationships, environmental health, and an overall score. The reliability of Quality of Life questionnaire was achieved through Cronbach's alpha which was equal to α= 0.79 and internal correlation coefficient was calculated for relative reliability which was equal to 0.85. After coordination with the officials of Khatam Ol-Anbia Hospital in Tehran, the researcher referred to the spinal cord injury wards and after introducing himself, explaining the nature and objective of the research, and the procedures to conduct the study to the ward staff, the patients, and their companions, received informed consent from the patients.The pre-test was performed for both groups and before the intervention, the questionnaires of demographic characteristics and WHO Quality of Life were completed by patients admitted to the spinal cord injury wards. Then, the intervention group was formed in the social network entitled "Self-care and spinal cord injuries" and in addition to the usual training, 30-session self-care training was conducted every day for 30 minutes which lasted a month. The training included description of the disease, complications of the disease, types of pharmacological and non-pharmacological treatments for disease control, self-care and its importance in rehabilitation, how to follow a proper diet, how to follow the prescribed medication and daily activities, exercise and physical activity, counseling and talking with friends, family and non- family support, the skills of how to change the position, transfer, increase performance and independence of patients with spinal cord injury.In this study, 42 patients participated in each group, and 4 patients in the intervention group and 2 in the control group were excluded from the study for reasons such as cancellation of cooperation, not completing the questionnaire in pre-test or post-test stages, not studying the material submitted for more than three sessions (according to the feedback, the daily review of message information, analyzing Read or Delivered option in the social network), and finally a total of 38 patients comprised the intervention group and 40 patients the control group. At first, the patients were asked not to post irrelevant material and to express their views if they had any questions or concerns about the training provided. Also, only routine trainings were performed for the control group. To perform the post-test, one month after the end of the educational intervention, the tools were completed again by the two groups. The post-test was performed for the patients who returned to the hospital and the spinal cord injury wards on time, but for other patients, the questionnaires were sent privately to the social network and were completed remotely. After the posttest, the educational booklet was given to the control group. In this research, educational content was prepared by referring to the available library resources and with the guidance of supervisors and consultants.The validity of the educational content was assessed qualitatively by a survey of 3 faculty members. After collecting data, the results were analyzed through descriptive and inferential tests such as Fisher's exact test, Chi-square, independent t-test, and paired t-test in SPSS 16.

The results indicated no difference between the two groups in terms of distribution of underlying variables. Comparison of quality of life showed that the quality of life in patients with spinal cord lesions was not statistically significant before and after the intervention (P >0.05) and also the quality of life in the two groups was improved after the intervention and a statistically significant difference was observed (P <0.001). Regarding the changes in quality of life score, the mean quality of life of patients with spinal cord injury before the intervention was 13.10 ± 14.57 in the intervention group and 13.43 ± 13.97 in the control group. One week after the intervention, the mean quality of life of patients with spinal cord injury was 22.38 ± 13.98 in the intervention group and 15 ± 14.48 in the control group.

The results indicate that self-care program training is effective in improving the quality of life of patients with spinal cord injury. According to the researcher, several factors affect the results, including the nature of the disease, involvement of all body systems, and difficult conditions (lack of definitive treatment, dependence on nurses and informal caregivers) that make it difficult to control the disease. On the other hand, environmental conditions and economic situation, as well as lack of easy access to some drugs may have been involved in assessing the quality of life of these patients. According to the results, the method used in the present study can be suggested to nurses as a simple, non-invasive, low-cost, and effective method in improving the quality of life of patients with spinal cord injury.