Journal of Holistic Nursing and Midwifery
Volume:32 Issue: 2, Spring 2022

The incidence and mortality of breast cancer will be reduced by screening.

The study aimed to determine breast cancer screening behaviors based on the health beliefs model in women living in Mashhad City, Iran.

This analytical cross-sectional study was conducted on 406 women referring to five health-medical centers in Mashhad from July 2018 to May 2019. They were selected by the multistage sampling method. The study data were collected with a questionnaire based on health belief model constructs consisting of two parts. The first part collects sociodemographic information. The second part is based on constructs of the health belief model (perceived susceptibility, perceived barriers, perceived severity, cues to action, and self-efficacy). The collected data were analyzed using descriptive and inferential statistics (the Smirnov-Kolmogorov, the Pearson correlation, and the Spearman test).

The mean ±SD age of the participants was 33.5 ±10.3 years, and perceived severity and perceived susceptibility of breast cancer screening behaviors were low and very low in 36.4% and 8.1% of the women, respectively. Perceived barriers were high in 70% of women; cues to action and self-efficacy were low in 57.4% and 17.2%, respectively. There was a negative and significant relationship between perceived barriers and perceived benefits (P = 0.001, r = -0.160). Also, there were significant statistical relationships between preventive behavior with self-efficacy (P = 0.001, r = 0.896) and cues to action (P = 0.001, r = 0.269). However, the Pearson test showed a negative and significant relationship between age and self-efficacy
(P =0.001, r = -0.231).

The present study highlights the educational programs for preventing breast cancer screening behaviors based on the health belief model. These programs should focus on increasing breast self-examination skills and understanding the perceived benefits of breast cancer screening behaviors.

Pregnancy is one of the most sensitive periods in a woman's life. Physical and psychological changes during pregnancy can significantly affect the couples' sexual relations. Healthy sexual desire during pregnancy is essential for the development of couples as parents.

This meta-analysis study estimates the prevalence of sexual dysfunction overall and in different trimesters of pregnancy.

This research is a systematic review and meta-analysis. A search was conducted in PubMed, Scopus, Science Direct, and Google Scholar databases to find cross-sectional and prospective cohort studies investigating the prevalence of sexual dysfunction in different trimesters using the female sexual function index (FSFI) published from 2000 to 2019. The methodological quality of each study was assessed using the modified from the STROBE (The Strengthening the Reporting of Observational Studies in Epidemiology) checklist to determine the risk of bias. The standard error of prevalence in each study was calculated based on the binomial distribution formula. Based on heterogeneity results, a random effect model was used to estimate the prevalence.

Fifteen articles met the inclusion criteria, with a total number of 3569 participants, of which 2538 were in cross-sectional studies and 1031 in prospective cohort studies. In the meta-analysis of both prospective cohort and cross-sectional studies, the prevalence rates of sexual dysfunction in the first, second, and third trimesters, and overall were estimated at 51.33% (95%CI; 37.41-65.25), 51.13% (95%CI; 38.93-63.33), 72.80% (95%CI; 65.78-79.81%), and 58.65% (95%CI; 51.50-65.80), respectively.

The trimester of pregnancy has a predictive role in the prevalence of sexual dysfunction during pregnancy. The prevalence of sexual dysfunction is higher in the third trimester.

Menopause is an essential part of human life that affects women's quality of life (QOL).

This study investigated the quality of life and some relevant factors in menopausal women.

This cross-sectional study was conducted on 45-60 years old menopausal women in 3 areas of Kashan city, Iran in 2018. By cluster sampling method, 236 participants were included in the study. The study questionnaires consist of demographic and obstetric information and menopausal quality of life (MENQOL). The Kolmogorov-Smirnov test, t test, the Pearson and Spearman correlation tests, as well as linear regression analysis, were used for data analysis.

The mean ±SD age of the women was 52.65 ±3.67 years. Also, their mean±SD years lapsed menopause was 2.89 ±1.53, and the mean ±SD for QOL was 31.24 ±11.47. There were no significant correlations between QOL and women's age, menopausal age, and elapsed years since menopause. Based on linear regression analysis, the variables of age (B= 2.61, 95%CI; 0.46-4.77, P=0.02), menopausal age (B= -2.19, 95%CI; -4.39 - -0.01, P=0.049), and satisfaction of spouse ((B= -4.90, 95%CI; -8.45- -0.35, P=0.007) remained in the model as relegated variables to quality of life (R2 = 11.8%).

Since most women had moderate menopausal QOL score, intervention programs to improve the QOL for postmenopausal women is recommended in health centers. Further studies are suggested to evaluate the quality of life in chronic diseases of postmenopausal women.

Since prescribing is a new subject in the nursing profession, it is necessary to assess nurses' attitudes to and readiness for this new responsibility.

This study aimed to investigate nurses' attitudes to and readiness for nurse prescribing in teaching hospitals of Tabriz City, Iran.

This cross-sectional analytical study was conducted on 335 nurses working in the hospitals of Tabriz from June to October 2019. The participants were selected with a stratified random sampling method, and study data were collected using a two-part questionnaire: demographics and the nurse prescribing questionnaire.The demographics were analyzed using descriptive statistics. The Spearman rank correlation coefficient and the Mann-Whitney U tests were employed to examine the correlation and to compare the mean scores, respectively. The significance level for all tests was determined to be less than 0.05.

About 82.1% of participants were female, 59.7% were working in general wards, and 42.1% were in critical care units. The results showed that the mean ±SD scores of attitude and readiness were 34.79 ±8.15 and 36.99 ±6.01, respectively. Moreover, 71.6% of nurses agreed with nurse prescribing. The results showed that the score of attitudes towards prescribing the drug was significant in terms of gender (P = 0.039), employment status (P = 0.032), work experience (P =0.041), and academic degree (P = 0.028). Also, results showed readiness to implement was significant in terms of gender (P = 0.028), employment status (P = 0.049), work experience (P = 0.037), and academic degree (P = 0.042). Finally, there was a positive and significant correlation between nurses' attitudes toward and readiness for prescribing (P = 0.042, rs=0.626).

Because nurses have a positive attitude toward and are ready for prescribing, it is
possible to make them more prepared for this new role by increasing their pharmacological knowledge and improving their accountability.

Survival after cardiac arrest is one of the most important issues related to the safety and quality of patient care, and unexpected events such as failure to follow guidelines can endanger the patient's safety.

This study aimed to determine the long-term survival after cardiopulmonary resuscitation and its predictors in patients with cardiac arrest.

In this retrospective study, individual, disease-related, and 3-day follow-up-related factors were monitored after the cardiopulmonary resuscitation (CPR) in all patients with long-term survival after cardiac arrest (CA) who were discharged from the hospital between 2016 and 2019. Patients' survival or death after CPR was followed up by telephone interviews. The patient's survival time after discharge was calculated until the interview day. The obtained data were analyzed by the Kaplan-Meier and Cox regression tests.

Out of 1565 CPR cases (both In-Hospital Cardiac Arrest [IHCA] and Out-of-Hospital Cardiac Arrest [OHCA]), 667 were successful, of which 156 patients had long-term survival. The mean ±SD of the survival time for patients was 30.98 ±1.78 months. Significant variables in associations with long-term survival were old age (>60 y) (HR=1.811, 95%CI;1.019-3.218, P=0.043), initial asystole rhythm (HR=4.199; 95%CI:2.129-8.282; P=0.001), ventricular tachycardia (VT) (HR=2.315; 95%CI:1.171-4.576; P=0.016), connection to mechanical ventilator (HR=1.992; 95%CI:1.229-3.229; P=0.005), cardiovascular disease (HR=1.795; 95%CI:1.111-2.901; P=0.017), and abnormal SpO2 (HR=2.447; 95%CI:1.507-3.972; P=0.001). Multivariate analysis also showed that asystole rhythm (P=0.001), VT (P=0.052), and prolonged duration of CPR (>20 min) (P=0.043) significantly increase the risk of death.

The major predictors in this study were age, initial rhythm, connection to a mechanical ventilator, CPR duration, cardiovascular disease, and SpO2 monitoring. Therefore, introducing post-resuscitation care protocols and conducting training programs and further studies are warranted.

Nurses' compliance with standard precautions is a viable tool for decreasing health hazards in health centers.

This study aimed to identify factors affecting compliance with standard precautions (SPs) of infection control based on the health belief model (HBM) among emergency department nurses employed in the educational-therapeutic centers affiliated with Guilan University Medical Sciences in Rasht City, Iran.

This cross-sectional study included 252 nurses working in the emergency departments of hospitals in Rasht City. The study samples were recruited using the convenience sampling method from September to October 2020. Nurses completed questionnaires, including demographics data, HBM constructs, knowledge, and compliance with standard precautions. A hierarchical multiple linear regression analysis was used to identify factors related to compliance with SPs.

The mean ±SD age of the nurses was 32.77±7.05 years, and the majority of them were females (88.9%). Their mean ±SD score for compliance with SPs was 63.2 ±16.0 (out of 100). The multivariable analysis results showed that the knowledge (β=0.47, 95%CI; 0.30-0.64, P=0.001), perceived benefits (β =0.19, 95%CI; 0.03-0.36, P=0.022) and perceived susceptibility (β =0.25, 95%CI; 0.13-0.36, P=0.001) constructs of HBM were positively correlated with the compliance with SPs. Furthermore, the level of education was significantly related to the compliance with SPs (β =9.51, 95%CI; 0.02-18.99, P=0.049). The final model accounted for 39.8% of the variance in compliance with SPs.

 Results indicated improvement in activity and safety level of the healthcare workers and also an increase in the overall level of compliance among nurses through education, regular training, and use of encouragement and punishment policies. It is suggested to follow the World Health Organization protocols. Also, the support management could have a better effect on perceived benefits and cues to action.

Infertility has biological and psychological effects on various aspects of the infertile couple's life.

This study aimed to investigate the effectiveness of integrated psychological counseling with a couple therapy approach on the quality of life of infertile women.

This clinical trial was conducted on 60 couples (30 couples in the intervention and 30 in the control group) referred to Infertility Center in Kerman City, Iran, from October to December 2018. They were assigned to intervention and control groups with available sampling and block allocation method. The intervention group received six group counseling sessions. The subjects completed the FertiQoL questionnaire before and after the intervention. It has 24 items specific to infertility that cover four subscales of the QoL )emotional, mind-body, relational, and social(. Data analysis was conducted by paired t test, Chi-square test, and Mann-Whitney test. P values less than 0.05 were considered significant.

The mean ± SD ages of the participants were 33.25 ± 5.89 and 33.53 ± 5.46 in the intervention and control groups, respectively. Results showed significant differences between the mean ± SD of the mind-body subscale of the intervention group (88.5 ± 6.39) and that of the control group (69 ±12.24), between the social subscale of the intervention group (78± 6.34) compared to that of the control group (60.5 ± 12.27), and between emotional subscale of the intervention group (73.75 ±6.71) compared to that of the control group (54.5 ± 12.29) at the
post-test (P =0.001). However, no significant change was seen in the relational subscale of intervention (52.25 ± 6.25) compared to the control group (57.25 ± 12.25) (P= 0.060). Results showed a significantly higher FertiQoL total score for the intervention group (70.56±6.49) compared to the control group (57.76±12.26) at the post-test (P=0.001).

The results indicated that integrated psychological counseling could improve the quality of life among infertile women. Therefore, it can lead to more satisfaction and cooperation in infertility treatment.

 Unplanned pregnancy and its complications are a global problem that affects women, families, and the community.

 This study aimed to assess the relationship between pregnancy intention, pregnancy outcomes, postpartum depression, and maternal role adaptation in pregnant women referred to healthcare centers of Robat Karim City, Iran. 

 This cohort study was conducted on 240 pregnant women referred to the healthcare centers of Robat Karim in 2019. They were selected by the convenience sampling method. After completing the London questionnaire in the 26th week of gestation, the participants were equally divided into planned and unplanned pregnancy groups. Edinburgh postnatal depression scale and parenting sense of competency scale were completed 10 days and 30 days after delivery. The obtained data were presented by descriptive statistics and analyzed by the Chi-square and t test for comparison between two groups and structural equation model for assessing the relationship between variables.

The mean ± SD values of age, marital duration time, and gravidity number of participants were 30±7.1, 1.5±0.02, and 5, respectively. The results revealed a significant difference between the two groups concerning the mean score of postpartum depression and maternal competency, 10 and 30 days after delivery (P=0.001). The results of path analysis showed that pregnancy intention had a negative and significant effect on postpartum depression (B = -0.58, t value=-2.5), but a positive and significant impact on maternal competency (B = 0.39, t value=-2).
According to the determined amount of variance, the variable of intention to pregnancy predicts 33% of postpartum depression (R2=0.33). Also, two variables of pregnancy intention and postpartum depression predict 55% of maternal competency (R2=0.55). 

  Pregnancy intention had a significant effect on maternal depression and competency. It is recommended that pregnancy intention be screened during pregnancy, and also appropriate training and social support be provided for mothers with unplanned pregnancies.

A fall is a sudden descent on the ground or other lower levels. It is a serious safety threat for hospitalized patients. Coronary artery bypass graft (CABG) surgery as an open heart surgery has complications such as cardiac arrhythmias and delirium that can increase the risk of fall.

This study aims to determine the risk of falls in patients after CABG surgery and investigate its associated factors.
Matetials and

This cross-sectional study was conducted on 302 patients undergoing CABG surgery in a specialized hospital in Rasht City, Iran, from November 2019 to July 2020. They were selected by a sequential sampling method. The data collection instrument included demographic information, disease-related factors, surgery-related factors (before, during, after), and the Morse fall scale (MFS) checklist. The study data were collected after the patient's surgery and transfer from the intensive care unit to the surgical ward. Descriptive statistics, as well as the Kolmogorov Smirnov, Wilcoxon, Mann-Whitney U, Kruskal-Wallis, and Spearman correlation, were used to analyze the collected data. A rank regression model was used to determine the factors related to the risk of falls in patients.

The mean ±SD age of participants was 59.35 ±8.37 years. About 70.53% of the patients were male, and 46.03% were overweight (Body Mass Index ranged 25-29.9 kg/m2). The majority of patients at the time of admission to the surgical ward and before surgery (92.72%) had no risk of falls. After surgery and transfer to the surgical ward, 82.12% had a low risk of falls. The mean risk of falling was higher in patients over 60 years (P <0.05). With decreasing hemoglobin values on the morning of surgery, the risk of postoperative fall increased (P = 0.046, r = -0.115). The sodium level on the morning of surgery had a significant negative correlation (P = 0.040, r = -0.118) with the risk of falling, but urea level on the morning of surgery had a significant positive correlation (P = 0.001, r = 0.212) with the risk of falling. Using regression model, the results showed that with increasing age (B = 0.23, 95%CI; 0.07-0.39, P = 0.003),  history of high blood pressure (B= 3.5, 95%CI: -0.69-0.39, P = 0.003), decrease in hemoglobin (B = -5.47, 95%CI; -10.2- -0.6, P = 0.02), an increase in creatinine (B = 17.73, 95%CI; 8.17-27.29, P = 0.001) and urea (B = 6.09, 95%CI; 2.57-9.61, P = 0.001) before the surgery, the risk of fall after CABG surgery increases.

Several factors can increase the risk of falls after CABG surgery. Considering that the risk of falls in patients undergoing CABG surgery in most medical centers is examined only at the beginning of admission, it is recommended to consider the possibility of postoperative falls based on the predicting variables.