Iranian Journal Of Nursing and Midwifery Research
Volume:27 Issue: 6, Nov-Dec 2022

Metacognitive skills have an important role in training efficient learners and competent clinicians in health professions education. The aim of this systematized review was to determine the factors enhancing metacognitive skills in nursing students.

For data collection, we searched the databases of PubMed, Ovid, Cochrane, Scopus, Web of Science, ProQuest, Springer, EMBASE, Science Direct, PsycInfo, Nursing and Allied Health, and ERIC up to the end of March 2019, using the study key words. We used PRISMA flowchart diagram for reporting the results of the study. Peer‑reviewed articles in English, addressing factors enhancing metacognition in nursing students, were included in our review. The Critical Appraisal Skills Program (CASP) checklist was used for assessing the quality of the included studies.

Out of 2355 studies, 16 were included for the review. Several factors, namely “specific curricular activities,” “self‑regulated e‑learning modules,” “e‑portfolio,” “cognitive apprenticeship,” “specific teaching techniques for classroom and experiential settings,” “metacognitive wrappers,” “problem‑based learning,” “blended learning,” “grit,” and “clinical log,” enhancing metacognition in nursing students, were extracted.

The findings of our study can contribute to planning for improvement of learners’ metacognitive skills. However, there is a need for future research on determining further factors influencing nursing students’ metacognitive skills. 

An evaluation of Iranian pregnant women’s mental health during the COVID‑19 outbreak is an ignored issue. The current study aimed to investigate the mental health of Iranian pregnant women during the COVID‑19 pandemic.

Literature searching was conducted, and studies were published from 01 March 2020 to 30 June 2022 on PubMed, Scopus, ScienceDirect, SID, and Magiran screened for the relevant articles.

There was a total of 10 studies included in this systematic review. In the present study, the prevalence of moderate to the high level of depression, anxiety, and stress symptoms was 40%, 19 to 74%, and 70%, respectively. There were some protective factors such as physical activity, social support, using progressive relaxation, and husbands’ involvement in caring behaviours of their pregnant wives that can enhance the mental health of Iranian pregnant women during the COVID‑19 pandemic.

Regarding the high prevalence of depression, anxiety, and stress among Iranian pregnant women during the current pandemic, the mental health status of pregnant women should be regularly evaluated and essential educational and interventional programs should be provided for this population.

During pregnancy, because of unique changes in the body, pregnant women need access to clothes that meet their biological needs and inspire a positive attitude toward the body. Accordingly, the aim of this study was to investigate the essential criteria for healthy designing maternity clothing.

The present study was conducted as a narrative review. Searches were performed in MEDLINE, ISI Web of Science, Scopus, PubMed, EMBASE, ERIC, and ProQuest databases for the documents written between 2000 and 2021 regardless of the research methodology and the employed tools.

The results of this study were presented in three areas including women’s expectations of maternity dress design, psycho‑social effects of maternity wear, and maternal clothing designs.

The results of this study expand the knowledge of healthy maternity wear designers and, consequently, show that maternity clothing should hold three characteristics, adaptability, comfort, and stylishness, and meanwhile minimize the protrusion of enlarged areas of the body. 

Today’s health systems require the collaboration of diverse staff such as physicians, nurses, social workers, and other healthcare professionals. In addition to professional competencies, they also need to acquire interprofessional competencies. Effective interprofessional collaboration among healthcare professionals is one of the solutions that can promote the effectiveness of the health system using existing resources.

A systematic review was conducted in 2021 according to the PRISMA and through searching Web of Science, Scopus, PubMed, ProQuest, Science Direct, Emerald, Springer Link, Google Scholar, SID, and Magiran databases. The official websites of WHO, United Nations, and World Bank were also searched. The time frame for the research was from 2010 to 2020, and included both the English and Persian languages. Out of 7267 initially retrieved articles, 17 articles finally met the quality evaluation criteria and were analyzed through qualitative content analysis. Then their full texts were retrieved and analyzed in MAXQDA software, and final results were categorized.

Competencies have been explored in various areas of health care, especially in the clinical field. The competencies introduced were extracted and categorized into six domains of “patient‑centered care,” “interprofessional communication,” “participatory leadership,” “conflict resolution,” “transparency of duties and responsibilities,” and “teamwork.” The competence of “transparency of duties and responsibilities” was mentioned in all studies and is required for any collaboration.

Interprofessional competencies provide quality, safety, and patient‑centeredness through effective collaboration. Integrating interprofessional competencies into the educational curriculum, in‑service training, and continue education is essential to form effective interprofessional collaboration. 

Peripherally Inserted Central Catheter (PICC), which is inserted through peripheral veins into the superior or inferior vena cava, is used to inject medications or parenteral nutrition in neonates with long‑term hospitalization in the intensive care unit. In this study, we assessed the complications of PICC in neonates admitted to the intensive care unit in hospital.

In the present retrospective cohort, neonates admitted to the Neonatal Intensive Care Unit (NICU) of Valiasr Hospital during 2015‑2018 had been divided into two groups with PICC and without it. Data included the occurrence of septicemia, tachycardia, perforation of large veins, pulmonary hypertension, cardiac tamponade, pericardial effusion, catheter site necrosis, hemorrhage, anemia, pleural effusion, ascites, phlebitis of catheter track and neonatal death, which were collected, using the comprehensive neonatal registry of Valiasr Hospital. Data analysis was performed with regression, mantel‑haenszel and independent t</em>‑test.

Data from 174 neonates with PICC were compared to 207 infants with classic IV‑Line. In the exposure group, the gestational age and birth weight were lower. Based on the results of the double logistic regression test, septicemia and hemorrhage in the injection site, independent of other variables, were related to the use of PICC and the risk of septicemia or hemorrhage in the injection site was significantly reduced if PCIC was used (p </em>< 0.01).

Using the PICC as a therapeutic procedure in hospitalized neonates in the NICU is a safe method. By improving its replacement skills among physicians and nurses, its side effects are minor and negligible. 

Structural planning is essential for the management of constipation in stroke patients. The current study aims to determine the impact of a care plan on the frequency of new‑onset constipation following stroke.Materials and Methods: This clinical trial was conducted on 132 stroke patients (two groups of 66) in three phases (pre‑intervention, during discharge, 1 month after discharge). Clients were randomly assigned to blocks based on gender, type of stroke, and age. The care plan according to the nursing process was conducted. Data collection tools included a demographic–clinical information questionnaire, Rome IV criteria (diagnosis of constipation), and Bristol scale (consistency of stool). Data were analyzed using the Chi‑square, McNemar, Wilcoxon, Analysis of Variance (ANOVA), and a general estimated model.

The prevalence of new‑onset constipation following stroke in the control group decreased from 66 (100%) at admission to 39 (67.20%) at discharge and in the intervention group from 66 cases (100%) to 18 cases (34%) (p </em>= 0.001), but it was not significant at follow‑up (p </em>= 0.16). The trend of frequency of constipation from admission to follow‑up was generally significant in the intervention group (p </em>= 0.03) vs the control group (p </em>= 0.21). The difference in the mean number of cases of constipation was statistically significant (2.89) 2.10) control group vs 1.58 (1.65) intervention group, p </em>< 0.001).

A significant impact of the care plan was observed from admission to discharge, but further follow‑up was required with more client‑side collaboration. Therefore, the present care plan is recommended in the hospital and home care.

Patient safety management includes the documentation of fall risks. This study aims to portray the nurses’ performance toward the risk of falling management in hospitals.

A cross‑sectional approach was used as the study design to measure the documentation completeness of the nursing process toward the risk of falling at hospitals during 2020. There are 110 selected medical records of hospitalized patients based on inclusion criteria such as low‑risk medical records, hospitalization within 3 days, and a maximum hospitalization length of one year after the beginning of the data collection procedure. Univariate analysis is chosen to analyze the data.

The results showed that nurses were inconsistent in implementing fall risk management. Furthermore, the assessment was 68.18%, where 45.45% of nurses made the nursing diagnosis, 4.55% described the problems and etiology, and also 32.72% evaluated patients’ integrated records.

The incomplete documentation of fall risk describes the nonoptimal risk management implementation. The head nurse should develop a dynamic interaction with the fall risk patients, as well as increase nursing coordination and integration. 

Couples undergoing Assisted Reproductive Techniques (ART) come across various information needs. This study aimed to identify the health information needs of couples undergoing ART.

The methodology of the present applied study was qualitative and the research method was conventional qualitative content analysis performed with the participation of 25 infertile couples under ART. The study took nine months (July 2020 to March 2021). The samples were objectively screened based on the criteria from the couples referred to the infertility center affiliated to Hormozgan University of Medical Sciences (Public) and Ome‑Leila Specialized infertility clinic (Private) in Bandar Abbas (Iran). Data collection was performed by semi‑structured interviews. The typical content analysis method was used in this research. Data analysis was carried out based on coding by the use of MAXQDA a software for qualitative and mixed methods data analysis.

Information needs of couples under ART were categorized into three main categories and ten subcategories: 1) main cause of infertility [feminine or masculine cause, and etiology (nature and origin)], 2) treatment of infertility [identifying ART, treatment success rate, complications and risks (outcomes) of the treatment method, and treatment duration], and 3) healthcare [advice on medication, healthy nutrition (diet), sexual relations, and daily routine].

The results of this study emphasize that the country’s health officials, especially those in charge of the healthcare of infertile couples under ART, must necessarily pay more attention to meeting the needs of this group of people in society.

Cognitive disorders are one of the most common disorders in elderly people with chronic renal failure. This study aimed to investigate the correlation and agreement of Montreal Cognitive Assessment (MoCA), Abbreviated Mental Test Score (AMTS), and Mini‑Mental State Examination (MMSE) tests in assessing the cognitive status of elderly patients undergoing hemodialysis at Guilan University of Medical Sciences in north of Iran.

This cross‑sectional study was conducted on 84 elderly people undergoing hemodialysis. Inclusion criteria was having an age of 60 years old and older, hemodialysis treatment for at least 6 months, and having reading and writing skills. The Pearson correlation test, Intraclass Correlation Coefficient (ICC) test, and Bland–Altman plot were used for data analysis.

The majority of samples were in the age group of 60–65 years (28.57%) and the majority of them were male (66.66%). The results showed a significant positive correlation between MoCA and MMSE (r </em>= 0.69, p </em>= 0.001), between MMSE and AMTS (r </em>= 0.64, p </em>= 0.001), and between MoCA and AMTS tests (r </em>= 0.62, p </em>= 0.001). The results also showed a weak agreement between MoCA and MMSE tests (ICC = −0.11, p </em>= 0.633), between MMSE and AMTS tests (ICC = −0.007, p </em>= 0.369), and between MoCA and AMTS tests (ICC = −0.001, p </em>= 0.780).

Based on the results, these tools seem to complement each other. The inconsistency between cognitive tests indicates a serious need to develop appropriate instruments for detecting cognitive disorders in elderly.

Gestational diabetes is a widespread pregnancy‑related health problem. Its associated complications can be minimized by empowering women to enhance their self‑care behavior. This study aimed to evaluate the effect of an educational intervention using the Beliefs, Attitudes, Subjective Norms, and Enabling Factors (BASNEF) model on Gestational Diabetes Self‑Care Behaviors (GD‑SCB) among gestational diabetic woman.

A randomized controlled clinical trial was performed at the outpatient clinic, El‑Shatby hospital, Alexandria, Egypt, on 180 gestational diabetic women (91 intervention and 89 control groups). Data were collected from April to November 2019 using an interviewing schedule involving sociodemographic characteristics and obstetrics/medical history, BASNEF model questionnaire, and gestational diabetes self‑care behavior scale.

The findings revealed that an absence of statistically significant differences in sociodemographic characteristics and obstetrics/medical history between the intervention and control groups. Two months post‑intervention, all BASNEF model subcontracts and total GD‑SCB showed significant improvement in the intervention than the control group; knowledge (F1 = 173.92, p </em>< 0.001), personal beliefs (F1 = 286.54, p </em>< 0.001), subjective norms (F1 = 248.82, p </em>< 0.001), behavioral intention (F1 = 235.43, p </em>< 0.001), enabling factors (F1 = 59.71, p </em>< 0.001), and total GD‑SCB (F1 = 775.10, p </em>< 0.001). The effect size showed that 48.60% of the improvement within the intervention group total GD‑SCB was due to the intervention.

Empowerment through education using the BASNEF model for enhancing GD‑SCB was effective and beneficial. Therefore, it can serve as a basic framework for constructing and executing educational programs in the field.

In Iran, many efforts have been made to improve the Quality of Life (QOL) of the elderly; however, despite the efforts made, there is no practice guideline based on the consensus of experts that can be used to prevent the functional decline of hospitalized elderly. Accordingly, the present study was conducted with the aim of adaptation of a practice guideline to prevent the functional decline of hospitalized elderly.

This study is a developmental study based on the adaptation steps of the practice guideline. First, a search was conducted in 8 databases. The only practice guideline that met the inclusion criteria was then evaluated by the research team using the Appraisal of Guidelines for REsearch and Evaluation (AGREE II) tool. After content analysis of this guideline, the recommendations were categorized in the Canadian Senior Friendly Care (sfCare) Framework and according to the community conditions. Relevant evidence was used to supplement the content. The draft practice guideline was evaluated and modified in two expert panels through the RAND technique.

The categorized recommendations were developed in the eight chapters of introduction to the prevention of functional decline of the elderly, general practice guideline, organizational support, care processes, physical ecology, emotional and behavioral environment, ethics in care, and evaluation of function.

To prevent functional decline in hospitalized elderly individuals according to the adaptive practice guideline, the hospital and health team need to be aware of support, care processes, and effective function appraisal to be able to provide care with coherent and coordinated solutions.

Due to the increasing prevalence of intestinal diseases, colonoscopy is considered a safe and fast diagnostic and treatment method for these patients. According to studies, most patients waiting for a colonoscopy experience fear and anxiety. This study aimed to investigate the effect of a pre‑colonoscopy education program on the fear and anxiety of patients undergoing colonoscopy.

This randomized clinical trial study was conducted on patients undergoing colonoscopy in hospitals in southeast Iran. A total of 90 participants were selected by convenient sampling and randomly assigned to two groups control (n </em>= 45) and intervention (n </em>= 45). The patients in the intervention group received nursing interventions before colonoscopy, while the patients in the control group received only routine care. The data were collected using a researcher‑made fear of colonoscopy scale, its Cronbach’s alpha coefficient (0.92), and the Spielberger State‑Trait Anxiety Inventory. The data were analyzed with a Chi‑square t</em>‑test and pair t</em>‑test.

The data showed that anxiety and fear of colonoscopy in the patients in the intervention group significantly decreased compared to the patients in the control group (p </em><0.001).

Using non‑pharmacological methods before colonoscopy can reduce the fear and anxiety in patients who are candidates for this procedure and similar invasive procedures. The intervention performed in this study can be used together with other methods to control patients’ fear and anxiety. Especially for nurses, It is recommended to do pre‑colonoscopy education programs for these clients.

Psychological Distress (PD) is one of the most common mental disorders during pregnancy and involves stress, anxiety, and depression. According to the literature, High‑Risk Pregnancy` (HRP) is a major physiological risk factor associated with PD during pregnancy. The main purpose of this study was to explore the perception and experience of women with HRP who, based on standard questionnaires, had moderate‑to‑severe stress and anxiety scores.

This qualitative study was conducted using conventional content analysis from December 2020 to June 2021. To this aim, 16 women with HRP were purposefully selected from Imam Khomeini Hospital in Ahvaz, Iran, with maximum diversity. In‑depth, semi‑structured, individual interviews were conducted to collect the data. The MAXQDA software was used for data analysis.

Data analysis led to the extraction of two main categories and nine subcategories. “Disrupted peace” and “inefficient adaptation to the situation” were the two extracted categories. The former included the five subcategories of concerns about pregnancy complications, concerns about the parenting process, concerns about the couple’s relationship, fear of Covid‑19, and occupation‑related stress. The latter included the three subcategories of unpleasant feelings, current pregnancy experiences, and previous pregnancy experiences.

This study highlighted a wide range of psychosocial factors involved in the PD of women with HRP. These findings can be used to design appropriate prevention strategies to manage the mental health problems of these women in order to turn their pregnancy into a pleasurable experience.

Clinical Reasoning (CR) is a main professional competency for nurses which have significant contribution to sound clinical performance in critical clinical conditions. Nonetheless, evidence shows that nurses do not have the necessary competencies and thinking skills for managing complex conditions in critical care units. This study aimed at exploring the barriers to the development of CR skills among coronary care nurses.

Using conventional content analysis, this qualitative study was conducted in 2020 in the Coronary Care Unit (CCU) of Heshmat Subspecialty Heart Center in Rasht, Iran. Participants were 15 nurses, head nurses, nursing supervisors, nursing managers, and nursing instructors. Data were collected using semi‑structured interviews and were analyzed using conventional content analysis.

The four main categories of the barriers to CR skill development among nurses were limited professional development, inefficient educational program, ineffective professional interactions, and limited professional self‑efficacy.

There are different personal, educational, professional, and interprofessional barriers to the development of CR skills among CCU nurses. Study findings can be used to develop effective strategies for supporting and developing nurses’ CR skills.</em>

Spirituality is an important dimension of holistic nursing, and spiritual care is essential to ensure the achievement of optimal care in nursing profession. The aim of this study was to explain the obstacles to providing spiritual care from the perspective of nurses.

The present qualitative study was conducted between November 2020 and June 2021 with a content analysis approach. Participants included 30 nurses, selected through purposive sampling, working in the general wards and intensive care units of Isfahan University hospitals. Data collection method was semi‑structured personal interviews. After recording and transcription word by word, all data were analyzed through qualitative content analysis. MAXQDA 11 was used for data analysis.

Research findings included 323 primary codes and two main categories “individual barriers and organizational barriers” and eight subcategories “non‑compliance with human resources standards, lack of attention of organizational managers to the importance of holistic care, motivational barriers, training barriers, barriers to interprofessional collaboration, environmental barriers, barriers related to the nurses, and communication barriers.”

Using the results of the study, policymakers and nursing managers will be able to help facilitate spiritual care, and ultimately, improve the quality of nursing care by improving the infrastructure and removing existing barriers. 

Mothers of infants hospitalized in the Neonatal Intensive Care Unit (NICU) may experience a variety of psychological problems such as anxiety, depression, and stress. This study investigated the effect of midwife‑based Listening Visit (LV) on stress, anxiety, and depression among mothers of premature infants in the NICU.

This randomized clinical trial study was performed on 60 mothers of premature neonates who were admitted to the NICU of Taleghani Maternity Hospital between February and April 2018 in Arak, Iran. They were selected through simple random sampling. For the intervention group (n </em>= 30), six counseling sessions were held twice a week. The control group (n </em>= 30) did not receive any intervention. The mean values of stress, anxiety, and depression were measured before and 4 and 8 weeks after the intervention. Data were gathered using the Depression, Anxiety, Stress Scale‑21 (DASS‑21). The t</em>‑test and Chi‑square test were used to analyze the data.

The mean scores of anxiety (F </em>(2, 98) = 19.92, p </em>< 0.001), stress (F </em>(2, 98) = 43.94, p</em>< 0.001), and depression (F </em>(2, 98) = 42.95, p</em>< 0.001) significantly reduced after 4 and 8 weeks of intervention in the LV group.

LVs delivered by midwives can be effective in improving anxiety, stress, and depression in mothers of preterm infants in the NICU. Implementation of LV in the NICU resolves a recognized need and highlights the importance of psychological screening, and monitoring and support services for these mothers. 

Protective behaviors play a key role in reducing the incidence of COVID‑19 in HealthCare Workers (HCWs), and these behaviors are related to other factors. These related factors have not been comprehensively evaluated and determined in the literature. This study aimed to determine protection behaviors against COVID‑19 and their related factors using the Protection Motivation Theory (PMT) among HCWs of hospitals in Tehran, Iran, in 2021.

For this cross‑sectional study, 270 HCWs of different wards in 3 hospitals in Tehran, Iran, were selected through multistage sampling (April to July 2021). The participants completed a self‑reporting questionnaire which consisted of a demographic characteristics form and questions about protective behaviors against COVID‑19 and other constructs of the PMT (60 items). Data analysis was performed using descriptive and inferential methods.

The mean score of the protective behaviors of the HCWs was 4.20 (SD = 0.56) and was significantly higher in the nurses, women, married individuals, and those with a BSc degree compared with others (p </em>< 0.05). Furthermore, the results of multiple regression analysis showed that protection behavior among HCWs could be strongly predicted by the type of profession, protection motivation/intention, and self‑efficacy constructs (F14, 255 = 16.34, p </em>< 0.001).

The protection behaviors of HCWs against COVID‑19 were relatively desirable and these behaviors were related to and predicted by various factors. These results could apply to developing plans for protective behaviors against COVID‑19 and possibly other infectious diseases among HCWs. Further research in this regard is recommended.