Journal of Holistic Nursing and Midwifery
Volume:33 Issue: 2, Spring 2023

The first contact between emergency patients and medical services is carried out by emergency medical services (EMS). EMS personnel must deliver high-quality and high-speed services. This condition might cause high levels of stress and violence in the patients and their companions.

In this research, we aimed to study the violent acts against pre-hospital EMS personnel in Guilan Province, Iran.

This research was a cross-sectional study. A total of 110 EMS personnel working in Guilan Province in the north of Iran were selected using a random selection method between March and June 2020. A researcher-made questionnaire was used to collect the study data from the EMS personnel. The results were analyzed by the Poisson regression.

A total of 144 questionnaires were sent to the personnel, of these 110 were completed. The mean age of the participants was 34.89±3.65 years and all of them were male. About 61.8% of the samples experienced some kind of physical or verbal violence in the past 3 months. All cases of physical violence were perpetrated by men and half of them were done by close relatives of the patients. A significant relationship was found between the marital status of the EMS personnel and the number of physical violence they experienced (β=2.246, 95% CI; 0.058 to 4.446, P=0.032). In addition, the number of experienced physical violence was higher in those staff who worked at road EMS services compare to city or town EMS services (β=1.519,95% CI; 0.092 to 2.934, P=0.001). According to the EMS personnel, most of the attacks were answered calmly. The personnel revealed that the most important reason for not reporting physical violence was the futility of reports and the lack of guidelines for reporting violence.

The findings of this study confirm that pre-hospital EMS are at high risk of workplace violence in Guilan Province which highly affects their health and well-being. Training EMS personnel and strengthening their communication skills are important factors in reducing violence against emergency services technicians.

Elevated pre-gestational body mass index (obese/overweight) and improper gestational weight gain are important risk factors for predicting adverse pregnancy outcomes.

We aimed to identify the association between pre-pregnancy body mass index (BMI) and gestational weight gain on birth outcomes.

Data from this retrospective cohort study were extracted from 1457 (out of 1800) pair health records belonging to the pregnant mother and infants at Ahvaz Iran health care centers from 2010 to 2018. Ten public health care centers were randomly selected from the headquarters west and east of Ahvaz City. The samples were selected based on the inclusion criteria. They divided into different groups based on BMI (underweight, normal, overweight, and obese) and gestational weight gain (GWG) groups (inadequate and excessive versus adequate). Pregnancy outcome was analyzed according to the GWG during pregnancy for each BMI group through multivariable multinomial logistic regression. Relationships between maternal BMI, GWG, and offspring weight were examined. The analysis of covariance (ANCOVA) was used with adjusting the baseline values. The risks for adverse birth weight outcomes in women with different pre-pregnancy BMIs and GWGs were tested using the multivariable multinomial logistic regression analysis.

The Mean±SD of maternal age was 28.36±5.60 years. The Mean±SD birth weight was 3271.37±486.57 g. About 4.5%, 89.3%, and 6.2% of newborns were low birth weight, normal weight, and macrosomia, respectively. Also, 46.4% of women had weight gain above the guidelines. The increased risk for large for gestational age in overweight mothers (odds ratio [OR] =3.18, 95%CI; 0.45-7.29, P=0.007) and an increased risk for small for gestational age in those mothers with gestational weight gain below the guidelines (OR=2.9, 95%CI; 1.16-7.45, P=0.02). An increased risk of large for gestational age, low birth weight, and macrosomia were observed in overweight mothers with gestational weight gain out of the guidelines. An increased association was found between the maternal pre-pregnancy BMI and fasting blood sugar in 24 to 28 weeks of gestation. Hence, hyperglycemia is related to the incidence of macrosomia (OR=3.58, 95%CI; 1.70-7.66, P=0.0001). 

Managing maternal weight with respect to reproductive health care is required for all women in childbearing age (before and during pregnancy) to reduce the adverse pregnancy outcome.

Auditory stimulation is a treatment method for sensory deprivation of comatose patients, which helps wake up the patient by activating the choroid plexuses in the brain.

This study aims to determine the effect of auditory stimulation with occupational noise on the consciousness level of comatose patients with traumatic brain injury (TBI).

This clinical trial was conducted on 50 comatose patients with TBI hospitalized in intensive care units of one of the hospitals in Qom City, Iran. They were randomly assigned to two groups of control (n=25) and intervention (n=25) using the block randomization method. The intervention group received auditory stimulation with occupational voice for 10 days in the morning and evening shifts, each for 15-20 minutes. The consciousness level of patients was evaluated before and after stimulation using the Glasgow Coma Scale (GCS). The obtained data were analyzed using descriptive statistics, the Chi-square test, the independent t test, and the generalized estimating equations model.

The Mean±SD ages of the patients were 35.92±14.68 years in the intervention group and 33.32±13.74 years in the control group. No significant difference was observed between the two groups regarding demographic or disease-related variables. The Mean±SD scores of GCS before the stimulation were 5.28±1.81 in the control group and 5.12±1.90 in the intervention group. This difference was not statistically significant. The Mean±SD scores of GCS after the stimulation were 6.60±3.25 in the control group and 8.80±4.05 in the intervention group. This difference was statistically significant (P=0.038). The level of consciousness in the intervention group increased more than in the control group in the 10th day of study.

Auditory stimulation with occupational noise can increase the consciousness level of comatose patients with TBI. Auditory stimulation can raise the consciousness level of these patients hospitalized in intensive care units.

Psychological distress is prevalent among the primary family caregivers of patients with stroke.

This study evaluated the effects of acupressure on anxiety, stress, and depression among the primary family caregivers of Patient With Stroke.

In this sham-controlled randomized clinical trial, 96 family caregivers of Patient with Stroke were selected and allocated to the acupressure (n=40) and sham (n=42) groups. The study data were collected using demographic questionnaires for the patients and caregivers, the Barthel index (for assessing independence in daily living activities,) and the Persian version of the Depression Anxiety Stress Scale (DASS). Participants in the acupressure group received training about acupressure on the Yin Tang and HT7 points, while participants in the sham group received training about acupressure on the CV24 and TB5 sham points. The acupressure intervention lasted for 30 consecutive days. Statistical tests, including the Kolmogorov-Smirnov test, the independent t test, the Chi-square test, the Fisher exact test, the Wilcoxon, Mann-Whitney U test, and the analysis of covariance (ANCOVA) were applied to analyze the data.

The mean ages of the participants were 46.1±12.1 years in the acupressure group and 42.7±11.8 years in the sham group. The mean ages of the patients in these groups were 75.1±8.1 and 76.8±9.7 years; respectively. Regarding the demographic characteristics, no significant differences were observed between the acupressure and the sham groups. Regarding the pre-test mean scores of anxieties, stress, and depression, there were no significant differences between the acupressure and the sham groups. Anxiety and stress significantly reduced after the intervention only in the acupressure group (P<0.05). However, depression did not change substantially during the study. The ANCOVA indicated significant differences between the two groups after the intervention regarding anxiety and stress. In other words, in the acupressure group, anxiety and stress significantly improved compared to the sham group (P<0.05).

It seems that the acupressure on the Yin Tang and HT7 points can help manage anxiety and stress among the primary family caregivers of Patient With Stroke.

An expectant mother’s experience of normal vaginal delivery significantly impacts her health. One of the determinants of a positive experience is to enjoy constant support during labor.

This study was conducted to understand the mother’s childbirth experience with the support of a doula during labor and delivery.

This research was a qualitative study with a content analysis approach. A total of 16 pregnant women that gave birth with the assistance of doulas in a hospital in Zanjan City, Iran, were included in this qualitative study with a content analysis approach. Purposive sampling was used to select the participants in 2019. The study data were collected through in-depth, semi-structured interviews with mothers, then transcribed and coded. All interviews were conducted in one session, so 16 interviews were obtained. Data analysis was done using the method proposed by Graneheim and Lundman.

The participants were 18-35 years old (27.5±6.7 years). Three women had a primary school education, 7 had a high school diploma, and 6 had a university education. Four women were employed, and the rest were homemakers. After data analysis, 4 main categories and 8 subcategories were extracted. Main categories and subcategories include comprehensive support (physical support, mental support), assisting in materializing the motherhood dream (inducing calm in the mother, being released from pain and suffering), internal reinforcement (self-esteem, pain acceptance), and mother-centered care (doula as a different supportive, bidirectional relationship).

Pregnant mothers’ satisfaction with delivery is affected by their experience. According to the results, all mothers were satisfied with doula support during delivery. The doula’s presence made childbirth a positive and satisfactory experience. The doula guided mothers from fear, pain, and ignorance to happiness and satisfaction. It is necessary to familiarize expectant mothers with the doula and the services they provide and facilitate their presence in labor and delivery rooms.

HIV infection and AIDS are associated with numerous challenges, and infected people experience extreme despair, fear, anxiety, and depression. However, counseling therapy and yoga techniques may help ease stress-related illness, produce internal strength through relaxation, and enhance immunity.

This study aimed to evaluate the effectiveness of counseling therapy and Hatha yoga on the adherence level, nutritional status, and quality of life (QOL) of HIV-infected adolescents.

A randomized controlled trial study was conducted. Through the simple random method, 388 (195 in the experimental and 193 in the control group) HIV-infected adolescents were selected. The data of HIV-infected adolescents and caregivers were collected from four main Antiretroviral Therapy clinics in Chennai, India, through Standardized Antiretroviral Therapy adherence, QOL, and a structured nutritional assessment questionnaire. Motivational counseling was given to the experimental group, and the researcher demonstrated selected asanas. The data were collected from both groups at 0, 3, and 6 months intervals. The descriptive statistics of mean, standard deviation, and inferential statistics of the student independent t test and Chi-square test were used to determine the effectiveness of interventional variables in both groups.

The Mean±SD age of the experimental group of adolescents was 13.6±2.2 years, and that of the control group was 13.8±2.4 years. There is an improvement range in the experimental vs the control group for the components of adherence level (13.4% vs 4.9%) and QOL (15.1% vs 0.9%) at a significance of P=0.001 with a 95% confidence interval. Also, the nutritional gain score was significantly increased to 9.3% vs 1.5% (P=0.05). Regarding CD4 (cluster of differentiation 4) count, the baseline mean score was 664.86 vs 669.72, whereas, in the sixth month, it significantly increased to 840.35 vs 703.35 (P=0.001).

Motivational counseling and behavior modification of yoga efficiently improved health status and well-being among HIV-infected adolescents in the experimental group compared to the control group.

Social competence can help adolescents achieve effective social interactions and establish and maintain successful relationships with peers and society.

The purpose of this study was to determine the status of social competence and its related factors in high school students in Rasht City, Iran.

In the cross-sectional analytical study, 491 high school students in Rasht were selected by multi-stage random cluster sampling. The study tool was a two-part questionnaire: the demographic characteristics of the participants and the social competence questionnaire. Descriptive statistics, 1-way analysis of variance (ANOVA), the Pearson correlation coefficient, independent t test, and multiple linear regression were used for statistical analysis.

Of 491 students, 65.4% were female, 63.1% were the first child of the family, and 94.3% had normal sleep amount. Also, 94.1% of students lived with their parents. Their mean social competence was at the desired level (261.7±8.31, total score: 47-329). There was a significant relationship between school grade point average (r=0.271, P=0.001), duration of Internet use (r=-0.103, P=0.022), and students’ sleep amount with social competence based on 1-way ANOVA test (P=0.005). Based on multiple linear regression analysis, a high-grade point average was associated with increased social competence (B=7.54, 95% CI; 5.43 to 9.78, P=0.001) and female gender (B=-6.71, 95% CI; -13.15 to -0.26, P=0.04), being the second child compared to the first (B=-8.19, 95% CI; -14.48 to -1.90, P=0.011), insomnia (B=-19.07, 95% CI; -36.14 to -2.01, P=0.029) and parental divorce and living with father (B=-46.47, 95% CI; -81.95 to -10.99, P=0.01) were associated with low social competence (R2=0.16). 

These results can help managers plan educational and training organizations and promote parents’ awareness to eliminate everyday barriers and develop social competence in adolescents.

The most important diagnostic indicator of Acute Coronary Syndrome (ACS) is typical clinical symptoms, like chest pain, but many patients may experience nonspecific (atypical) symptoms. Understanding these symptoms and their associated factors results in early diagnosis and more appropriate treatments.

We aimed to determine atypical clinical symptoms and their predictors in patients with Acute Coronary Syndrome.

This cross-sectional study was conducted on 1167 patients with ACS hospitalized at a specialized hospital in Rasht City, Iran, between December 2019 and October 2020. The research samples were selected by a consecutive sampling method. Data were collected through a researcher-made questionnaire by interview, in which sociodemographic characteristics, risk factors, disease-related factors, and symptoms of patients with ACS were collected. Data analysis was done by descriptive statistics and multiple logistic regression by the backward LR (likelihood ratio) method. The significance level was set as P<0.05.

In this study, 56.3% of the patients were male. The Mean±SD age of the patients was 60.9±11.1 years. About 28.1% of the patients experienced atypical clinical symptoms. The most common atypical symptoms were shortness of breath (29.4%), back pain (18.3%), and left shoulder pain (12.7%). The predictors of atypical symptoms were age (OR=0.98, 95% CI; 0.975 - 0.999, P=0.047), alcohol use (OR=1.86, 95% CI; 1.047 - 3.303, P=0.034), brain diseases (OR=2.36, 95% CI; 1.463 - 3.811, P=0.001), blood diseases (OR=1.45, 95% CI; 1.059 - 2.002, P=0.021), and gastroesophageal reflux (OR=1.31, 95% CI; 1.006 - 1.719, P=0.045)

Since more than a quarter of ACS patients have unusual symptoms, detecting these symptoms and related factors can help in early diagnosis and conduct more appropriate medical treatment.

Cushing disease is a rare problem that usually has an important effect on the quality of life (QoL).

This survey aimed to evaluate patients’ QoL and determine predictors of improving QoL scores in patients.

In this before-after study, basic characteristics were collected from 56 patients with Cushing disease who underwent endoscopic transsphenoidal surgery, and their QoL score during one year was assessed. Finally, predictor factors of QoL score improvement were identified. To compare the QoL scores before, 6 months, and 12 months after surgery, repeated measures ANOVA and for determining predictors of QoL score improvement, multivariable logistic regression analysis was used. P<0.05 was considered significant in all tests.

The Mean±SD age of the samples was 33.92±12.82 years, and 43 (76.8%) were female. In all 56 patients who underwent endoscopic transsphenoidal surgery, the QoL score significantly improved. In multivariable logistic regression analysis, weight loss (OR= 1.2, 95% CI; 1.01-6.5, P=0.01), no fatigue (OR= 2.1, 95%CI; 1.6-8.3, P=0.009), no decreased libido (OR= 1.5, 95% CI; 1.2-10.62, P=0.01), no gonadal axis disorder (OR=2.2, 95% CI; 1.07-4.06, P=0.01) and post-operation no thyroid axis disorder (OR=2.5, 95% CI; 1.8-5.7, P=0.01) were predictors for more QoL score improvement.

According to the results of this study, many factors can affect the quality of life in patients with Cushing disease. Therefore, support groups should include the cooperation of physicians and psychologists, provision of health services, and social support to improve the QoL of patients.