Journal of Holistic Nursing and Midwifery
Volume:34 Issue: 2, Spring 2024

Infertility creates a crisis in people’s lives, resulting in many psychological consequences. One of these consequences is infertility stress. Infertile men’s spouses are as stressed as infertile women in many areas.

This study aimed to investigate the effect of existential group therapy on infertility stress in infertile men’s spouses.

This clinical trial was conducted on 91 women whose husbands were infertile and living in Shahrood City, Iran, from August 2021 to March 2022. The subjects were randomly divided into two groups (48 in the intervention and 48 in the control group). A random sampling method was used to select samples, and a random block of size 4 was used for allocation. Eight existential group therapy sessions were conducted for the intervention group. All participants completed the demographic information questionnaire and infertility stress questionnaire before and after the intervention. The obtained data were analyzed using the paired and independent t-tests.

The mean±SD ages of the participants were 31.46±5.80 and 31.89±4.53 years in the intervention and control groups, respectively. Duration of infertility in the intervention and control groups were 5 and 4 years, respectively. Results showed significant differences between the mean±SD of the social concern subscale of the intervention group (28.35±10.36) and that of the control group (38.39±9.44), between the sexual concern subscale of the intervention group (28.68±8.72) compared to that of the control group (35.88±9.03), between communication concern subscale of the intervention group (29.28±12.18) compared to that of the control group (41.86±10.34), between lifestyle without children subscale of the intervention group (31.06±8.78) compared to that of the control group (37.13±8.78), and between need to be a parent subscale of the intervention group (37.55±9.22) compared to that of the control group (47.43±10.34) at the post-test (P=0.001). Results showed a significantly lower infertility stress total score for the intervention group (154.95±25.94) compared to the control group (190.02±25.91) at the post-test (P=0.001).

Existential group therapy counseling may be a useful approach to reduce the stress of infertility among couples who struggle with infertility.

Premature infants in neonatal intensive care units are exposed to painful experiences due to various procedures, and effectively and safely pain relief is the responsibility of nurses. Due to their harmful effects on the neural development of premature infants, reducing environmental stimuli such as light and sound is one of the essential pillars of caring for these infants. 

This study aimed to determine the effectiveness of modulation of environmental stimuli on pain caused by peripherally inserted central catheter (PICC) placement in preterm infants.

This controlled trial study was conducted on 60 infants receiving PICC-port implantation. The infants who met the inclusion criteria were selected by random sampling. Then, they were randomly placed in an intervention or control group (30 in each group). The sound and light were reduced in the intervention group using earmuffs and eye shields. When implanting a central venous catheter, the pain amount was measured using the premature infant pain profile (PIPP) instrument. The control group measured neonatal pain without light and sound reduction. The data were recorded for statistical tests using the independent t-test, chi-squared test, and Fisher exact test.

Most of the studied neonates were female (56.6%) and analysis of covarianse. The total number of newborns who were candidates to receive a PICC-port was 80, of whom 60 were included in the study. The neonates have no surgery and congenital anomalies. Both genders were included in this study; 24.6% of them suffer from respiratory distress syndrome and prematurity simultaneously. The Mean±SD scores of pain were 9.37±3.15 in the intervention group and 12.63±2.19 in the control group. The independent t-test showed no significant difference between the two groups regarding demographic characteristics before the intervention. The mean score of PIPP after the intervention was significantly less in the intervention group than in the control group (P=0.001). According to the results of the analysis of covariance, adjusting the environmental stimuli of light and sound was effective on the pain level of the neonate during PICC implantation with an effect size of 0.917.

Environment modifications are effective, inexpensive, accessible, and safe methods during PICC placement for premature infants in the neonatal intensive care unit and should be used to promote neonatal outcomes in terms of the neural development of the infant.

In many healthcare centers, evidence-based practice (EBP) is a vital tool for providing better and safer healthcare services. 

This study investigates the psychometric properties of the Persian version of the EBP implementation questionnaire in nurses.

This is a methodological and cross-sectional descriptive analytical study. We selected 400 nurses (200 for exploratory factor analysis and 200 for confirmatory factor analysis) via convenience sampling. The study questionnaire was translated based on the World Health Organization (WHO)’s guidelines. Construct validities of the EBP were assessed through exploratory and confirmatory factor analyses. The repeatability was also evaluated by the test re-test method. The study was conducted based on the COSMIN (consensus-based standards for the selection of health status measurement instruments) checklist.

The exploratory factor analysis revealed four factors: Evidence evaluation, development of evidence use, evidence sharing, and access to evidence. These factors could explain 58.30% of the total variance of evidence-based care in the nurses. Confirmatory factor analysis confirmed the goodness of fit of the 4-factor model of EBP implementation. The reliability of the evidence evaluation, development of evidence uses, evidence sharing, and access to evidence factors was confirmed using the Cronbach α coefficient. In addition, this questionnaire had excellenttest re-test reliability and the intra-class correlation coefficient (ICC), whose values were reported to be 0.996 with a confidence interval (CI) of 0.991 to 0.998 and P=0.001. Also, its re-test reliability was equal to 0.85.

The Persian version of the EBP implementation scale has acceptable reliability and validity. In addition, the number of items in this questionnaire is low. Therefore, it can be used to measure the implementation of EBP in Iranian nurses and identify groups of nurses needing special interventions.

Not-prescribed use (NPU) of herbal products and supplements during pregnancy is a potent risk for both mother and fetus and a big challenge for anesthesiologists. However, little is known about this topic in Guilan Province, Iran. 

This study aimed to determine how pregnant women take supplements and herbal medications. 

This analytical cross-sectional study was conducted in 2022. Eligible pregnant women enrolled in the survey, and a checklist containing items about maternal demographic data and the maternal pattern of herbs and supplements used during pregnancy was filled out through a face-to-face interview. Multivariate logistic regression, the Chi-square, and the Mann-Whitney U statistical tests were used to analyze the data.

The data from 682 women were analyzed. A total of 488 women (71.6%) were less or equal to 30 years old; 498(73%) lived in urban areas; 508(74.5%) were homemakers; 444(65.1%) had under-diploma or diploma education, 292(42.8%) were gravid one or 251(36.8%) gravid two. In addition, 25.1% reported using at least one herbal remedy during pregnancy, and 90% took supplements; 0.7% had NPU of supplements and 93.6% took herbal products. About 10% did not take any supplements. Iron (23.3%) and folic acid (23.1%) were the most frequently taken supplements, and thyme (20.2%) and mint (17.5%) were the most commonly taken herbs. Using logistic regression, we found that urbanization (OR=1.91, 95% C, 1.6%, 3.14%, P=0.01), employment (OR=2.21, 95% CI; 1.46%, 3.33%, P=0.0001), and higher gravidity (OR=2.03, 95% CI; 1.22%, 3.36%, P=0.006) increases the probability of consuming supplements and herbal products during pregnancy.

The lack of physicians’ supervision of the herbal therapy process among pregnant women in an academic center was worrying. However, most women received the supplements based on healthcare professionals’ advice. A few women did not take essential supplements.

Insomnia in older people results from aging and declining body function. However, no studies have identified the proper therapy to reduce insomnia in older adults. 

This study aimed to examine the complementary therapies commonly used to lessen insomnia in older adults. 

A systematic review was conducted based on PRISMA (the preferred reporting items for systematic reviews and meta-analyses), and quantitative and randomized controlled trials were searched in PubMed, Science Direct, Google Scholar, Lilacs, SciELO, DOAJ, ProQuest, and GARUDA. The methodological quality of the included studies was assessed using the EPHPP QAT (the effective public health practice project for quality assessment tool) for quantitative studies. Only studies of moderate and strong quality were included. 

We analyzed 11 studies with a sample of 2495 older people. The significance of therapeutic effects on elderly insomnia had a strong influence with a P of 0.05 and Cohen’s kappa of 0.80 in four studies. We identified 11 articles that found complementary therapies appropriate and recommended in reducing insomnia in older adults, including Tai Chi, cognitive behavior therapy, lavender aroma, and digital cognitive therapy. The results of the insomnia score were more than 50% positive changes, without adverse effects, including improvement in sleep efficiency (57%), total sleep time (60%), and insomnia rating scale score (75%).

The application of complementary therapy has put forward alternative treatments for older adults to reduce insomnia problems, improve their quality of life, and enhance the qualifications of nurses in other applied fields.

Third- and fourth-degree perineal tears are considered severe, whose prevalence rate is different based on the population, place, and time, and several factors can be involved in their occurrence.

This study aims to determine the prevalence of severe perineal tears during normal vaginal delivery (NVD) and its risk factors among women in Qom, Iran.

This is a descriptive-analytical retrospective study with a case-control design, which was conducted on the medical records of women who gave birth from March 2010 to March 2019 in three teaching hospitals in Qom (n=115,107). Those with third- and fourth-degree perineal tears were put in the case group (n=138), and those with no severe perineal tears were considered as controls (n=138). Information was collected using a checklist surveying demographic information, previous medical history, and obstetric information. The data analysis was done using independent t-test, chi-square test, Fisher’s exact test, and multivariate logistic regression analysis. The significance level was set at 0.05.

Among 115,107 childbirths in the hospitals, 138 cases (0.12%) had third- and fourth-degree tears. The mean age of women was 27.00±4.64 years and their mean gestational age was 39.09±1.05 weeks. None of the mothers consumed alcohol, and only two were smokers. The birth weight of newborns, parity, length of the first and second stages of labor, nationality, and time of delivery were significantly different between the two groups (P<0.05). The results of the multivariate logistic regression analysis showed that only the variables of birth weight of newborn (OR=0.91, 95% CI; 0.96%-0.99%, P=0.009), length of the first stage of labor (OR=0.06, 95% CI; 0.02%-0.19%, P=0.001) and length of the second stage of labor (OR=0.04, 95% CI; 0.03%-1.1%, P=0.001) were the significant predictors of severe perineal tears.

the high birth weight of newborns and the prolongation of the first and second stages of labor are the risk factors for severe perineal tears. Therefore, it is recommended that obstetricians in Iran pay attention to these risk factors in the management of the labor process.

The unique occupational nature of the nursing profession creates anxiety as the most common psychiatric disorder among nurses. 

This study investigated the relationship between personality traits and health anxiety among nurses.

In this analytical cross-sectional descriptive study, 185 nurses from six teaching hospitals affiliated with Zanjan University of Medical Sciences in Iran were selected by stratified random sampling. Data collection tools included a demographic questionnaire; neuroticism, extraversion, openness personality inventory, NEO 5factor inventory (NEOFFI) personality traits (short form), and health anxiety inventory (HAI), which the participants completed by the self-report method. The obtained data were analyzed using descriptive (frequency, percentage, Mean±SD) and inferential (the independent t-test, ANOVA, the Pearson correlation, and multiple linear regression) statistics.

The participants’ Mean±SD age was 34.83±8.26 years. About 58.4% of the nurses were female, and most were married (82.2%). Nurses’ Mean±SD score of health anxiety was 22.86±4.05. The results of the NEO personality questionnaire showed that the highest mean (29.34±8.40) was related to the conscientiousness personality trait and the lowest to extroversion (25.53±8.64). The findings showed a positive and significant relationship between health anxiety and neurotic personality trait (P=0.001, r=0.411) and negative relationships with extraversion (P>0.05, r=-0.199) and openness to extroversion (β=-0.19, 95%CI, -0.66%, -0.04%, P=0.039) personality traits. Also, neuroticism (β=0.23, 95%CI, 0.06%, 0.8%, P=0.012) and extroversion (β=-0.19, 95%CI, 0.66% to 0.04%, P=0.039) personality traits  can predict health anxiety in nurses. The findings revealed that 7.9% of the variance of health anxiety could be explained by the nurse’s personality traits (F=2.81, R=0.256, R2=0.098, adjusted R2=0.079, P<0.05). 

 According to the study results and considering the importance of nurses’ quality of performance, it is recommended that nurses with personality traits vulnerable to anxiety be identified, and the necessary training will be provided to them in the form of anxiety control and management workshops.

Anxiety and changes in hemodynamic indices are common problems of patients undergoing coronary artery bypass grafting (CABG). These problems can affect the outcome of the surgery.

This study aimed to determine the effect of the Benson relaxation technique and lavender aromatherapy on anxiety and hemodynamic indices of patients undergoing CABG.

In this randomized, nonblinded, parallel-group controlled trial, 105 candidates for CABG were randomly selected by convenience sampling and then allocated to relaxation (n=35), aromatherapy (n=35), and control (n=35) groups by a six-block random assignment. Benson relaxation technique was used in the relaxation group. In the aromatherapy group, the inhalation of five drops of lavender essential oil with a concentration of 20% was used, and the control group only received routine nursing care before surgery. Data were collected using demographic characteristics form, checklist of hemodynamic indices, and Spielberger state-trait anxiety inventory before and after the intervention. The obtained data were analyzed using descriptive and inferential statistics (the chi-square test, the Kruskal-Wallis test, the Wilcoxon test, one-way ANOVA, the paired t-test, post hoc Mann-Whitney U test, and the Bonferroni test).

The Mean±SD ages of the patients were 58.46±12.45 years in the relaxation group, 61.54±11.93 years in the aromatherapy group, and 60.17±14.76 in the control group. After the intervention, the respiratory rate, pulse rate, systolic blood pressure, and mean trait-state anxiety scores significantly differed in the intervention groups compared to the control group (P<0.05). However, oxygen saturation and diastolic blood pressure were not significantly different in the two intervention groups from the control group. Benson relaxation technique was significantly superior only on systolic blood pressure compared to lavender aromatherapy (P=0.001).

Benson relaxation and lavender aromatherapy as non-invasive, easy, and cheap complementary therapies can effectively reduce anxiety and stabilize hemodynamic indices of patients undergoing CABG surgery in clinical settings.

A significant challenge in disaster response operations is the willingness of healthcare providers (HCPs) to engage and work in critical situations. Therefore, identifying the factors associated with the intention to participate in disaster response operations will lead to planning better and coping with such situations. 

This systematic literature review aims to determine the factors affecting the intention of HCPs to work in disaster response operations.

In this systematic literature review, a search strategy was developed using keywords in relevant articles to obtain relevant studies published between 1950 and November 1, 2020. Those keywords were obtained through consultation with experts’ opinions in disaster risk management and a medical librarian. This study was designed as a systematic review, following the PRISMA (the preferred reporting items for systematic reviews and meta-analyses) guidelines. Databases examined included Scopus, PubMed, and Web of Science. The relevant data (title, author/s, year of publication, country, population of HCPs, sample size, response rate, study design, tools, data collection method, and type of disasters) in the included studies were extracted using a checklist designed for this purpose. Then, the factors affecting staff intention were categorized by thematic analysis.

Out of 5721 retrieved articles, 16 were enrolled in this review. Extracted factors affecting the staff intention to work were classified into 3 main categories and 16 subcategories as follows: organizational factors (supply management, risk management, organizational environment, organizational climate, managerial support, financial incentives), personal factors (demographic, familial, beliefs and values, health status, individual experiences, knowledge and education, occupational, self-efficacy), and nature of disaster (type of disaster).

The results of this study showed that the intention and motivation of the HCPs to work in the disaster response phase depends on the type of disaster, the risks affecting their health and their families, commitment to the community, professional and financial issues, and responsibility.

Coronary artery bypass graft (CABG) is the primary surgical process to reduce mortality in patients with coronary artery disease. Atelectasis, as the most important pulmonary complication, postpones the recovery period. One of the most innovative methods for preventing atelectasis is continuous positive airway pressure (CPAP). 

The present study evaluated the effect of adding CPAP to the cardiac rehabilitation program after CABG on exercise and respiratory parameters.

This research was a randomized clinical trial conducted on 40 patients of two intervention groups (20 patients) and control (20 patients) after CABG. They were randomly assigned with four block randomizations to receive CPAP mask besides incentive spirometry (IS) in the intervention group or only IS in the control group. Data collection tools were demographic information, modified Borg scale 10, exercise, and respiratory parameters. Participants were assessed from the first to the fourth days of the study. The repeated measures analysis of covariance, t-test, Mann-Whitney test, and multivariate analysis of covariance were used for data analysis.

There were 17 men and 3 women in the intervention group and 12 men and 8 women in the control group. Their Mean±SD age was 59.80±9.54 years in the intervention and 54.45±11.32 years in the control group. From the first to the third day, the values of dyspnea (P=0.001), leg effort (P=0.001(, walking time (P=0.001), and peripheral oxygen saturation before and after walking (P=0.001) were statistically significant in both groups. Considering the group effect, dyspnea (P=0.002), leg effort (P=0.001), walking time (P=0.001), and peripheral oxygen saturation before and after walking (P=0.001) were significant between the two groups. Considering the group and time effect, the tidal volume (P=0.001), minute ventilation (P=0.006), forced vital capacity (P=0.001), forced expiratory volume in one second (P=0.001), and peak expiratory flow (P=0.001) were significant. 

Adding a ventilation assist gadget featuring CPAP to cardiac rehabilitation programs may improve the exercise and respiratory parameters after CABG.