JOURNAL OF HOLISTIC NURSING AND MIDWIFERY
Year:2024 | Volume:34 | Issue:3|Papers Count:10

Introduction: The physiological changes with increasing age make older adults more prone to acquiring chronic diseases, and their treatment needs multiple drug regimens. However, the extensive use of medications is accompanied by an increased risk of adverse drug reactions (ADRs), partly due to polypharmacy (concomitant use of multiple drugs). Both polypharmacy band medication adherence are considered major public health concerns, which are growing worldwide. Objective: This study was conducted to determine drug adherence in older adults with polypharmacy referred to selected educational medical centers of Iran University of Medical Sciences, Tehran City, Iran, in 2021. Materials and Methods: The present study is a descriptive cross-sectional analytical study. The sample consisted of 243 older people. The participants were selected using a non-probability sampling method (continuous method with categorical proportional allocation). The inclusion criteria were older adults taking polypharmacy (five or more prescribed drugs). Data collection tools were a demographic personal and clinical characteristics form, a drug compliance questionnaire, and a 10-point visual analog scale (VAS) of self-perception of health. After the participants had completed the questionnaires, the raw data were analyzed using descriptive and inferential statistics methods, including analysis of variance, independent t-test, and the Pearson correlation coefficient. The significance level was considered P<0.05. Results: The mean age of the subjects was 69.38±6.6 years; their mean perception of health was 5.83±2.33, and the mean number of underlying diseases was 2.3±1.19. The study participants showed moderate drug adherence, which was insufficient. No significant relationship was found between demographic and clinical variables with drug adherence. The Pearson correlation test results showed a weak correlation between age and medication adherence (r= 0.029, P=0.001), as well as age and number of underlying diseases (r=0.031, P=0.001). Conclusion: This study demonstrated moderate drug adherence in older adults with polypharmacy, which is not optimal. Healthcare professionals involved in patients’ medication use play a key role in providing essential education to older adults with polypharmacy to improve drug adherence.

Introduction: Chronic kidney disease is one of the public health issues in the world. Imbalances in the gut microbiome contribute to the progression of multiple diseases, including chronic kidney disease. The consumption of probiotics and synbiotics in treating various diseases has progressed significantly.  Objective: The present study investigates the effects of synbiotic supplements on the intestinal microbiome, resulting in improving fatigue and sleep quality of end-stage renal disease patients undergoing hemodialysis. Materials and Methods: The study was a double-blind, randomized, placebo-controlled clinical trial. A total of 52 patients with end-stage renal disease undergoing hemodialysis were included in the research and, through permuted block randomization, assigned to the synbiotic group (28 patients) and the placebo group (24 patients). The intervention group received 500 mg of synbiotic (Lactocore) twice a day for eight weeks, and the control group received a placebo for the same period. The patients were evaluated with the Chalder fatigue and Pittsburgh sleep quality questionnaires at the beginning, the fourth week of the study, and at the end of the study. Demographic variables were analyzed using the chi-square test, Fisher exact test, or independent sample t-test, as appropriate. The repeated measures test was used because the outcome variable has been measured three times in each group. Results: The samples, consisting of 26 males (50%) and 26 females (50%), were randomly allocated to the placebo (n=24, 46.16%), 12 males and 12 females, and the synbiotic supplement (n=28, 53.84%), 14 males and 14 females, groups. The result showed regular use of a synbiotic supplement for 8 weeks did not show a change in the amount of fatigue and sleep quality reported in patients receiving the synbiotic supplement considering the effect of time and group compared to the placebo group. Conclusion: In general, the 8-week consumption of synbiotic supplements in the intervention group compared to the control group did not significantly affect the fatigue and sleep quality of patients undergoing hemodialysis treatment. However, further studies with larger sample sizes and longer duration are suggested.

Introduction: Medication error and professional commitment are two topics in the nursing profession. Objective: The current study aims to determine the association between professional commitment and reported medication errors in nurses working in hospitals in Ardabil and Khalkhal cities, Iran, in 2021. Materials and Methods: This descriptive-analytical research was correlational and was conducted on 350 nurses working in educational and medical centers in Ardabil and Khalkhal cities in the north of Iran in 2021. Sampling was done by simple random method. The questionnaire on professional commitment and medication error was used to collect information. The t-test, Pearson test, chi-squared test and multivariate linear regression were used to determine the associations between study variables.  Results: The results show that the Mean±SD of the study participants’ age was 34.76±27.20 years and most participants were female (78.28%). Also, the Mean±SD of the total score of medication error and professional commitment in nurses were 14.64±4.56 and 94.15±11.97, respectively. Statistically, there was a significant relationship between medication error and nurses’ professional commitment (P=0.008, r=-0.15). The results show that among the investigated variables and their effect on medication error, commitment to the nursing profession (β=0.154, 95% CI; 0.001%, 0.3%, P=0.048) has a direct and significant relationship, with the increase in commitment to the nursing profession, medication error increases and also married status (β=-0.261, 95% CI; -2.96%, -1.007%, P=0.002) has an indirect and significant relationship with medication error.  Conclusion: The study’s findings showed a statistically significant relationship between professional commitment and medication errors in nurses. Therefore, strengthening the organizational commitment of nurses can reduce medication errors and ultimately increase the safety of patients.

Introduction: During the COVID-19 epidemic, the mental status of nurses and other healthcare workers was strongly influenced by environmental conditions.  Objective: This study aimed to determine the association between social support and resilience with the mediating role of self-efficacy in nurses working in public hospitals. Materials and Methods: In this cross-sectional study, 220 nurses working in the educational and medical centers of Rasht City, Iran, in 2021 were recruited by simple random sampling. The general self-efficacy scale, multidimensional scale of perceived social support questionnaire, and Connor and Davidson resilience scale were used to collect data. The Pearson correlation coefficient test was used to investigate the linear relationship of the variables. To evaluate the fit of the proposed model, the chi-square test, degrees of freedom, goodness of fit index, Tucker-Lewis index, comparative fit index, and root mean square error of approximation were calculated. Bootstrap test was used to investigate the role of self-efficacy in the middle of social support and resilience and to assess the direct effects of variables.   Results: The results showed that 201 women (91.4%) and 19 men (8.6%), with a mean age of 36±8.43 years, participated in this study. Moreover, 25.5% and 74.5% of participants worked in COVID-19 or non-COVID-19 wards, respectively. Data analysis using the Bootstrap test showed that self-efficacy mediated between social support and resilience (P=0.001). Also, the study findings have shown that the direct effects of social support on resilience are significant, with a path coefficient of 0.203 (P=0.004), so when social support increases, resilience increases, too. Also, in this research, the direct path of self-efficacy on resilience was significant with a path coefficient of 0.595 (P=0.001), so when self-efficacy increases, resilience increases, too. Conclusions: Findings of this study have shown that nurses’ self-efficacy serves as a mediator in the relationship between social support and productivity. Empirical evidence suggests that individuals who receive greater social support exhibit heightened levels of self-efficacy.

Introduction: Anxiety is a manifestation of psychological changes occurring during pregnancy. It is important to involve the husband in supporting the mother during pregnancy. Objective: This study aimed to determine the effectiveness of audiovisual media about pregnancy support as an educational tool for husband’s support and the level of anxiety in pregnant women. Materials and Methods: This quasi-experimental study applies a pre-test-post-test design on study participants without a control group. The post-test was performed after seven days of intervention. This study was conducted on 60 couples of pregnant women and their husbands (purposive sampling). The intervention was conducted on husbands by providing education using audiovisual media about pregnancy support. Questionnaires collected demographic information and support the husband provided during pregnancy. The level of anxiety that occurs during pregnancy was measured using the Hamilton anxiety rating scale. A paired difference test using the Wilcoxon sign rank test was administered to assess the difference before and after the intervention. Multivariable logistic regression analysis was used to assess the correlation between the variables. Result: Most pregnant women aged 20-35 years (Mean=29.5±3.8) were primipara (51.7%). Meanwhile, most of the husbands were ≥25 years of age (Mean=31.4±4.1). The husband and pregnant mother were highly educated (81.7% and 71.7%, respectively). Both are employed at 100% and 53.3%, respectively. There was an increase in husband’s support during pregnancy after husbands were given an education with audiovisual media (P=0.001). The level of anxiety in pregnant women decreased after husbands were given an education using audiovisual media (P=0.001). Lack of support from husbands during pregnancy increased the risk of anxiety in pregnant women (OR=2.29, 95% CI; 1.39%, 3.79%, P=0.001). Conclusion: The use of audiovisual media as an educational tool is effective in increasing husband support and reducing the level of anxiety in pregnant women.

Introduction: The postpartum period is associated with stress due to extensive psychological and physiological changes that occur in women. These changes may result in a re-evaluation of sexual function and related factors.  Objective: The main aim of this study was to investigate the relationship between body image concern and sexual function with the mediating role of sexual self-esteem among women in the postpartum period.  Materials and Methods: In this descriptive-analytical correlational research, the study population consisted of all women referring to medical centers affiliated with the Tehran University of Medical Sciences, Tehran City, Iran, in 2022. The sample consisted of 239 participants selected by multi-stage convenient sampling. The female sexual function index, body image concern inventory, and sexual self-esteem inventory were used to collect data, which were analyzed using Pearson correlation and structural equation modeling. Results: The data analyses from 239 participants with a mean age of 32.42±6.60 years indicated a significant correlation between body image concern and sexual self-esteem (P=0.01, r=-0.54). In addition, there was a significant correlation between sexual self-esteem and female sexual function (P=0.01, r=0.43). Although there was a significant relationship between body image concern and female sexual function, this correlation was not strong enough (P=0.01, r=-0.24). The results of path analysis also indicate that body image concern is not directly related to women’s sexual function. Still, it can indirectly play a role in women’s sexual function through sexual self-esteem.  Conclusion: Based on the results, body image concern affects sexual function among women after childbirth through sexual self-esteem. Thus, mental health professionals are recommended to consider body image concerns and sexual self-esteem to select the most appropriate treatment for sexual dysfunction in women.

Introduction: Cervical cancer is a significant public health concern and has caused numerous unfortunate deaths. The Pap smear (PS) test is a widely-recognized and affordable screening technique used to detect cervical cancer at an early stage. Objective: This study aimed to investigate the inequality in cervical cancer screening uptake. Materials and Methods: This cross-sectional research was conducted on 774 married 30–37 women selected by multi-stage cluster sampling. They were living in Kermanshah City, Iran, in 2019. Their socioeconomic status was evaluated using the principal component analysis (PCA) and was shown by the index and curve of concentration of socioeconomic inequality in PS. The obtained data were analyzed using the chi-square, t-test, logistic regression, and compensation statistical tests. Results: The mean age of participants was 45.42±10.66 years. About 43.9% of women had education levels under a diploma. Also, 89.3% of women were married, and 58.1% had already done a PS test at least once. In addition, 26.5% of women had a regular PS test uptake. The concentration index for PS test uptake was 0.062 (P=0.115). Education level (OR=1.181, 95% CI; 1.022, 1.364, P=0.024) and a positive family history of cervical cancer (OR=3.591, 95% CI; 1.811, 7.120, P=0.001) had significant impacts on regular PS uptake. Conclusion: A person’s level of education and family history of cervical cancer were the most critical factors for getting regular PS test uptake. Furthermore, the concentration index showed that the frequency of PS test uptake was slightly higher in the rich group. Focusing interventions on less educated and disadvantaged women may provide useful insights to promote PS test uptake, thereby reducing inequalities. Moreover, using fear appeal strategies to promote PS test uptake may be beneficial.

Introduction: The performance of invasive methods, such as urinary catheterization in children, usually creates emotional distress in their parents. It is necessary to use appropriate interventions to reduce the anxiety of mothers and hospitalized children. Objective: The present study aimed to investigate the effect of the animation display of urinary catheterization on the anxiety of mothers with hospitalized children in 2021. Materials and Methods: This quasi-experimental study was conducted on 60 mothers (30 mothers in each group) of children aged 1 month to 12 years in the emergency ward of one of the children’s teaching hospitals affiliated with Mashhad University of Medical Sciences, Mashhad City, Iran. They were selected by convenience sampling. Mothers were grouped into intervention and control by random allocation. In the first stage, animation videos on inserting a urinary catheter were prepared separately for male and female children. In the second stage, in the intervention group, mothers watched the animation related to the procedure before the urinary catheter insertion. In the control group, the mothers of hospitalized children were provided face-to-face explanations about the method before urinary catheterization. The Spielberger state-trait anxiety inventory was completed before and after the intervention for both control and intervention groups. The obtained data were analyzed using descriptive (Mean±SD) and inferential (the independent t-test and chi-square test) statistics. Results: The Mean±SD ages of mothers in the intervention and control groups were 36.9±10.87 and 34.44±9.27, and the mean ages of the children in these two groups were 3.5±6.29 and 2.89±6.73 years, respectively. The results of the present study demonstrated no statistically significant difference between the two groups in the mean anxiety score of mothers before watching the animation video. Nonetheless, after watching that animation, there was a significant difference between the two groups (P=0.001), and watching the animation video of urinary catheterization significantly reduced mothers’ anxiety. Conclusion: The present study pointed out that educational animation videos of urinary catheterization reduce mothers’ anxiety levels. It seems that the use of educational animation as an effective, quick, accessible, and easy intervention can be helpful in the reduction of anxiety and enhancement of knowledge among mothers of hospitalized children.

Introduction: The first 1000 days of a child’s life are crucial for growth and development. Appropriate infant feeding practices, especially complementary feeding, play a vital role in optimal growth and survival. Objective: This study aimed to assess complementary feeding practices and associated factors among mothers of children aged 6–24 months. Materials and Methods: A community-based cross-sectional study was conducted in a rural area of Sudurpashchim Province, Nepal, in 2023. A total of 381 mothers were interviewed using a structured interview schedule. Respondents were selected using purposive sampling. Statistical analyses, such as descriptive statistics, were performed for summarizing categorical variables. Also, the chi-square test and multivariate logistic regression were performed to identify significant factors associated with complementary feeding practices. The significance level was set at P<0.05.  Results: Most participants (42.8%) were aged 21-25, with a mean age of 25.74±4.96 years. Complementary foods started at 6 months (65.1%), adhering to recommended dietary frequency (90.5%), minimum acceptable diet (84.7%), and dietary diversity (68.6%). However, 61.4% had improper feeding practices based on the World Health Organization (WHO) guidelines. The odds of appropriate complementary feeding were higher among mothers with children aged 13-24 months (adjusted odds ratio [aOR]=2.2, 95% CI; 1.4, 3.5, P=0.001), primary family income from business (aOR=2.3, 95% CI; 1.1, 5.0, P=0.025) or profession (aOR=2.3, 95% CI; 1.1, 4.8, P=0.026), Chhetri ethnicity (aOR=2.6, 95% CI; 1.2, 5.6, P=0.016), marriage at age ≥20 (aOR=2.1, 95% CI; 1.3, 3.3, P=0.001), mother’s age at first pregnancy ≥20 (aOR=1.9, 95% CI; 1.3, 3.0, P=0.002), secondary or university education (aOR=4.9, 95% CI; 2.6, 9.3, P=0.001), service occupations (aOR=3.6; 95% CI, 1.5, 8.8; P=0.005), and with a history of complete antenatal care visits (aOR=2.2, 95% CI; 1.1, 4.5, P=0.025).  Conclusion: The majority of respondents exhibited inappropriate complementary feeding practices. Effectively improving complementary feeding practices can be achieved by preventing child marriage, delaying early pregnancy, ensuring access to education, providing better job opportunities, and encouraging health services utilization.

Introduction: Hypertension in pregnancy is one of the three main causes of maternal death after hemorrhage and sepsis. Education of hypertensive pregnant mothers can be effective in promoting self-care behaviors and ultimately proper control of blood pressure. The use of educational models can be very helpful in this regard compared to traditional methods. Objective: This study aims to assess the effectiveness of education based on the health belief model (HBM) in improving the self-care behaviors of pregnant women with hypertension. Materials and Methods: This is a quasi-experimental study with a pre-test/post-test design that was conducted on 90 women with hypertension in pregnancy who referred to one of the specialized women’s hospitals in Rasht, Iran, during January-August 2020. The participants were randomly divided into two groups of intervention and control using the random allocation software. The data collection tools included a demographic/obstetric form, a researcher-made HBM questionnaire, and a researcher-made hypertension in pregnancy self-care profile. The HBM-based education was provided to the intervention group at three sessions with an interval of one week. Data analysis was done using chi-square test, independent t-test, and ANCOVA. Cohen’s d (effect size) was also measured.  Results: The final data analysis was done on 39 women in the intervention group (mean age: 33.48±4.54 years) and 38 women in the control group (mean age: 32.73±5.93). The difference in the scores of knowledges and HBM constructs was not statistically significant between the two groups at baseline, but it was significant after education (P=0.001). The difference between the two groups was not statistically significant in self-care behaviors at baseline, except for diet/physical activity and disease/stress management (P=0.001). To control the effects of these two variables, ANCOVA was used. After intervention, the difference between the two groups in self-care behaviors was statistically significant (P=0.001). Conclusion: The HBM-based education can make pregnant mothers more aware of hypertension and increase their self-care behaviors for proper control of blood pressure.