Sexual experience of Iranian women in their middle life: a qualitative approach

Background: Sexual problems are common among the middle-aged women; however, there is no deep understanding of sexuality in midlife. The current study aimed to investigate Iranian women's attitudes and experiences about sexual life changes in midlife

Methods: This is a descriptive qualitative study. Seventeen women aged 40 65- years old were purposively selected from urban health centers in Gorgan, Iran, in 2015. Face-to-face, semi-structured and in-depth interviews were conducted for data collection until data saturation was attained. The resulting data were analyzed based on Graneheim and Lundman's approach. MAXQDA 10 was used for organization of data

Results: Data analysis demonstrated seventh sub-themes and three themes. The emerged themes were entitled [1] "Continuous paradox over being a sexual agent" with three subthemes of beliefs on asexuality as socially accepted view for women in midlife, changing in motivation for sex and changing in sexual performance, [2] "Considering menopause; opportunities and threats for sexual life" with two subthemes of menopause related cons for sexual life and menopause related pros in sexual life, and [3] "Coping strategies for changes in sexuality in midlife" with two subthemes of different psychological reactions to changes that have influenced the sex and take practical steps for restoration of sexual attraction

Conclusion: The findings demonstrated that middle-aged women in a male-dominant culture encounter paradox over being a sexual agent. In a bio-psycho-social approach, they perceived menopause as an opportunity or threat for their own sexuality. Following the conflicts, threats and changes of sexuality in midlife, they adopt diverse coping strategies to improve their sexual relationships and preserve their family

educational effects of mobile learning on students of medical sciences: a systematic review in experimental studies

Introduction: the demand for mobile learning in the medical sciences educational program is increasing. The present review study gathers evidence highlighted by the experimental studies on the educational effects of mobile learning for medical sciences students

Methods: the study was carried out as a systematic literature search published from 2007 to July 2017 in the databases PubMed/Medline, Cumulative Index to Nursing and Allied Health Literature [CINAHL], Web of Knowledge [Thomson Reuters], Educational Resources and Information Center [ERIC], EMBASE [Elsevier], Cochrane library, PsycINFO and Google Scholar. To examine quality of the articles, a tool validated by the BEME Review was employed

Results: totally, 21 papers entered the study. Three main themes emerged from the content of papers: [1] improvement in student clinical competency and confidence, [2] acquisition and enhancing of students' theoretical knowledge, and [3] students' positive attitudes to and perception of mobile learning. Level 2B of Kirkpatrick hierarchy had been examined by all the papers and seven of them had reported two or more outcome levels, but level 4 was not reported in the papers

Conclusion: our review showed that the students of medical sciences had positive response and attitudes to mobile learning. Moreover, implementation of mobile learning in medical sciences program might lead to valuable educational benefits and improve clinical competence and confidence along with theoretical knowledge, attitudes, and perception of mobile learning. The results indicated that mobile learning strategy in medical education can positively affect learning in all three domains of Bloom's Taxonomy

Contributing factors to high-risk sexual behaviors among Iranian adolescent girls: a systematic review

Background: Adolescence is a period of overwhelming changes and challenges, which expose the adolescents to high-risk behaviors. Risky sexual relationship is one of these behaviors that entails physical risks and psychosocial harms. Various factors have been recognized to shape sexual behaviors in adolescents. This paper is an attempt to investigate the factors contributing to high-risk sexual behaviors in Iranian adolescent girls

Methods: A literature review of the research published by Iranian authors, in Farsi or English language in local and foreign journals, was conducted using PubMed, Science Direct, Scopus, Scientific Information Database [SID], IranMedex, IranDoc, and Google Scholar. The search in each database included all the years covered at that time using keywords such as "sexual, adolescents, and Iran", and continued using other keywords such as "sexual behavior, high-risk behavior, sexual risk and reproductive behavior" individually and in combination

Results: Sixteen published articles were identified. Factors contributing to high-risk sexual behaviors in girls can be divided into four general groups including personal, family, peer, school and community

Conclusion: Regarding the identified risk and protective factors, appropriate individual, family and school-based interventions can be designed and implemented to strengthen protective factors. While individual and family factors are considered more in research, factors related to peers, school and community have received less attention. Since social values, beliefs and norms are important factors in formation of sexual behaviors, further research regarding these factors is suggested

Spirituality: a panacea for patients coping with heart failure

Background: Many patients with heart failure grapple with related problems that threaten their feeling of well-being and quality of life. Patients look for ways to cope with the new situation. The present study aimed to explore religious coping from the perspective of patients with heart failure

Methods: This qualitative study used the content analysis of the semi-structured interviews. The data were collected from 18 participants referring to training hospitals in Kerman University of Medical Sciences in southeastern Iran. The data were analyzed using Lundman and Graneheim qualitative content analysis

Results: The main theme of "Spiritual coping, a dominant strategy" was extracted with two categories: 1- "religious belief" having the sub-categories of "inner faith" and "search of meaning" 2- "connection to God as the supreme power" with sub-categories of "seeking healing through supplication and rituals", "worship as a barrier to the flood of problems", and "submission to and trust in God"

Conclusion: The findings suggest that a spiritual strategy helps the patients effectively to cope with heart failure. Patients learn to use religious beliefs and faith to accept the reality of the disease and its stages and to manage their condition with patience, tolerance, and hope calmly and confidently for a bright future

Family Adaptation to Stroke: A Metasynthesis of Qualitative Research based on Double ABCX Model

PURPOSE: There is growing interest in synthesizing qualitative research. Stroke is a very common cause of disability often leaving stroke survivors dependent on their family. This study reports an interpretive review of research into subjective experience of families with stroke survivors based on the components of the Double ABCX Model including stressors, resources, perception, coping strategies, and adaptation of these families. METHODS: Metasynthesis was applied to review qualitative research looking at stroke family members' experiences and responses to having a stroke survivor as a family member. Electronic database from 1990 to 2013 were searched and 18 separate studies were identified. Each study was evaluated using methodological criteria to provide a context for interpretation of substantive findings. Principal findings were extracted and synthesized under the Double ABCX Model elements. RESULTS: Loss of independence and uncertainty (as stressors), struggling with new phase of life (as perception), refocusing time and energy on elements of recovery process (as coping strategy), combined resources including personal, internal and external family support (as resources), and striking a balance (as adaptation) were identified as main categories. Family members of stroke survivor respond cognitively and practically and attempt to keep a balance between survivor's and their own everyday lives. CONCLUSIONS: The results of the study are in conformity with the tenets of the Double ABCX Model. Family adaptation is a dynamic process and the present study findings provide rich information on proper assessment and intervention to the practitioners working with families of stroke survivors.

causal relationship between interns' knowledge and self-efficacy and their value in predicting the interns' communication behavior with patients

After many years of teaching, both the efficiency and efficacy of communication skills programs are under question because patients' dissatisfaction with doctors' communication behavior is at the top of the complaint lists. It is assumed that finding the specific role of different determinants of doctors' communication behavior, instructional designers can plan more effective training programs. This study aims to explore the predictive value of interns' knowledge and self-efficacy in building effective relationship with patients and determine the causal relationship between interns' knowledge and self-efficacy about effective doctor-patient relationship. In this cross-sectional study, PRECEDE model was applied and the analyzed content from semi-structured interviews with 7 interns and 14 faculty members was combined with the items from literature review. All the emerged items were categorized under eight constructs of social cognitive theory. The validity and reliability of the items of the research questionnaire were examined by 40 interns and an expert panel of 14 faculty members. The questionnaires were completed by 203 medical interns and confirmatory factor analysis [CFA] was done on the items. The data were analyzed by SPSS.21 and LISREL 8.80. CFA indicated a good fit to the data. Knowledge and self-efficacy, together, explained 23 percent of the variance in interns' communicative behavior. 53 percent of the changes in interns' self-efficacy were attributed to the changes in interns' knowledge. Improving the interns' shared vision can increase the quality of their knowledge and instructional designs based on learning facts, and gaining insights about effective doctor-patient relationship can increase the interns' self-efficacy and consequently improve the interns' communication skills

impact of polycystic ovary syndrome on the health-related quality of life: a systematic review and meta-analysis

Polycystic ovary syndrome [PCOS] has been shown to cause a reduction in health-related quality of life [HRQOL]. However, the relative degree of impairment in each domain differed among samples, and it was not clear which aspect of disease-specific HRQOL [modified polycystic ovary syndrome health-related quality of life questionnaire] was most negatively affected. To systematically review the effects of PCOS on specific domains of HRQOL. Literature search using search engine of database [PubMed, PsychInfo, CINAHL, CENTRAL, and Scopus] between 1998 to December 2013 yields 6 relevant publications. Pairs of raters used structural tools to analyze these articles, through critical appraisal and data extraction. The scores of each domain of polycystic ovarian syndrome questionnaire [PCOSQ] or modified version [MPCOSQ] of 1140 women with PCOS were used in meta-analysis. The combine mean of emotional [4.40; 95% CI 3.77-5.04], infertility [4.13; 95% CI 3.81-4.45] and weight [3.88; 95% CI 2.33-5.42] dimensions were better, but menstruation [3.84; 95% CI 3.63-4.04] and hirsutism [3.81; 95% CI 3.26-4.35] domains were lower than the mean score of PCOSQ/MPCOSQ in related dimension. The meta-analysis showed that the most affected domains in specific HRQOL were hirsutism and menstruation. Based on these findings, we recommend healthcare providers to be made aware that HRQOL impairment of PCOS is mainly caused by their hirsutism and menstruation, which requires appropriate management

Designing and psychometric the measure for determining the professional competence of nursing faculty members

Of the significant processes for educational quality promotion is to evaluate the teachers' competency. This study has been conducted with the goal for Designing and psychometric the Measure for Determining the Professional Competence of Nursing Faculty Members. The present research is the qualitative part of a sequential exploratory combined study of the concept known as competency where first through a qualitative study, a questionnaire with the appropriate items has been extracted from nursing teachers being evaluated by the students, and then this questionnaire has been psychometrically tested via a methodological study. The face validity has been evaluated by considering nursing students and nursing faculty staff and the content validity by nursing experts' judgment. The construct validity has also been done using exploratory factor analysis. In the content validity stage, the total mean of tool validity index has been calculated 0.92.The minimum item impact score obtained in qualitative face validity was 3.4.The results of the construct validity brought about 4 factors: commitment and follow-up for making the theoretical and clinical education effective, student nurturing, mastership ethics and character, the capability for educational and research management. Alpha-Cronbach was achieved 0.96 and reliability with re-test as 0.94. The questionnaire has been designed using the main stakeholders' experiences and then psychometrically tested. And it can be employed for evaluating nursing faculty staff professional competency

Development and psychometric properties of [Iranian Diabetic Adolescent Girl's Quality of Life] questionnaire

Diabetes with permanent changes in a person's lifestyle may influence diabetic adolescent quality of life [QOL] negatively. Studies conducted on diabetic patients are increasingly measuring patient-centered outcomes such as functional status and health-related QOL [HRQOL]. The development of a HRQOL questionnaire with an optimal measuring performance provides nurses with a standardized assessment tool in order to determine the impact of the disease on diabetic adolescent girl's activity daily living. This study aimed to develop and assess psychometric properties of [Iranian Diabetic Adolescent Girl's QOL [IRDAGQOL]] questionnaire. The items and content of [IRDAGQOL] questionnaire were generated from themes and items extracted from a qualitative study using content analysis approach with the participation of 20 adolescent girls with diabetes. Face validity of questionnaire with the participation of 10 adolescent girls and content validity by 15 experts, was approved. Convergent and discriminant validity of questionnaire confirmed. Exploratory factor analyses using principal component extraction method was performed to determine the questionnaire domains. The Cronbach's coefficient alpha was calculated to determine the instrument internal consistency in 250 samples. In 30 samples, using SPSS statistical package, test re-tests after 2 weeks confirmed questionnaire reliability. The patient interviews allowed for the identification of 50 items in the final questionnaire. Principal components analysis revealed the presence of five components that jointly accounted for 79.945% of the variance. The face and content validity processes resulted in an approved and valid questionnaire. Reliability analysis showed satisfactory result [Cronbach's alpha = 0.870]. The findings showed that the [IRDAGQOL] questionnaire presented in this study is a valid and reliable instrument that can be used for measuring adolescent girl's QOL

[Psychometric properties of questionnaire of predicting factors for dental caries in adolescents: Fitness theory through factor analysis]

Background: There is an absence of a valid and reliable tool basedon a field study for predictingfactors related to dental caries in adolescents. Also the lack of preventivemodels of tooth decay has been perceived. The aim of thisstudy was to design preventive models by assessing psychometric properties of questionnaire of predictive factors for dental caries inadolescents using factor analysis.

Materials and Methods: This descriptive analytical research was done in 2013-14onadolescents who lived in Tehran city.First, model and questionnaire of predictive factors for dental caries in adolescents were designed based on qualitative research using grounded theory. Using systematic samplings, 607 studentsand 400 students [12 and 16 years old] were selected for Exploratory Factor Analysis and Confirmatory Factor Analysis respectively. The reliability of the questionnairewas calculated by two different

methods: Cronbach'salphaand test-retest. Also, in order to determine the validity of the scale, we used three methods including face validity, content validity, and construct validity. Exploratoryand ConfirmatoryFactorAnalysis were done bySPSS softwareversion 16 and LISLER softwareversion 8.8 respectively. Finally, appropriate models for preventing of tooth decay were presented.

Results: During exploratory factor analysis, eightfactors developed: behavioral factors, fear, social support, motivational beliefs, role of school, instructive elements, socio – economic status, and value of teeth. Results of confirmatory factor analysis showed that the eightfactor model for preventing of dental caries fit Iranian adolescents and the four-factor model isthe strongest predictor of oral health behaviorwhich foresees 76% of behaviors related to oral and dental health.Also test-retest scoreobtained 0.74 and internal consistency was 0.85.

Conclusion:Based on the results of this study, the validity and reliability of the38-item questionnaires of predictive factors for dental caries in adolescents is acceptable and suitable. Therefore the presented models can be used in designing educational programs. Also this tool can be applied in future researches and different groups of students.

Facilitators and barriers to the professionalization of nursing in Iran

In recent years, Healthcare organizations have supported the professionalization of nursing in order to improve the quality of care delivered to patients. The purpose of this study was to explore facilitators and barriers to professionalization of nursing in Iran. A qualitative study was conducted using the conventional content analysis. Semi-structured interviews were held with 18 nurses working in various nursing positions and in different healthcare settings. Themes related to the professionalization of nursing was developed. During the data analysis, five themes were developed: [communication], [motivation and attitude], [organizational culture and structure], [academic education], and [supportive resources]. Each theme as a factor impacted the professionalization of nursing in a positive or negative manner. Recognizing factors influencing professionalization of nursing contributes to improvement of quality of nursing care delivered to patients. Healthcare system authorities can facilitate the development of the nursing profession and facilitate the professionalization of nursing through increasing the number of postgraduate nurses and also improving the nurses work conditions

Causes of dental caries from the perspectives of adolescents: a qualitative study

Objective: Various factors affect dental caries and impact the patterns of dental care. A few studies have been conducted to identify these factors from the perspectives of students. This study aimed to explore factors influencing dental caries from students' perspectives

Methods: A qualitative design using content analysis approach was conducted to collect the perspectives of 18 Iranian students who were studying in 8 guidance schools. They were chosen through purposive sampling. Semi- structured private interviews and focus groups were held for data gathering. The tape-recorded interviews were transcribed verbatim and analyzed using an inductive content analysis approach. In order to support the validity and rigor of the data, different trustworthiness criteria such as acceptability, confirm ability and transferability were considered

Results: During data analysis, four main categories were developed: "difficult conditions of care", "disability in caring", "uncontrollability of dental caries" and "intangible sense of the factors causing dental caries"

The participants more emphasized their own experiences about having insufficient dental-oral care, not paying attention to oral health, dental fear and the lack of both knowledge and competency regarding this issue

Conclusion: The findings of this study revealed factors influencing dental caries from students' perspectives and emphasized the roles of individual, parent, dentist and community in this respect

The findings of this study can be considered to be a valuable basis to design oral health interventions. However, more studies are required to improve our understanding of dental fear and denote barriers and social beliefs pertinent to oral health in different groups of students?

[Life threatening: the most important concern of patients confronting cancer diagnosis]

Increase in cancer prevalence results in feeling fear of being diagnosed with cancer among individuals. Understanding concerns of patients diagnosed with cancer helps health care professionals to provide appropriate caring plans. This study aimed to understand main concerns of patients who confront cancer diagnosis. This was a qualitative study with content analysis approach. Fifteen patients with cancer were selected from a specialized hospital, an oncology clinic, and Emdad Center of Cancer patients in Sari using a purposeful sampling method during May 2011 to June 2012. The sample size was completed regarding data saturation. Data were collected using interviews, observations and recording field notes. All interviews were tape-recorded and transcribed verbatim. Data were analyzed using descriptive content analysis and the Granhim and Landmann method. Three categories including 485 primary codes were emerged. The derived codes were as follows: 1] sever personal and family disturbance; 2] imagination of despair; and 3] unclear imagination of future. The main code included in all derived codes was life threatening nature of cancer. The findings showed that life threatening nature of cancer is a source of fear that makes the disease frightening. Clinical staff and nurses should pay more attention to concerns of patients with cancer and design their care plan accordingly

[ qualitative study on social predisposing factors of adolescents' health]

Society is the living context of adolescents' health and includes social constitutions. Adolescents as an important social group experience many disturbances because of the characteristics of current society and special features of adolescence. The life style and habits of adolescence sometime lasts until death; so the resulted problems would affect all the life. A qualitative content analysis has been used. Open semi structured Interviews were conducted until data saturation These three categories have been emerged: the semiology of an unhealthy society, adolescents' expectations from the society, social health prerequisites. Both the adolescents and their health are affected by the essential role of social predisposing factors. To develop the social aspect of adolescents' health is necessary. The social aspect of health which is related to the family, employment, welfare and communications could be useful in a healthy foundation of the future. Understanding adolescents' perspectives is not only important but is useful for maintaining a healthy society. Therefore, families, teachers, health workers and policy makers should develop prevention and intervention programs based on adolescence developmental processes especially tending to social factors

Effect of orientation program on hemodynamic variables of patients undergoing heart catheterization

Physiologic signs of anxiety usually change hemodynamic variables in patients undergoing heart catheterization. This study carried out to determine the effect of Orientation Program on hemodynamic variables in patient undergoing heart catheterization. In this experimental study, 60 patients undergoing heart catheterization were randomly assigned to either the test or control group. Data were collected using the demographic checklist and a hemodynamic variables checklist for recording hemodynamic variables. The collected data were analyzed using the Chi-square, repeated measurement, and independent t test in the SPSS. According to the results, there were significant reductions in the systolic and diastolic blood pressures, pulse rate, respiratory rate and systolic left ventricle pressure in the intervention group after the intervention [P<0.05]. There were no significant statistical difference between the two groups in systolic aorta pressure [P=0.173], diastolic aorta pressure [P=0.104], and end diastolic left ventricle pressure [P=0.886]. Orientation program had positive effects on most of the hemodynamic variables in the intervention group. The Orientation program is recommended to be used during invasive diagnostic procedures in order to prohibit anxiety's physiologic complications

concept of hospitalization of children from the view point of parents and children

Disease and hospitalization can be the first crisis that a child encounters. The aim of this study is to reveal a clear picture of the meaning of hospitalization in children, to show the experience and behavior of hospitalized children and to discover the meaning and understanding of hospitalization in them. This study is a phenomenology study of qualitative research within the framework of Husserl Eidetic phenomenology through comprehensive interviewing. The objective group consisted of children 7-11 years old and their parents hospitalized in the children's ward of 22 Bahman Hospital and the surgery ward of 15 Khordad Hospital during the study [2008]. Method of selection of participants was as follows: having experience of hospitalization, having ability to answer the questions, and being volunteered. Sample size was detected by data saturation. In the method of sampling, an object group of 20 [12 children and 8 parents] were chosen and interviewed. The Seven Colaizzi Stages were used for analysis of data. The analysis of the interviews and the written narrations of the participants led to the extraction of 6 inner themes consisting of sickness, environment, reciprocal relationship, parents' personal problems, mental and emotional matters and a spiritual dimension; all of which define a specific aspect of the experience of hospital in children and parents. The experience of hospitalization in children can be considered as a process of effort for returning to health and, on the whole, the regaining of the individual's status in the world. Nurses can ease this process by showing the importance of experience and feelings of individuals at the time of hospitalization and help people to adapt themselves to their new surroundings. This matter can enable the nurses to utilize methods of helping in the adaptation of individuals and thus guide the unique powers present in every individual to ease and quicken recovery

[ impact of professional portfolio on nurses' clinical competence]

Background and Objectives: Portfolios as new educational tools can play an important role in improving clinical competence of nurses. However, scientific evidences about the impact of portfolios on nurses' clinical competence are limited and few studies have been done in Iran. This study aimed to determine the impact of professional portfolio on nurses' clinical competence in a hospital affiliated to Shiraz University of Medical Sciences

Methods: In this quasi-experimental, pretest- intervention- posttest study, from 22 units of the selected hospital, 4 general units were selected randomly. Nurses of 2 units were studied as experimental group and participated in a 12-month portfolio-based Professional development program. Nurses of 2 other units were considered as control group and participated in the routine professional development programs of their units. Data were collected by a valid and reliable scale measuring clinical competence of nurses. Data were analyzed by using descriptive statistics, independent and paired t-test

Results: After intervention, mean clinical competence in experimental group showed a significant increase from 76.72 [+/- 6.45] to 85.68 [+/- 6.43] [p<0.001], while in the control group this increase 75.31 [+/- 11.9] to 80.69 [+/- 7.11] was not significant [p=0.08]

Conclusion: This study showed that portfolio is an effective tool for improving nurses' clinical competence. Studying about the efficacy of these tools in nursing practice in order to enhance nursing professional development is necessary?

[ comparison of nurses' clinical competences in two hospitals affiliated to Shiraz and Boushehr universities of medical sciences: a self-assessment]

Introduction: Evaluating nurses' clinical competencies is of special importance in managing care process and determining their educational needs. The objective of this study was to compare the clinical competencies and clinical skills application by nurses in two hospitals affiliated to Boushehr and Shiraz Medical Universities

Methods: In this cross-sectional study, the clinical competencies of all 266 nurses employed in two main hospitals of Boushehr and Shiraz medical universities and volunteered for participation in the study were compared. A questionnaire containing 73 nursing skills in seven domains of clinical competencies was used to investigate the level of nurses' clinical competencies through Visual Analogue Scale [0 to 100] and their clinical skills application via a 4 degree Lickert Scale. Data was analyzed by SPSS software using descriptive statistics, independent t-test, and Pearson Correlation Coefficient

Results: Having a mean score of 87.03 +/- 10.03, Shiraz University of Medical Sciences' nurses enjoyed higher level of clinical competencies compared to the mean score of 71.07 +/- 13.66 achieved by those in the hospital affiliated to Boushehr University of Medical Sciences. Moreover, 70 percent of clinical skills are recurrently exploited by nurses employed in Boushehr while this rate is more than 83 percent in the hospital affiliated to Shiraz Medical University

Conclusion: The level of clinical competencies and the extent to which nursing skills are employed by nurses is dissimilar in these two hospitals. Educational needs assessment for nurses and modification of health care quality in different hospitals is recommended to be investigated

[ implication of health belief model in planning educational programmes for preventing HIV/AIDS among university students]

To plan an educational program to prevent HIV/AIDS among university students based on Health Belief Model [HBM]. This descriptive cross-sectional study was conducted in Tehran University in academic year of 2004-2005. The instrument used was a questionnaire including demographic information, knowledge questions, health belief model constructs [perceived severity, perceived susceptibility, perceived benefits and barriers] and attitude towards HIV/AIDS patients, high risk behaviors questionnaire and intention to take HIV test. The participants were selected through stratified and systematic methods. Data were analyzed performing Chi-square test, Pearson correlation and one was ANOVA. In all 664 students participated in the study. The mean age was 18.74 +/- 8/1. according to self report,%4.1 were smoker,%2.9 used substance drugs,%1.5 suffered from sexual transmitted disease and HIV/AIDS.%26.4 believed that their knowledge is insufficient.%71.1 believed in having low risk of being infected. Almost all of the participants were highly aware of HIV/AIDS. The results also indicated that there was a significant relationship between the participants' knowledge and their perceived severity and susceptibility and benefits in term of willing to take the test. Lack of HIV voluntary counseling and testing center and feat of the test results were the main barriers of HIV test. The findings suggest that we need to educate and raise the people consciousness about the perceived benefits of HIV test, the way of giving the test results, and the contact details and services for voluntary counseling and testing centers

[Effectiveness of simultaneous rhythmnic breathing and Z-track method in prone position with foot internal rotation on the pain associated with intramuscular injection]

Intramuscular injection is one of the effective methods of drug administration. Yet the procedure is painful and avoided if at all possible. This study examines the effectiveness of simultaneous rhythmic breathing and Z- track method in prone position with foot internal rotation on reducing the pain of intramuscular injection. This quasi experimental [before and after] study included 100 patients who had intramuscular injection of Metocarbamol. Standard method was evaluated against the combination of rhythmic breathing and Z - track method in prone position with foot internal rotation. Pain intensity was measured before and after intervention using visual analog scale. Descriptive statistic was used for demographic information. Means were compared on paired T-test. While before the intervention, 57% and 43% of the patients had severe and very severe pain respectively, after the intervention 24% of the patients experienced a mild pain with 67% reporting a moderate one. In addition, a statically significant difference was observed between the pain intensity means before and after intervention [p<0.0001]. Based on the results, simultaneous rhythmic breathing and Z - track method in prone position with foot internal rotation could reduce the pain associated with intramuscular injection of Metacarbamol