Nonpharmacological pain relief for labour pain: knowledge, attitude, and barriers among obstetric care providers.

Background: Labor pain is considered the worst pain in a woman's life. Hence, pain control should be essential to labor management at any level. There is scarce information, and there are gaps regarding the knowledge, attitude, and barriers to the utilization of nonpharmacological approaches for pain relief in Saudi Arabia. Therefore, the current study aims to evaluate nonpharmacological pain relief (NPPR)-related knowledge, attitudes, and barriers among obstetric care providers in Najran, Saudi Arabia. Methods: A cross-sectional analytical study was performed at maternity departments in Maternal and Children Hospital (MCH), Najran, Saudi Arabia, from April 1 to May 26 2023. The study involved 186 obstetric care providers (OPCs), physicians (19), nurses (144), and midwives (23). A structured self-reported questionnaire was used to collect data and involves five main sections: demographic data, work-related data, nonpharmacological pain relief-related attitude, perceived barriers, and knowledge quiz. The adjusted odds ratio (AOR) along with 95% CI was estimated to determine the factors associated with nonpharmacological pain relief-related knowledge and attitude using multivariate analysis in the binary logistic regression. Results: Over three-quarters (79%) of obstetric care providers had adequate knowledge of nonpharmacological pain relief methods. The majority (85.5%) of the participants had a positive attitude toward NPPR in labour pain management, with the mean scores ranging from 3.55-4.23 for all sub-items. Obstetric care providers acknowledged that patient belief, lack of time, and workload were the strongest barriers to offering nonpharmacological pain relief methods for labour pain 67.6%, 64.5%, and 61.3%, respectively. In binary logistic regression analysis, the in-service training related to nonpharmacological pain relief (AOR = 5.871 (2.174-15.857), p = 0.000), (AOR = 3.942 (1.926-11.380), p = 0.013) and years of work experience (AOR = 1.678 (1.080-2.564), p = 0.019), (AOR = 1.740 (1.188-2.548), p = 0.003) were significantly associated with obstetric care providers' knowledge and attitudes regarding nonpharmacological pain relief (p ≤ 0.05). Conclusion: Although most OPCs have adequate knowledge and a positive attitude regarding NPPR, they need motivational strategies to enhance their utilization. In addition, an effort should be made to decrease OPCs' workload to provide more time for NPPR application and patient education. Training courses and in-service training can play an important role in enhancing NPPR knowledge and attitude and, consequently, its application. Also, in each working unit, the policymakers should provide clear guidelines and policies that enhance and control the utilization of NPPR.

Mode of delivery preferences: the role of childbirth fear among nulliparous women.

Introduction: The increasing Cesarean Section (CS) rates may be attributed to women's increasing requests for elective CS. High Fear of Childbirth (FOC), especially among nulliparous women, may be significantly associated with CS preference without medical indications. The current study aims to investigate the impact of childbirth fear on the mode of delivery preference among nulliparous women. Methods: A cross-sectional correlational study was performed in the Maternal and Children Hospital (MCH) from the beginning of October 2022 to the end of February 2023 and incorporated a convenience sample of 342 nulliparous women. The data was collected using a self-reported questionnaire comprising participants' demographic and obstetrics characteristics and the FOC questionnaire. A logistic regression model examined the relationship between CS preference and the other independent variables. Results: The results indicated that 74.3% of the nulliparous women preferred vaginal delivery, while 25.7% preferred Cesarean Section. Concerning childbirth-related fear, the highest mean scores were related to fear of clinical procedures, fear of harming or distressing the infant, and fear of pain 5.19 ± 1.13, 5.12 ± 1.27, and 5.09 ± 1.22, respectively. High FOC was present among 74.6%, moderate in 17.3%, and severe in 6.7% of the participants. Logistic regression analysis showed maternal age and monthly income were the significant sociodemographic determinants of choosing CS as the preferred delivery mode (p < 0.05). Moreover, the participants who had increased fear of harming or distressing the infant, fear from pain, fear from the body's ability to give birth, fear from not being involved in decision-making, and overall FOC had a higher probability of choosing CS as the preferred delivery mode compared to the participants who had lower fear (p < 0.05). Discussion: Having high FOC increases the CS preference among nulliparous women. Increased fear of harming or distressing the infant, fear from pain, fear from the body's ability to give birth, and fear from not being involved in decision- making seem to be significant dimensions of childbirth fear associated with CS preference among nulliparous women.

The Effect of an Educational Intervention Based on Protection Motivation Theory on Pregnant Women's Knowledge and Self-Protection Regarding COVID-19. An Intervention Study.

Background: COVID-19 infection endangers pregnant women and newborns. Infection prevention measures are available and easy to apply, but the problem is the application continuity. Empowering pregnant women to increase their intention for self-protection is very important. This study explores the effect of educational intervention based on the Protection Motivation Theory (PMT) on pregnant women's knowledge and self-protection regarding COVID-19. Materials and Methods: A randomized, controlled trial was conducted at the Obstetrics and Gynecology outpatient clinic at El Shatby Hospital, Alexandria governorate/Egypt, from November 2020 to May 2021. The study included a convenient sample of 163 pregnant women using the randomization block technique. A self-reported questionnaire was used for data collection. For the intervention group, the PMT-based education included need assessment, planning, implementation, and evaluation. Two months later, a reevaluation was done. Results: ANCOVA showed a significant improvement in the intervention group's knowledge (F1 = 8.56, p < 0.001) when taking the pretest as a reference. The effect size shows that 25.8% of the intervention group's knowledge improvement and 58.80% of the difference between the two groups were due to intervention. ANCOVA showed a significant improvement in the intervention group's PMT constructs when taking the pretest or group as a reference (p <0.001). The effect size shows that 56.10% of the intervention group's total PMT constructs improvement and 89.60% of the differences between the two groups were due to the intervention. Conclusions: PMT-based intervention is effective in improving pregnant women's knowledge and self-protection intention regarding COVID-19. PMT is recommended to tailor educational intervention for pregnant women.

Effect of Digital-Based Self-Learned Educational Intervention about COVID-19 Using Protection Motivation Theory on Non-Health Students' Knowledge and Self-Protective Behaviors at Saudi Electronic University.

BACKGROUND: The COVID-19 pandemic has disastrous impacts that impose the cultivation of knowledge and motivation of self-protection to foster disease containment. AIM: Evaluate the effect of digital self-learned educational intervention about COVID-19 using the protection motivation theory (PMT) on non-health students' knowledge and self-protective behaviors at Saudi Electronic University (SEU). METHODS: A quasi-experimental study was accomplished at three randomly chosen branches of SEU (Riyadh, Dammam, Jeddah) using a multistage sampling technique to conveniently select 219 students. An electronic self-administered questionnaire was used, which included three scales for assessing the students' knowledge, self-protective behaviors, and the constructs of the PMT. The educational intervention was designed using four stages: need assessment, planning, implementation, and evaluation. A peer-reviewed digital educational content was developed after assessing the participants' educational needs using the pretest. Then, distributed through their university emails. A weekly synchronous Zoom cloud meeting and daily key health messages were shared with them. Finally, the post-test was conducted after two months. RESULTS: The mean participants' age (SD) among the experimental group was 28.94 (6.719), and the control group was 27.80 (7.256), with a high female percentage (63.4%, 73.8%) and a previous history of direct contact with verified COVID-19 patients (78.6%, 69.2%), respectively. A significant positive mean change (p = 0.000) was detected in the total COVID-19 knowledge of the experimental group post-intervention, either when it was adjusted for the covariates effect of the control group (F1 = 630.547) or the pretest (F1 = 8.585) with a large effect size (η2 = 0.745, η2 = 0.268, respectively). The same was proved by the ANCOVA test for the total self-protective behaviors either when it adjusted for the covariates effect of the control group (F1 = 66.671, p = 0.000) or the pretest (F1 = 5.873, p = 0.020) with a large effect size (η2 = 0.236, η2 = 0.164, respectively). The ANCOVA test proved that post-intervention, all the PMT constructs (perceived threats, reward appraisal, efficacy appraisal, response cost, and protection intention) and the total PMT score were significantly improved (p = 0.000) among the experimental group either when adjusted for the covariates effect of the control group (F1 = 83.835) or the pretest (F1 = 11.658) with a large effect size (η2 = 0.280, η2 = 0.561, respectively). CONCLUSIONS: The digital PMT-based self-learned educational intervention effectively boosts non-health university students' COVID-19 knowledge, protection motivation, and self-protective behaviors. Thus, PMT is highly praised as a basis for COVID-19-related educational intervention and, on similar occasions, future outbreaks.

Predictors of premarital screening and genetic counseling knowledge and attitude among deaf and hard hearing females in Tabuk, Saudi Arabia.

According to Saudi Arabia's 2030 vision, research should be directed to prevention, early detection, and intervention to reduce all types of disability. The current study aimed to investigate the predictors of Premarital Screening and Genetic Counseling (PMSGC) knowledge and attitude among deaf and hard hearing females' in Tabuk, Saudi Arabia. Descriptive correlational design was conducted on a convenience sample of 67 deaf and hard hearing students from the Tabuk region. Data were collected by an electronic questionnaire elaborated to the participants using sign language. The results revealed that most participants had incorrect answers regarding most PMSGC questions. Around two-thirds (68.7%, 65.7%, and 71.6%) of them strongly agree that PMSGC is very important, compatible with Islamic principles, and prevents family social and psychological problems, respectively. Older, urban area residents and university-educated participants have significantly higher knowledge and attitude scores than their peers (t=2.239, 4.887, 4.790 & p<0.05), respectively. Multiple regression shows that age (b=0.302, t=-2.795, p=0.007), education (b=0.336, t=2.425, p=0.019), mothers' education (b=0.314, t=2.345, p=0.023), and monthly income (b=-0.337, t=-2.503, p=0.015), are significant predictors of PMSGC knowledge. Furthermore, age (b=0.659, t=4.024, p=0.000), residence (b=0.293, t=2.233, p=0.030), education (b=-0.395, t=3.028, p=0.004), and type of disability (b=-0.443, t=-3.763, p=0.000) are significant predictors of PMSGC attitude. Although most deaf and hard hearing females have incorrect knowledge regarding PMSGC, most have a positive attitude. The study concluded that participants' education, mothers' education, and monthly income are significant predictors of PMSGC knowledge. Moreover, age, residence, education, and type of disability were significant predictors of higher PMSGC attitudes.

Gestational Diabetes Self-Care Behavior: An Empowerment Educational Intervention Based on BASNEF Model.

Background: Gestational diabetes is a widespread pregnancy-related health problem. Its associated complications can be minimized by empowering women to enhance their self-care behavior. This study aimed to evaluate the effect of an educational intervention using the Beliefs, Attitudes, Subjective Norms, and Enabling Factors (BASNEF) model on Gestational Diabetes Self-Care Behaviors (GD-SCB) among gestational diabetic woman. Materials and Methods: A randomized controlled clinical trial was performed at the outpatient clinic, El-Shatby hospital, Alexandria, Egypt, on 180 gestational diabetic women (91 intervention and 89 control groups). Data were collected from April to November 2019 using an interviewing schedule involving sociodemographic characteristics and obstetrics/medical history, BASNEF model questionnaire, and gestational diabetes self-care behavior scale. Results: The findings revealed that an absence of statistically significant differences in sociodemographic characteristics and obstetrics/medical history between the intervention and control groups. Two months post-intervention, all BASNEF model subcontracts and total GD-SCB showed significant improvement in the intervention than the control group; knowledge (F1 = 173.92, p < 0.001), personal beliefs (F1 = 286.54, p < 0.001), subjective norms (F1 = 248.82, p < 0.001), behavioral intention (F1 = 235.43, p < 0.001), enabling factors (F1 = 59.71, p < 0.001), and total GD-SCB (F1 = 775.10, p < 0.001). The effect size showed that 48.60% of the improvement within the intervention group total GD-SCB was due to the intervention. Conclusions: Empowerment through education using the BASNEF model for enhancing GD-SCB was effective and beneficial. Therefore, it can serve as a basic framework for constructing and executing educational programs in the field.

The Effect of Jacobson's Progressive Relaxation Technique on Postoperative Pain, Activity Tolerance, and Sleeping Quality in Patients Undergoing Gynecological Surgery.

BACKGROUND: Inadequate pain management and sleep disturbances of patients undergoing gynecological surgery are associated with delayed recovery time. This study aimed to assess the effect of Jacobson's Progressive Relaxation Technique (JPRT) on postoperative pain, activity tolerance, and sleeping quality in patients undergoing gynecological surgery. MATERIALS AND METHODS: A randomized controlled clinical trial conducted at Obstetrics and Gynecology Department/Damanhour educational institute, Elbehira, Egypt. The study sample involved 116 patients undergoing gynecological surgery who were equally distributed between intervention and control groups. Data collected from April to September 2019. Four tools were used for data collection: Demographic data interview schedule, pain analog scale, activity tolerance questionnaire, and the Groningen sleeping quality scale. For the intervention group, the women were asked to perform JPRT for 30 min on the second and third postoperative day, three times a day. SPSS 23.0 is used to analyze data using Chi-square, Fisher's exact, independent t-test, and Analysis of Covariance (ANCOVA). A significance level considered at p < 0.05. RESULTS: The study results showed that JPRT significantly improves pain, sleep quality, and activity tolerance mean scores among the intervention group compared to the control group (F1 = 119.13, p < 0.001), (F1 = 361.49, p < 0.001), and (F1 = 157.49, p < 0.001), respectively. ANCOVA results showed that 33% of the decreased pain score, 12% of decreased sleeping quality score, and 26% of improved activity tolerance score are due to JPRT. CONCLUSION: JPRT should be offered as a part of standard postoperative nursing care for patients undergoing gynecological surgery to control pain and improve sleeping quality and activity tolerance.

COVID-19 Pandemic: Psycho-social Consequences During the Social Distancing Period Among Najran City Population.

BACKGROUND: COVID-19 is a global pandemic that endanger the health and enforced social distancing for the whole world. Social distancing may generate stress, anxiety, and depression. Understanding the psychosocial consequences of COVID19 during social distancing may help decision-makers to take suitable decisions that help in increasing awareness. Evaluate the psychosocial consequences of COVID-19 pandemic during the social distancing period and explore the relationship between social media use and psychological stress during COVID-19 outbreak among Najran city population. Research design is descriptive correlational research design. SUBJECTS AND METHODS: A snowball sampling technique, was used to recruit participants live in Najran city during the COVID-19 pandemic (1508 participant). RESULTS: A statistically significant differences (P<0.05) are observed between Saudi and non-Saudi participants in all social aspects assessed except for time spent on social media. In addition, a high mean of depression, stress, and anxiety subscale scores are observed in non-Saudi compared to the Saudi participants with statistically significant differences (p=0.000). As well as high DASS-21 total scores in non-Saudi compared to the Saudi participants. Also, there are positive statistically significant correlations (≤0.05) between participants' time spent in social media and their depression, stress, anxiety, and total DASS scores during the COVID-19 outbreak. CONCLUSION: The findings of the present study indicate that COVID-19 pandemic generates stress, anxiety and depression among Najran population especially, non-Saudi. This poor psychological condition is exaggerated with prolonged social media use. COVID-19 also has negative impact on social wellbeing and use of social media cannot replace direct contact with friends. The current study results may be utilized to formulate interventions that enhance psychosocial health and resilience during the COVID-19 outbreak.

Corrigendum to "Effect of lower leg compression during cesarean section on post-spinal hypotension and neonatal hemodynamic parameters: Nonrandomized controlled clinical trial" [Int J Nurs Sci 6/3 (2019) 252-258].

[This corrects the article DOI: 10.1016/j.ijnss.2019.06.003.].

Effect of lower leg compression during cesarean section on post-spinal hypotension and neonatal hemodynamic parameters: nonrandomized controlled clinical trial.

OBJECTIVES: This study aimed to determine the effect of lower leg compression during cesarean section (CS) on post-spinal hypotension (PSH) and neonatal hemodynamic parameters. METHODS: This study is a nonrandomized controlled clinical trial conducted in the cesarean delivery unit of the National Medical institute, Damanhour, Egypt. The sample included 120 parturients (60 intervention and 60 control). The researchers developed three tools for data collection: sociodemographic data and reproductive history interview schedule, electronic monitoring of maternal hemodynamic parameters, and neonatal hemodynamic assessment sheet. All parturients received ordinary pre-operative care. For the intervention group, a long elastic stocking (ordinary pressure 20-30 mmHg, 1 mmHg = 0.133 kPa) was applied on both legs during cesarean section. The control group received the same care without the elastic stocking. RESULTS: Systolic blood pressure, diastolic blood pressure, and mean arterial blood pressure were significantly higher in the intervention group throughout the entire operation period except in the last 5-15 min. Heart rate was significantly lower in the intervention group. Only 13.3% of the intervention group took ephedrine compared with 45% of the control group. Apgar score was higher among neonates of intervention group compared with the control group at 1 min. Neonatal acidosis was significantly higher in the control group than in the contral group. CONCLUSION: Lower leg compression technique can effectively reduce PSH and neonatal acidosis.