Relationship between mental workload and musculoskeletal disorders with intention to leave service among nurses working at neonatal and pediatric departments: a cross-sectional study in Iran.

BACKGROUND: Despite the challenge of nursing shortage in the world and its subsequent impact on care quality as well as aggravation of the situation by intention to leave service, this issue has not been properly addressed, especially among neonatal and pediatric nurses. The present study aims to identify the relationship between mental workload and musculoskeletal disorders with intention to leave the service among nurses working at neonatal and pediatric departments. METHODS: This descriptive-analytical study was conducted on 145 nurses working at neonatal and pediatric departments in six hospitals in Bushehr Province using full-census method. The data were collected using national aeronautics and space administration-task load index (NASA-TLX), Cornell musculoskeletal discomfort questionnaire(CMDQ) and Mobley and Horner's voluntary turnover questionnaire. The data were analyzed using descriptive statistics, independent t-test, Mann-Whitney U test, one-way analysis of variance (ANOVA), Kruskal-Wallis test, Pearson's and Spearman correlation tests and hierarchical linear regression in simultaneous model in SPSS 19.0. RESULTS: The mean score of intention to leave the service was 9.57 ± 3.20 (higher than the moderate level) and the mean mental workload was 71.65 ± 15.14 (high level). Pain in at least one of the legs (100%), back (77.3%) and knees (76.6%) was highly prevalent. However, no statistically significant correlation was found between musculoskeletal disorder categories and intention to leave the service (p > 0.05). The regression analysis results revealed among mental workload domains, only effort-induced workload was negatively and significantly correlated with intention to leave the service (p = 0.003; ß=-0.078). However, the number of night shifts per month was positively and significantly correlated with intention to leave the service (p = 0.001; ß = 0.176). CONCLUSIONS: Planning for appropriate allocation of night shifts, investigating the etiology of musculoskeletal disorders and providing solutions for reducing mental workload should be prioritized by policymakers, while maintaining pediatric nurses' motivation for making efforts.

Evaluation of maternal performance about food security in dietary diversity for children aged 12-24 months and its relationship with anthropometric measurements.

BACKGROUND: Despite growing awareness of the problem of food security, some areas of Iran continue to experience food insecurity. The aim of the present study was to evaluate maternal performance about food security in dietary diversity for children aged between 12-24 months and its relationship with anthropometric measurements in Bushehr. METHODS: A cross-sectional study was carried out using 400 mothers of children aged from 12 to 24 months in Bushehr selected via quota sampling. Data were collected using a reliable localized version of a 32-item food frequency questionnaire, consisting of six subscales, with a Cronbach's α: 0.81. The anthropometric measurements of height and weight were also calculated. Data analysis was performed using median, Mean±SD and multinomial logistic regression test, and odds ratio in SPSS, version 18. RESULTS: According to standard servings, only 24% of the mothers fed their infants cereals, whereas 54.8%, 36.3%, 39.8%, and 20.3% of the mothers used meat, fruits, vegetables, and dairy products, respectively. The strongest associations were between attendance at educational classes and vegetable consumption (OR=2.09, CI=1.03-4.21), age at the onset of complementary feeding and the consumption of meat (OR=1.30, CI=1.02-1.66) and fruits (OR=1.44, CI=1.03-2.03), and the mothers' level of education and use of dairy products (OR=0.29, CI=0.09-0.90). No evidence of a significant association was found between consumption of any food groups and the anthropometric measurements. CONCLUSIONS: Mothers in Bushehr performed poorly in providing their infants with the required nutrition with regard to dietary diversity and amount of food. However, their performance can be improved by enhancing their basic nutrition knowledge, holding practical classes on food preparation for them, and focusing on mothers with infants in high-risk groups, e.g. infants suffering from excessive weight gain, obesity, and malnutrition.

Relationship of sleep quality, chronotype, and obstructive sleep apnea with migraine in the elderly population.

PURPOSE: Disturbances of sleep have frequently been reported in individuals with migraine. On top of this, an elderly patient with migraine also suffers from sleep disturbances due to changes in physiologic and mental health associated with aging. This study aimed to compare several sleep factors, namely sleep quality, chronotype, and obstructive sleep apnea (OSA) risk, between elderly people with and without migraine. METHODS: This was a multicenter cross-sectional study conducted in 10 neurologic clinics located in Tehran, Iran, over 2 years. The sample size was calculated as 189, including 63 migraine and 126 non-migraine patients. RESULTS: A significant difference was observed in the mean score of the global Pittsburgh Sleep Quality Index (PSQI) between migraine and non-migraine groups (p-value = 0.002), and in the individual components of the PSQI. However, there were no significant differences in the frequency of different types of chronotype (p-value = 0.125, T = 1.541) or OSA risk between the two groups (p-value = 0.568, T = -0.573). The binary logistic regression model showed that the relationship between global PSQI and migraine was significant (p = 0.002). CONCLUSION: Sleep quality is a problem for elderly migraine sufferers. Meanwhile, certain factors such as chronotype and OSA have no significant relationship with migraine among community-dwelling seniors. Further studies are required to enhance our understanding of this observation.

The gap in the clinical learning environment: The viewpoints of nursing students.

INTRODUCTION: The clinical environment is an essential and irreplaceable resource in preparing nursing students for their professional role. Despite many changes that occur in the clinical learning environment (CLE), these environments remain important to nurse training. With regard to the importance of students' viewpoints in the evaluation of CLE, this study was performed to the determination of nursing students' viewpoint of the actual and preferred CLE at Bushehr University of Medical Sciences in Iran 2013. MATERIALS AND METHODS: In this cross-sectional analytic study, due to the small size of the research population, all nursing students (86 students) of Bushehr University of Medical Sciences in Iran who had passed at least one clinical course were selected through the census. Participants were invited to complete anonymously the actual and preferred Farsi versions of the CLE Inventory consisting of 42 items originally developed by Professor Chan (2001). Data were analyzed using frequency distribution, mean, standard deviation, and paired t-test. RESULTS: The results indicated that there were significant differences between students' perceptions of the actual and the preferred CLE (P < 0.001). The highest and lowest mean scores of actual CLE belonged to student involvement and individualization, respectively, and the highest and lowest mean scores of preferred CLE belonged to task orientation and individualization, respectively. CONCLUSION: In general, students prefer a more positive CLE than what they actually have experience and would prefer an environment with higher levels of clarification of personalization, student Involvement, satisfaction, task orientation, innovation, and individualization.

Factors promoting Iranian older adults' spirituality: a qualitative content analysis.

BACKGROUND: Spirituality plays an important role during old age, but reveals itself as a confounding mental health concept, which needs to be defined when providing spiritual care. The purpose of this study was to explore factors promoting Iranian older adults' spirituality. METHOD: In a qualitative content analysis approach, we searched for the factors promoting spirituality among a selection of Iranian older adults. Totally, 22 people aged above 60 years old were interviewed using open-ended questions. The recorded interviews were then transcribed, and a coding process was applied based on a qualitative, conventional content analysis. RESULTS: Three key factors were found to promote the spirituality among the older adults: 1) insight in personal belief, 2) spiritual socialization, and 3) peace of mind. Traditional dimensions, the cultural surroundings, and participants' religious beliefs were apparent in each of the categories. CONCLUSION: Society's role in making the seniors spiritual role models was very important; moreover the hereafter life on religious grounds seemed to be another important factor in reaching for high levels of spiritual and mystical perfection. Educational interventions based on the elders' needs for spiritual empowering by health care professionals especially with regards to their spiritual based social interactions and reaching peace of mind, will comprise a major part of wellness approaches.

The effects of an empowering self-management model on self-efficacy and sense of coherence among retired elderly with chronic diseases: a randomized controlled trial.

BACKGROUND: Being elderly and retired are related phenomena that overlap in a time symmetry. The present study aimed to assess the effect of an empowering self-management model on the self-efficacy and sense of coherence (SOC) in retired elderly with chronic diseases. METHODS: A randomized controlled trial that included 60 elderly people was carried out in Bushehr (Iran) in 2016. The participants were randomly assigned to either a control group or an intervention group. Based on an empowering self-management model, the intervention group participated in a five-stage plan: 1) self-awareness of changes and understanding their personal level of performance and expectations; 2) optimal goal setting; 3) planning; 4) adjusting physical, psychological, and social structures; and 5) evaluation. Self-efficacy and SOC were measured using the questionnaires developed by Sherer and Antonovsky, respectively, before and after the intervention. The results of the observed differences between the groups were subsequently compared. Data were presented as mean±SD. RESULTS: The mean change of the self-efficacy score in the intervention and control groups was 9.48±5.32 and 1.68± 6.04, respectively, (t[56]=5.20, P<0.001). The mean change of the SOC score in the intervention and control groups was 24.17±12.05 and 0.10±13.42, respectively, (t[56]=7.18, P<0.001). CONCLUSION: The applied empowering self-management model led to an improved self-efficacy and SOC among the retired elderly with chronic diseases. This model can be used to empower the elderly to achieve comprehensibility, manageability, and meaningfulness in their lives.

Assessment of the knowledge and attitude of infants' mothers from Bushehr (Iran) on food security using anthropometric indicators in 2016: a cross-sectional study.

BACKGROUND: Among the main elements of food security, in terms of food usage, are knowledge and attitude. These are particularly important during the initial two years of a child's life. The present study was conducted in 2016 and aimed to assess the knowledge and attitude of infants' mothers from Bushehr (Iran) towards food security using anthropometric indicators. METHODS: The present cross-sectional, descriptive-analytical study was performed on 400 mothers of children aged 1-2 years in Bushehr, Iran. Data were collected using a 20-item knowledge questionnaire (CVR = 0.95, CVI = 0.95, and reliability 0.7), a 26-item attitude questionnaire (CVI = 0.94, CVR = 0.91, and reliability 0.76), and a 16-item Radimer/Cornell questionnaire, which were completed by all mothers. Anthropometric indicators of children, including height-for-age, weight-for-age, and weight-for-height were also measured in accordance with the z-score benchmark of the World Health Organization. RESULTS: A positive and significant relationship was found between knowledge and attitude (r = 0.26, P = 0.0001) as well as between knowledge and household food security (r = 0.11, P = 0.02) in complementary feeding. Approximately 26% of the studied children fell under the risk category of overweight to obese. A significant relationship was found between inadequate knowledge of the mothers and height-for-age (OR = 4.87, P = 0.001) and weight-for-height (OR = 2.33, P = 0.04) indices, as well as between the negative attitude of the mothers and weight-for-height index (OR = 2.91, P = 0.03). CONCLUSIONS: The knowledge of food security purely relates to the dimension of the household food security of a family and not to the individual/child level of food security. It seems that the knowledge of a mother, as a positive factor, does not support child's food security when the severity of household insecurity triggers the child's hunger and food inaccessibility. Also, inappropriate knowledge and negative attitude towards food security were associated with an increased risk of obesity. Increased weight, in addition to being affected by the knowledge and attitude of the mothers, is probably also influenced by the incorrect conduct of the mothers. Further investigation on this topic is recommended.

Perspectives of nursing and midwifery students regarding the role of the hidden curriculum in patient education: A qualitative study.

BACKGROUND: Although education is one of the most substantial needs of patients that should be taught by nurses and midwives, it is not clearly defined through the hidden curriculum in students' teaching programs. The aim of this study was to explore the patient education through the hidden curriculum in the perspectives of nursing and midwifery students. MATERIALS AND METHODS: A qualitative, content analysis study was performed and twenty nursing and midwifery students were interviewed. Data were collected using face-to-face semi-structured interviews and analyzed using conventional content analysis approach. RESULTS: Students' perception of the hidden curriculum in patient education emerged in three main themes concerning: (1) interactions, (2) teaching and learning opportunities, and (3) reflective evaluation. CONCLUSIONS: The hidden curriculum in patient education can be transferred as interactions between professors, students, nurses, doctors, and also patients who are rooted from paying attention to the human dimension of the patient, avoiding the materialistic treatment of the patient and treating the patient with dignity. Educational policies and students' assignments should be designed based on the patient's educational goals and the goal of evaluation has to be presented to the students clearly.

Transition from being OK to NOT OK with tooth loss among a selection of older people in Iran: a qualitative study.

BACKGROUND: Several studies have covered oral health and dental decay in old age, but these studies mostly applied standard quantitative tools and did not include consideration of older people's views on oral problems, partial edentulism in particular. OBJECTIVE: To explore people's perceptions in terms of the transition from being OK to NOT OK with tooth loss among a selection of older people in Iran. MATERIALS AND METHODS: A qualitative content analysis study was chosen for the research by interviewing 15 older people using open-ended questions. Criteria for participation in the study were as follows: fitting the Kennedy class I or class I modification I category, having a minimum of four teeth but not more than 20 and being aged 60 years or more. The recorded interviews were then transcribed, and a coding process was applied based on a qualitative, conventional content analysis. RESULTS: The four main themes that emerged were as follows: (i) gradual realisation of the need to deal with the problem; (ii) the search for information on dental health; (iii) the challenge of adaptation; and (iv) tendency towards dental rehabilitation. CONCLUSION: The turning point in the transition from being OK to NOT OK seemed to be associated with an edentulous crisis that had occurred from another problem such as stomach ache, distention, or nocturnal dyspnoea due to swallowing food that had not been properly chewed and had an affect on an elderly person's life, physically and mentally. It is important to recognise the concept of healthy eating in relation to edentulism.

Evaluation of the knowledge level of health violations in food production, distribution, sales centers and public places and their authorities investigating among the women of Bushehr city.

BACKGROUND: Women and mothers are the most important educational audience to convey health teachings. This study was aimed to evaluate the knowledge level of different types of health violations of food production, distribution, sale centers and public places; and authorities investigating the violations among women referring to health care centers in Bushehr. MATERIALS AND METHODS: In this descriptive-analytical study, which was done cross-sectionally, 600 women who were referred to health care centers affiliated to the Bushehr University of Medical Sciences was selected by convenience sampling. Two-part questionnaire was used to collect data: demographic information and a researcher-designed knowledge survey questionnaire consisted of 25 questions with Cronbach's alpha = 0.7. Data were analyzed with the software SPSS version 13; using Chi-square test and Phi and Cramer test. P ≤ 0.05 was considered to be statistically significant. RESULTS: The findings showed that 56.9% and 26.5% of women had good and moderate knowledge levels regarding health violations, while the general knowledge level of authorities investigating health violations were at the moderate level among 57.3% and at the good level among 15.3% of women. Overall, there was a significant relationship between education level and the women's knowledge level of health violations (P < 0.0001). The relationship between the women's education level and authorities investigating health violations was not significant (P = 0.073). CONCLUSION: Applying interventional methods of education in health violations to the women by health centers can elevate the level of health knowledge among them.

Bushehr Elderly Health (BEH) Programme, phase I (cardiovascular system).

PURPOSE: The main objective of the Bushehr Elderly Health Programme, in its first phase, is to investigate the prevalence of cardiovascular risk factors and their association with major adverse cardiovascular events. PARTICIPANTS: Between March 2013 and October 2014, a total of 3000 men and women aged ≥ 60 years, residing in Bushehr, Iran, participated in this prospective cohort study (participation rate=90.2%). FINDINGS TO DATE: Baseline data on risk factors, including demographic and socioeconomic status, smoking and medical history, were collected through a modified WHO MONICA questionnaire. Vital signs and anthropometric measures, including systolic and diastolic blood pressure, weight, height, and waist and hip circumference, were also measured. 12-lead electrocardiography and echocardiography were conducted on all participants, and total of 10 cc venous blood was taken, and sera was separated and stored at -80 °C for possible future use. Preliminary data analyses showed a noticeably higher prevalence of risk factors among older women compared to that in men. FUTURE PLANS: Risk factor assessments will be repeated every 5 years, and the participants will be followed during the study to measure the occurrence of major adverse cardiac events. Moreover, the second phase, which includes investigation of bone health and cognition in the elderly, was started in September 2015. Data are available at the Persian Gulf Biomedical Research Institute, Bushehr University of Medical Sciences, Bushehr, Iran, for any collaboration.

Exploring nursing students' experience of peer learning in clinical practice.

BACKGROUND: Peer learning is an educational process wherein someone of the same age or level of experience level interacts with other students interested in the same topic. There is limited evidence specifically focusing on the practical use of peer learning in Iran. The aim of this study was to explore nursing students' experiences of peer learning in clinical practice. MATERIALS AND METHODS: A qualitative content analysis was conducted. Focus groups were used to find the students' experiences about peerlearning. Twenty-eight baccalaureate nursing students at Bushehr University of Medical Sciences were selected purposively, and were arranged in four groups of seven students each. The focus group interviews were conducted using a semi-structured interview schedule. All interviews were tape-recorded, transcribed verbatim, and analyzed using conventional content analysis method. RESULTS: The analysis identified four themes: Paradoxical dualism, peer exploitation, first learning efficacy, and socialization practice. Gained advantages and perceived disadvantages created paradoxical dualism, and peer exploitation resulted from peer selection and peer training. CONCLUSION: Nursing students reported general satisfaction concerning peer learning due to much more in-depth learning with little stress than conventional learning methods. Peer learning is a useful method for nursing students for practicing educational leadership and learning the clinical skills before they get a job.

Mothers' perceptions of fever in children.

BACKGROUND: Fever is one of the most common symptoms for children. Most fevers are not dangerous; parents, especially mothers, nevertheless experience severe anxiety confronting children's fevers. This study aimed to explore the mothers' perceptions of fever in their children. MATERIALS AND METHODS: Mothers of hospitalized febrile children were selected by purposeful sampling method from two hospitals in Bushehr in 2012. Data saturation was reached after in-depth semi structured interviews with 12 participants. Data analysis was done by conventional content analysis method. FINDINGS: Sense of concern, the necessity for quick action and the need for protection emerged from mothers' views. Sense of concern came from concerns over cause of fever, child's hospitalization and possible side-effects of fever. The necessity for quick action resulted from gathering information, self-medication and referring to healthcare centres; the need for spiritual and emotional protection created the need to protect in mothers. CONCLUSION: Findings showed that mothers need educational, emotional and spiritual protection in order to overcome their concerns and managing their children's fever. It is recommended that an empowering model based on these findings be developed in order to strengthen mothers in dealing with fevers in order to prevent excessive concern and anxiety.

Children with asthma and their families' viewpoints on spiritual and psychological resources in adaptation with the disease.

Recognition of the spiritual and psychological needs of children and their families with chronic asthma disease may be helpful in a successful coping with their problems in order to control over the condition. In a qualitative content analysis study, nine children with moderate to severe asthma and 10 parents were studied in order to discover the resources of compatibility of them. The participants were chosen purposefully and they were asked some semi-structure questions about their experiences. The spiritual and psychological experiences of the participants were divided into two main categories as follows: (1) contrive to religious-belief consisting of three sub-categories known as "religious rituals, believe in a divine predestination, and Islamic-based patience," and (2) psycho-intellectual management that includes the five sub-categories of "psycho-intellectual attention, maintaining family's mental peace, reduction in negative burden of disease, satisfaction from optimal treatment, and matching internal desires with disease conditions." It is recommended that heath care providers by reinforcing parent's and children's religious and spiritual backgrounds and according to child's cognitive development at this age provide a suitable foreground through necessary instructions for children and their families in order to spiritual growth and suitable adaptation with disease.

Power resources of older people in Iran.

BACKGROUND: Maximising the client's power resources facilitates their ability to cope with chronic illness. Nurses must be well informed about power resources and feelings of empowerment among older people. AIM: This article reports on a study exploring power resources in daily life from the perspective of older people in Iran. DESIGN: A qualitative content analysis study was conducted. The participants were selected from older community dwellers in Iran using in-depth, semi-structured interviews to understand their experiences with power resources. RESULTS: Power in older people in Iran is represented by four dimensions: spiritual, intellectual, social and physical. Each power dimension can be divided into intrinsic and extrinsic modes. CONCLUSION: By maximising older people's power in intellectual, social and especially in spiritual resources, the effect of the loss of physical power, with its deteriorative or depressogenic effect on older people's sense of power and well-being can be compensated for. It is recommended that nurses should plan their interventions to enhance older people's power, especially their spiritual power. IMPLICATIONS FOR PRACTICE: Different models of empowering older people should be explored in Iranian nursing care delivery.

Renal artery stenosis and its predictors in hypertensive patients undergoing coronary artery angiography.

BACKGROUND: Renal artery stenosis (RAS) has been increasingly recognized in the recent years, especially in patients with coronary artery disease (CAD). RAS affects the patients with hypertension (HTN), but the exact prevalence is not known. OBJECTIVES: This study was performed to determine the prevalence and to identify the predictors of RAS in hypertensive patients undergoing coronary artery angiography. PATIENTS AND METHODS: In a cross-sectional study from August 2008 to August 2009, 481 patients with HTN and suspected CAD underwent selective coronary and renal angiography for screening and predicting RAS. RAS was defined as a higher than 50% stenosis in the renal artery lumen. Multivariate analysis of factors associated with the presence of RAS were examined using a logistic regression model. RESULTS: The mean ± standard deviation of age was 59.25 ± 10.81 years and 50.3% were men. According to angiographic data, 425 patients (88.4%) had CAD, while 56 (11.6%) had normal coronary arteries. RAS was seen in 94 (22%) patients with CAD. The multivariate logistic regression analysis identified only age (P < 0.001) and the number of significant coronary lesions (P < 0.001) as independent predictors of RAS. Gender, smoking, congestive heart failure, diabetes mellitus (DM), hyperlipidemia (HLP) and body mass index (BMI) were not independent predictors. CONCLUSIONS: This study suggests that in the management of patients with RAS, risk factors should most likely be considered as beneficial. In addition, the clinical and angiographic features are helpful in predicting its presence in elderly patients with CAD.

Elderly self-management: a qualitative study.

BACKGROUND: The population of elderly in Iran and in the world is increasing. It is predicted that the population of elderly reaches to 10 millions in Iran by the year 2019. Elders more than other age groups are at risk of chronic diseases and health problems; and elderly affects their self-management and makes them feel disabled. Since the knowledge of self-management for Iranian elderly is not well developed, this paper aimed to determine the concept of self-management for Iranian elders. METHODS: This was a qualitative study with grounded theory approach on Iranian elderly self-management. Data were collected through deep interviews with 26 participants in a period of one year and were analyzed using a Strauss Corbin analysis method. RESULTS: Self-management in the context of power means using different managing methods in dealing with daily life needs, especially in interactions with others in a way that accelerates affairs with efficiency and satisfaction. The main categories emerged from this qualitative study included: managing plans, managing life goals and policies, persuading the desired goals, managing self-care, directing others, coordinating and consulting with others. CONCLUSIONS: The findings of this study provided a deep understanding of elderly perceptions of self-management in their lives. These findings can be a baseline for future researches on developing effective health interventions such as developing a nursing model for increasing the elderly self-management abilities in Iran. Such a model can provide a strong basis for nursing care.