Major and minor criteria for gastric dystemperaments in Persian Medicine: Sari gastric dystemperament criteria-I (SGDC-I).

Background: Gastric disorders are one of the most common human ailments, which impose a huge economic burden on countries. In Persian Medicine (PM), it is possible to predict the susceptibility to gastric diseases with diagnosis of gastric Mizajes (temperaments) and dystemperaments. The semiology of gastric dystemperaments has been investigated in PM textbooks, although the value of each sign and symptom is not mentioned. Consequently, this research is designed to determine the major and minor criteria for classifying gastric dystemperaments on the basis of valid manuscripts and with the help of PM specialists in the present era. Methods: This was a consensus-based study consisting of four phases. In the first phase, reference PM textbooks were studied. Symptoms and signs of gastric dystemperaments were collected and listed in four groups. In the second phase, semi-structured interviews with a sample of PM experts were carried out. Phase three included a focused group discussion with experts. Eventually, findings were integrated from the three study phases in a two-day meeting in Sari City. Results: Selected criteria included eight major and eight minor criteria for hot-cold dystemperament, as well as six major and eight minor criteria for wet-dry gastric dystemperament. Conclusion: Modern lifestyles and the interfering factors are responsible for some changes in diagnostic signs and symptoms according to PM. This was the first step to coordinate PM diagnostic criteria for gastric dystemperaments. Further studies are recommended to reach a unique protocol in the field of PM diagnostics. The next step includes design and validation of national diagnostic tools.

Predictors of Quality of Life in Infertile Couples.

OBJECTIVES: This study was conducted with the aim of examines the quality of life of infertile couples and their relationship with the practical resilience of infertile couples referring to Yazd's centers of infertility. METHODS: This research is a descriptive-correlational study. The research population consisted of all infertile couples who referred to Infertility Centers in Yazd, Iran in the winter of 2016. Sampling was conducted in a non-random and accessible manner. The instrument used in the research included a) demographic information questionnaire, b) Conner and Davidson's Resilience Scale, and c) quality of life infertile couples questionnaire. Data were analyzed by SPSS software version 17 at a significant level of P < 0.05. To describe the data, descriptive statistics methods were used and the inferential statistics (Pearson correlation coefficient, regression, independent t test, and variance analysis) were used to test the research hypotheses. RESULTS: People (202 couples) participated in this research. Three variables of resilience (ß = 0.04, P = 0.04), gender (ß = -0.22, P < 0.001), and education level (ß = 0.21, P < 0.001) had a prediction coefficient and there was a significant relationship with quality of life. CONCLUSIONS: This study showed that resilience, gender, and education predict the quality of life of infertile couples. In the infertile couples counseling program, resilience should be considered as a coping factor.

Appetite Reducing Herbal Drugs from the Perspective of Avicenna and Aghili in Iranian Traditional Medicine (Persian medicine).

The increasing prevalence of obesity is one of the major problems of today's society. Man needs food to continue living, daily activities, and even the metabolism of food; and appetite plays an important role in receiving foods. Appetite and weight reducing synthetic drugs, which are mostly costly and have significant side effects, are recommended for some patients, and have limited effectiveness in the treatment of obesity. Given the epidemic of obesity and the lack of satisfaction with synthetic drugs these days, people are more likely to use herbal medicines. Complementary medicine has always been considered for the choice of new treatment. This medicine has a long history. Persian Medicine is one of the traditional medicine systems. This study was a qualitative study on the Books of Canon and the Makhzan Al-Aladvia. Saffron has been introduced in both modern medicine and in Iranian medicine to reduce appetite. In the case of Purslane seed and Chio nut, Figs, Sesame seeds, Camphor, and Solomon's seal, and Opium poppy, which have been appetite suppressant in traditional medicine books, in the books and articles of modern medicine, they have not proved to be appetite reducing. Modern medicine has known Gourd as a weight reducing food with the effects on fat but there is no talk about its effects on appetite. According to traditional Iranian medicine, Chio nut causes anorexia due to weakness in the stomach. Therefore, it is not advisable for weight loss. More clinical studies are conducted to prove the effects of appetite suppressant and weight loss effects of these herbal medicines seem logical.

Relationship between Oncology Nurses' Spiritual Wellbeing with Their Attitudes towards Spiritual Care Providing Based on Neuman System Model: Evidences from IRAN.

Introduction: Oncology nurses should create a balance in their personal and professional life to provide holistic care to patients. The more the awareness of spirituality in oncology nurses develops, the more obviously it manifests itself in their attitudes toward spiritual care. This study aimed to assess the relationship between oncology nurses' spiritual wellbeing, and their attitudes toward spiritual care based on Neumann's Systems Model. Methods: This descriptive correlational study tested the relationships of Neuman system-based model constructs, named oncology nurses antecedents, their spiritual wellbeing, and attitudes to spiritual care by using a causal model and path analysis. 130 oncology nurses from 12 Tehran hospitals completed the study questionnaires, having completed written informed consents. The study administration permission was approved by Urmia University of medical sciences ethical committee. The collected data were coded and entered to computer to be analyzed by SPSS 13. We used path analysis and multiple regressions for assessing the relationships among the variables of the hypothesized study model. Results: The model testing revealed, from four antecedents' predictors' variables, only age and spiritual wellbeing had a direct and meaningful relationship with oncology nurses' attitudes towards spiritual care. The nurses' antecedent and mediator variable, and spiritual wellbeing explained 32.5% of the variance in their attitudes towards spiritual care. Moreover, the nurses' spiritual wellbeing was found to have a positive relationship with their attitude to spiritual care (ß= 0.450). Conclusion: However, the study model and its constructs proved to be quite efficient in indicating oncology nurses' attitudes to spiritual care-related factors, but it is not a comprehensive model and other studies are required for its empirical testing.

Relationship between illness-related worries and social dignity in patients with heart failure.

BACKGROUND: Heart failure is a major growing problem and affects not only patients but also their families and community networks and reduces the functional capacity of patients and impairs their social life. RESEARCH QUESTIONS: This study was conducted to investigate relationship between illness-related worries and social dignity in patients with heart failure. DESIGN: The study had a descriptive-analytic design, and data collection was carried out by means of two specific questionnaires. Participants and context: A total of 130 inpatients from cardiac wards in hospitals affiliated with Tehran and Shahid Beheshti University of Medical Sciences participated. Ethical consideration: This study was approved by the Research Committee of Shahid Beheshti University of Medical Sciences. RESULTS: The highest mean score of illness-related worries was attributed to the dimension of patient's worry of physical-mental complications, and the least mean score was related to the dimension of the worry about the future of disease. The highest mean score of social dignity was associated with the dimension of social communication and support, and the least is attributed to the dimension of burden to others (economic). Pearson's statistical test showed a significant correlation (r = 0.455, p < 0.05) between the score of illness-related worries and social dignity. DISCUSSION: As the result of this study showed that reducing illness-related worries in patients with heart failure can improve their social dignity, using strategies to decrease worries and promote social dignity in these patients is recommended. CONCLUSION: This study affirms the importance of careful evaluation of individual patients to determine their needs related to dignity. We hope these results will help to promote actions by patient-care staff that honor and support patient dignity, resulting in benefits to patients and developing the quality of care based on human rights.

Test of a Dignity Model in patients with heart failure.

BACKGROUND: Identifying, maintenance, and promotion of dignity in different patients of various cultures is an ethical responsibility of healthcare workers. RESEARCH QUESTIONS: This study was conducted to investigate factors related to dignity in patients with heart failure and test the validity of Dignity Model. DESIGN: The study had a descriptive-correlational design, and data collection was carried out by means of four specific questionnaires. Participants and context: A total of 130 in-patients from cardiac wards in hospitals affiliated with Tehran and Shahid Beheshti University of Medical Sciences participated. Ethical consideration: This study was approved by the Research Committee of Shahid Beheshti University of Medical Sciences. FINDINGS: Significant correlation showed the following: between illness related worries with dignity conserving repertoire score, between illness related worries with social dignity, between illness related worries with dignity conserving repertoire score, and between social dignity with dignity score. Goodness Fit Index and Comparative Fit Index were calculated greater than 0.9. DISCUSSION: This study affirms the importance of careful evaluation of individual patients to determine their needs related to dignity. CONCLUSION: According to the results, the necessity of using appropriate tools to assess various aspects of patients' dignity by clinical healthcare staff and design activities with particular focus on the main factors affecting dignity such as illness related worries and social dignity is recommended. Attention to this issue in everyday clinical practice can facilitate health professionals/nurses to potentially improve their patients' dignity, develop quality of care and treatment, and improve patients' satisfaction.

Quality of life and general health of infertile women.

BACKGROUND: Measuring the quality of life (QOL) is a benchmark in today's world of medicine. The aim of the present study was to determine the general health and QOL of infertile women and certain affecting conditions. METHODS: In a cross-sectional study, 161 infertile women referring to Dr. Rostami's Infertility Center of Shiraz, Southern Iran, in 2013 were enrolled by the convenience sampling method. Data were collected via a socio-demographic, general health (GHQ28), and the QOL Questionnaire of Infertile Couples and analyzed using descriptive and analytical statistics. RESULTS: According to 146 completely filled-out questionnaires, the mean age of the participants and their spouses were 29.4 ± 5.4 and 33.8 ± 5.8 years, respectively. Moreover, the general health of 57 (39%) patients was normal and that of 89 (61%) patients showed a degree of impairment. The scores for depression and physical symptoms were the highest and lowest, respectively. In addition, quite positive, positive, neutral, and negative specific QOL of infertile women were detected in 4 (2.8%), 72 (49.3%), 70 (47.9%), and 0 (0%) individuals, respectively. The total QOL scores had maximum correlation with GHQ anxiety (r = -0.596, P < 0.001) and general health scores had the highest correlation with physical QOL (r = -0.637, P < 0.001). The QOL was economically (P = 0.027), emotionally (P = 0.004), sexually (P = 0.017), physically (P = 0.037), and psychologically (P = 0.001) less for the women living in rural areas than other infertile women. However, university education (P = 0.015) and higher income per month (P = 0.008) had positive associations with QOL. CONCLUSION: General health of more than half of the infertile women indicated a degree of disorder. These women face the risk of anxiety, social dysfunction, and depression. Educational status, monthly income, and rural/urban residency are the major factors influencing the QOL.

Validating the Farsi version of the Pregnancy Worries and Stress Questionnaire (PWSQ): An exploratory factor analysis.

INTRODUCTION: Biological, environmental, inter- and intrapersonal changes during the antenatal period can result in anxiety and stress in pregnant women. It is pivotal to identify potential stressors and prevent their foetal and maternal consequences. The present study was conducted to validate and examine the factor structure of the Farsi version of the Pregnancy Worries and Stress Questionnaire (PWSQ). METHODS: In 2015, 502 Iranian healthy pregnant women, referred to selected hospitals in Tehran for prenatal care at 8-39 weeks of pregnancy, were recruited through a randomized cluster sampling. The PWSQ was translated into Farsi, and its validity and reliability were examined using exploratory factor analysis by SPSS version 21. RESULTS: The content validity of items on the PWSQ was between 0.63-1. The content validity index for relevance, clarity and simplicity were 0.92, 0.98, and 0.98, respectively, with a mean of 0.94. The Kaiser-Meyer-Olkin measure of sampling adequacy was 0.863. Test-retest reliability showed high internal consistency (α=0.89; p<0.0001). CONCLUSION: The psychometric evaluation and exploratory factor analysis showed that the translated questionnaire is a valid and reliable tool to identify stress in Iranian pregnant women. Application of the questionnaire can facilitate the diagnosis of stress in pregnant women and assist health care providers in providing timely support and minimizing negative outcomes of stress and anxiety in pregnant women and their infants.

Examining Factor Structure and Validating the Persian Version of the Pregnancy's Worries and Stress Questionnaire for Pregnant Iranian Women.

BACKGROUND AND OBJECTIVES: Pregnant women tend to experience anxiety and stress when faced with the changes to their biology, environment and personal relationships. The identification of these factors and the prevention of their side effects are vital for both mother and fetus. The present study was conducted to validate and to examine the factor structure of the Persian version of the Pregnancy's Worries and Stress Questionnaire. MATERIALS AND METHODS: The 25-item PWSQ was first translated by specialists into Persian. The questionnaire's validity was determined using face, content, criterion and construct validity and reliability of questionnaire was examined using Cronbach's alpha. Confirmatory factor analysis was performed in AMOS and SPSS 21. Participants included healthy Iranian pregnant women (8-39 weeks) who refer to selected hospitals for prenatal care. Hospitals included private, social security and university hospitals and selected through the random cluster sampling method. FINDINGS: The results of validity and reliability assessments of the questionnaire were acceptable. Cronbach's alpha calculated showed a high internal consistency of 0.89. The confirmatory factor analysis using the c2, CMIN/DF, IFI, CFI, NFI and NNFI indexes showed the 6-factor model to be the best fitted model for explaining the data. CONCLUSION: The questionnaire was translated into Persian to examine stress and worry specific to Iranian pregnant women. The psychometric results showed that the questionnaire is suitable for identifying Iranian pregnant women with pregnancy-related stress.

Relationship between ICU nurses' moral distress with burnout and anticipated turnover.

BACKGROUND: Moral distress is one of intensive care unit nurses' major problems, which may happen due to various reasons, and has several consequences. Due to various moral distress outcomes in intensive care unit nurses, and their impact on nurses' personal and professional practice, recognizing moral distress is very important. RESEARCH OBJECTIVE: The aim of this study was to determine correlation between moral distress with burnout and anticipated turnover in intensive care unit nurses. RESEARCH DESIGN: This study is a descriptive-correlation research. PARTICIPANTS AND RESEARCH CONTEXT: A total of 159 intensive care unit nurses were selected from medical sciences universities in Iran. Data collection instruments included "demographic questionnaire," "ICU Nurses' Moral Distress Scale," "Copenhagen Burnout Inventory" and "Hinshaw and Atwood Turnover Scale." Data analysis was done by using SPSS19. ETHICAL CONSIDERATIONS: Informed consent from samples and research approval was obtained from Shahid Beheshti Medical Sciences University Research Ethics Board in Tehran. FINDINGS: The findings showed intensive care unit nurses' moral distress and anticipated turnover was high, but burnout was moderate. The results revealed that there was a positive statistical correlation between intensive care unit nurses' age, their work experience and the fraction of nurses' number to number of intensive care unit beds with their moral distress and burnout. However, there were no correlation between gender, marriage status, educational degree and work shift and moral distress. DISCUSSION: Some of the findings of this research are consistent with other studies and some of them are inconsistent. CONCLUSION: Similarly, moral distress with burnout and anticipated turnover did not have statistical correlation. However, a positive correlation was found between burnout and anticipated turnover. The results showed that increase in the recruitment of young nurses, and nursing personnel, and diminishing intensive care unit nurses' moral distress, burnout and their turnover intention are essential.

Developing a valid and reliable instrument to predict the protective sexual behaviors in women at risk of human immunodeficiency virus.

BACKGROUND: One much needed tool to assist with the monitoring and evaluation of Human Immunodeficiency Virus (HIV) prevention programs is to provide a valid instrument to measure protective sexual behavior and related factors. OBJECTIVES: The current study aimed to design a valid and reliable instrument to predict the protective sexual behaviors of women at risk of HIV in Iran. PATIENTS AND METHODS: The current study was a sequential mixed cross-sectional and methodological research. Initially, via a qualitative research, constructs and factors associated with sexual protective behavior of women at risk were identified through 25 in-depth interviews. The questionnaire on predictors of protective sexual behaviors in women at risk of HIV (PSPB) was designed based on a qualitative study, and then its qualitative validity, content, and construct validity were evaluated. Exploratory factor analysis was performed and 200 women at risk participated. RESULTS: Seven concepts emerged after exploratory factor analysis of the 48 items. The content validity ratio (CVR) of the questionnaire constructs were 0.55 to 0.76, and content validity index (CVI) structure was 0.86 to 0.95. Cronbach's alpha coefficient for the entire questionnaire was 0.78, and correlation coefficient of the test-retest reliability for the constructs was from 0.73 to 0.89. CONCLUSIONS: The current study proved the capability of the predictors of sexual protective behavior in women at risk for HIV questionnaire as a valid and reliable instrument for the Iranian community.

Spirituality as experienced by Muslim oncology nurses in Iran.

Spirituality, as an essential part of holistic care, is concerned with faith and meaning, and is usually conceptualised as a 'higher' experience or a transcendence of oneself. A resurgence of interest in this area is evident in post modern culture because of the effects that spirituality and religious beliefS may have on health. Up until the last two decades, spirituality and spiritual care, although vital, were invisible aspects of nursing. However, now that these concepts have made their way into the mainstream, literature in this area has burgeoned. In addition, modern nursing grew out of spiritual roots, and spiritual care is a component of holistic care. In the Islamic Republic of Iran,little information exists documenting the expressed spirituality of nurses in general and of oncology nurses in particular. This article presents spirituality as it is experienced by Muslim oncology nurses.The investigation involved a qualitative analysis of the spirituality of 24 participants, using semi-structured interviews. Participants were oncology nurses at 12 hospitals in two educational universities of medical sciences in Tehran. The main categories of spirituality as experienced by oncology nurses included religious and existential dimensions in an Iranian Muslim context. Findings are consistent with the holistic view of Islam, that considers all dimensions of personhood simultaneously. This study is important to transcultural nursing because of the benefits of increasing nursing knowledge through research that examines nurses' spirituality in diverse cultures.

How do women at risk of HIV/AIDS in Iran perceive gender norms and gendered power relations in the context of safe sex negotiations?

Sexual transmission of HIV/AIDS among women is growing in the Middle East region. Despite the fact that there are numerous gender-related sociocultural factors influencing HIV/AIDS protective behaviors, little gender-specificity is carried out in HIV prevention in Iran. In order to close this gap, we aimed to provide preliminary work that explored the perceptions that women at risk of HIV had about gender norms and gendered power and their ability to protect themselves against HIV/AIDS. Twenty-five semi-structured in-depth interviews were conducted with women at risk of HIV/AIDS, aged 21-49 years, at Voluntary Counseling and Testing Centers or Drop in Centers in Tehran, Iran. Results showed that perceived gender norms were essential barriers of protective behavior through sexual socialization, male control over condom use and sexual decision-making, male pleasure predominating in sexual encounters and sexual double standards, and economic dependencies. In the conclusions, we consider how HIV/AIDS preventive programs can be structured to be gender-sensitive and empowering in Iran.

Iranian intensive care unit nurses' moral distress: a content analysis.

Researchers have identified the phenomena of moral distress through many studies in Western countries. This research reports the first study of moral distress in Iran. Because of the differences in cultural values and nursing education, nurses working in intensive care units may experience moral distress differently than reported in previous studies. This research used a qualitative method involving semistructured and in-depth interviews of a purposive sample of 31 (28 clinical nurses and 3 nurse educators) individuals to identify the types of moral distress among clinical nurses and nurse educators working in 12 cities in Iran. A content analysis of the data produced four themes to describe the nurses' moral distress. The four themes were as follows: (a) institutional barriers and constraints; (b) communication problems; (c) futile actions, malpractice, and medical/care errors; (d) inappropriate responsibilities, resources, and competencies. The results demonstrate that moral distress for intensive care unit nurses is different and that the nursing leaders must reduce moral distress among nursing in intensive care.

Barriers to condom use among women at risk of HIV/AIDS: a qualitative study from Iran.

BACKGROUND: The growing trend of women infected with HIV through sexual transmission is alarming. Factors influencing condom use have not yet been fully identified, especially in countries with conservative cultures and backgrounds. The present study aimed to explore the barriers of condom use in Iranian women at risk of HIV. METHODS: Using the grounded theory methodology, participants' experiences and their perceptions regarding condom were collected during semi structured in depth interviews. Participants were 22 women, aged 21-49 years, considered to be at risk for HIV, due to their own or their partner's sexual behaviors. Qualitative analysis of the data was conducted manually and was guided by constant comparative analysis. RESULTS: Two main barriers, personal and socio-environmental emerged from data analysis. Lack of perceived threat, absence of protective motivation, inadequate knowledge, perceived lack of control, negative attitudes towards condom and misperception were the major personal barriers, while unsupportive environments and cultural norms were the common socio-environmental barriers to condom use among these at risk women. CONCLUSIONS: These critical barriers have to be addressed for implementing effective prevention programs against HIV among populations at risk for HIV.

Patient dignity and its related factors in heart failure patients.

Maintenance and promotion of patient dignity is an ethical responsibility of healthcare workers. The aim of this study was to investigate patient dignity and related factors in patients with heart failure. In this qualitative study, 22 patients with heart failure were chosen by purposive sampling and semi-structured interviews were conducted until data saturation. Factors related to patient dignity were divided into two main categories: patient/care index and resources. Intrapersonal features (inherent characteristics and individual beliefs) and interpersonal interactions (communication, respect, enough information, privacy, and authority) were classified as components of the patient/care index category. Human resources (management and staff) and environmental resources (facilities and physical space) were classified as components of the resources category. The results will increase healthcare staff's understanding of patient dignity and its related factors, and provide information regarding the development of systems and processes that support patients in ways that are consistent with these values.

Identifying challenges for effective evaluation in nursing education: A qualitative study.

BACKGROUND: Although nursing education in Iran has a positive trend in growth; it is still facing with multifaceted challenges. This study aims to explore the challenges for effective evaluation of nursing education perceived by academic managers. MATERIALS AND METHODS: A qualitative study was performed by using 21 face-to-face, in-depth interviews with academic managers in medical universities and at the Ministry of Health and Medical Education in Iran. All interviews were recorded digitally, transcribed verbatim, and analyzed by qualitative content analysis. RESULTS: The main challenges could be categorized under 3 themes, each included 3 subthemes: managerial issues (inefficacy of management, inadequacy of policies and strategies, ineffective evaluation planning); administrative issues (inefficient and affected evaluators, inappropriate implementation, and inefficacy of approaches and tools); and structural issues (inappropriate culture, clinical education complexity, lack of alumni follow-up system). CONCLUSIONS: The results emphasize the need for educational evaluation development in nursing, including systematic and regular educational evaluation planning focusing on efficient feedback system and regard to excellence models. The comprehensive educational evaluation requires participation, involvement, and collaboration among the Nursing Board, Nursing ministerial office, faculties of nursing, and Nursing Organization. Thus, it is necessary to better designate current educational evaluation systems, policies, approaches, methods, and procedures.

Quality of life in ostomy patients: a qualitative study.

PURPOSE: Therapeutic procedures may not only treat disease but also affect patient quality of life. Therefore, quality of life should be measured in order to assess the impact of disease and therapeutic procedures. To identify clients' problems, it is necessary to assess several dimensions of quality of life, including physical, spiritual, economic, and social aspects. In this regard, we conducted a qualitative study to explore quality of life and its dimensions in ostomy patients referred to the Iranian Ostomy Association. METHODS: Fourteen patients were interviewed about their quality of life dimensions by purposeful sampling. Data were gathered by semistructured interviews and analyzed using the content analysis method. RESULTS: Nine main themes emerged using this approach, including physical problems related to colostomy, impact of colostomy on psychological functioning, social and family relationships, travel, nutrition, physical activity, and sexual function, as well as religious and economic issues. CONCLUSION: The findings of the study identified a number of challenges in quality of life for patients with ostomy. The results can be used by health care providers to create a supportive environment that promotes better quality of life for their ostomy patients.