The effect of virtual interactive nurse-led support group intervention on fatigue, shock anxiety, and acceptance of implantable cardioverter defibrillator patients: a randomized trial.

BACKGROUND: Implantable cardioverter defibrillators (ICD), as a gold and standard treatment for fatal cardiac arrhythmia, may lead to some physical and psychological problems for the patients. Therefore, performing some interventions to reduce or eliminate these issues is crucial. This study aimed to determine the effect of virtual interactive nurse-led support group intervention on fatigue, shock anxiety, and acceptance of ICD patients. METHODS: This is a clinical trial study on 72 patients with ICD. They were randomly allocated to the intervention (n = 36) and control (n = 36) groups. A virtual interactive nurse-led support group intervention through WhasApp was performed for one month. Multidimensional fatigue inventory, Florida Shock Anxiety Scale, and Florida Patient Acceptance Scale were used. Data were analyzed to perform the analysis of data through SPSS, using independent and paired-t test, Mann-Whitney U test, Wilcoxon test, and ANCOVA. RESULTS: Before the intervention, no significant difference was observed between the two groups with regard to fatigue, shock anxiety, and ICD acceptance. However, after the intervention, a significant difference was found between the two groups with regard to fatigue, shock anxiety, and ICD acceptance (P < 0.05). CONCLUSION: This study showed that virtual interactive nurse-led support group intervention reduced fatigue and shock anxiety and improved the ICD acceptance. PRACTICE IMPLICATIONS: This flexible, accessible, and interactive nurse-led support group intervention is suggested to be used for ICD patients. TRIAL REGISTRATION: This trial was registered and approved by Iranian Registry of Clinical Trials (Trial Id: 60,738, date: (24/02/2022). ( https://www.irct.ir/trial/60738 ).

The predictive roles of parental stress and intolerance of uncertainty on psychological well-being of parents with a newborn in neonatal intensive care unit: a hierarchical linear regression analysis.

BACKGROUND: Hospitalization of newborns in neonatal intensive care units (NICU) exposes parents to considerable stress. This study aimed to determine the predictive role of parental stress and intolerance of uncertainty on the psychological well-being of parents with a newborn in NICU using hierarchical linear regression analysis. METHODS: This cross-sectional study included 130 parents of newborns hospitalized in the NICU. Data were collected using Parental Stress Scale, Intolerance of Uncertainty Scale, and Psychological Wellbeing Scale. The data were analyzed in SPSS v.26 using hierarchical linear regression analysis. RESULTS: The mean scores of the parents' psychological well-being, parental stress, and intolerance of uncertainty were 79.08 (SD = 11.70), 63.06 (SD = 26.71), and 75.38 (SD = 19.40), respectively. The result of the hierarchical linear regression analysis revealed that, in step 1, academic education had a significant proportion of the variance of parents' psychological well-being (ß = 0.26, P = 0.005). In step 2, it was shown that academic education (ß=-0.25, P = 0.006) and parental stress (ß=-0.25, P = 0.006) had a significant proportion of the variance of parents' psychological well-being. According to step 2, education levels, parental stress, and intolerance of uncertainty explained 22% of the changes in parents' psychological well-being. CONCLUSION: There was a significant association between the parents' psychological well-being and education levels, intolerance of uncertainty, and parental stress. Academic education and parental stress were the predictors of parents' psychological well-being. Based on these findings, early detection of parents' education and stress are important for their psychological well-being.

The effect of telephone counseling based on Orem's model on adherence to treatment and resilience of patients with coronary angioplasty: a randomized clinical trial.

BACKGROUND: This study aimed to determine the effect of telephone counseling based on Orem's Self-Care Model on adherence to treatment and resilience of patients with coronary angioplasty. METHODS: This randomized clinical trial was performed on 80 patients in the Cardiac Intensive Care Unit of Shiraz University of Medical Sciences. Patients were randomly divided into two groups of 40 (intervention and control). Questionnaires on adherence to treatment of chronic patients and resilience for patients with cardiovascular and respiratory diseases were filled out before and 8 weeks after the intervention. In the intervention group, the telephone call schedule consisted of three calls per week for 8 weeks. RESULTS: Before the intervention, no significant difference was found between the groups about adherence to treatment and resilience. However, after the intervention, a significant difference was found between the groups as to adherence to treatment and resilience (P < 0.001). CONCLUSION: Nursing consultation using telephone calls based on Orem's model increases the adherence to treatment and resilience of patients undergoing coronary angioplasty. Telephone counseling can help the patients adhere to their treatment plans and develop resilience skills.

A qualitative study on hope in iranian end stage renal disease patients undergoing hemodialysis.

BACKGROUND: End Stage Renal Disease (ESRD) patients undergoing hemodialysis are faced with serious problems in their lives. Hope, as a multifaceted factor, plays a critical role in these patients' lives. Given the multifaceted process of hope, this study aimed to describe hope and identify the challenges, strategies, and outcomes of hope in Iranian ESRD patients undergoing hemodialysis. METHODS: This is a qualitative study using content analysis. The participants were selected using purposive sampling. The data were collected using deep, semi-structured interviews with 14 participants; it continued until reaching data saturation. Graneheim and Lundman content analysis approach was used to analyze the data. RESULTS: Five main categories and twenty-two subcategories emerged; the categories consisted of (1) Hope described as a particular event to happen, (2) Opportunities and threats to achieve hope, (3) Negative emotions as barriers to achieve hope, (4) Positive coping strategies to achieve hope, and (5) Growth and excellence as the outcomes of hope. CONCLUSIONS: Based on the findings, ESRD patients undergoing hemodialysis described hope as a positive feeling of expectation and desire for a special thing to happen. They faced threats and opportunities to achieve hope, which exposed them to negative emotions as barriers of hope. Thus, they make use of positive coping strategies to achieve hope. Moreover, hope led to growth and excellence. Through awareness of hope, definition and strategies to achieve it, and teaching them, physicians and nurses working in hemodialysis wards can enhance hope in patients.

Risk and protective factors for resilience among adolescents and young adults with beta-thalassemia major.

BACKGROUND: Resilience is the ability to overcome adversity in response to a potentially traumatic event. It can relieve people's discomfort and build personal capacity when facing a stressful situation such as beta thalassemia major. Resilience is a complex and multidimensional concept and is influenced by protective and risk factors. Therefore, the aims of the present study were to (1) investigate the relationship between protective (social support and hope) and risk (uncertainty and defensive coping) factors with resilience and (2) examine the mediating role of courageous coping between these protective and risk factors in resilience. METHODS: This descriptive-analytical study was performed on 312 adolescents and young adults with beta-thalassemia major aged 12-24 years; they were selected using purposeful sampling from two different outpatient thalassemia clinics in the south of Iran. Data were collected in a face-to-face survey using Zimmet Multidimensional Scale of Perceived Social Support, Herth Hope, Stewart Uncertainty in Illness scale, Jalowiec Coping, and Connor-Davidson resilience Scale from April 2022 to November 2022. The collected data were analyzed using descriptive tests, Pearson correlation, and a structural equation model. RESULTS: According to the main findings of mediation analysis, courageous coping partially mediated the relationship between social support and resilience [(ß = 0.042; 95% BC CI (0.003, 0.131)] and fully mediated the relationship between hope and resilience [(ß = 0.166; 95% BC CI (0.031, 0.348)]. In other cases, uncertainty and defensive coping had a direct and indirect effect on resilience, respectively. CONCLUSION: Based on these results, health professionals and healthcare policymakers should consider this mediator in developing programs to improve resilience. Also, the use of courageous coping could modulate the effect of defensive coping on resilience. Therefore, teaching the use of courageous coping can play an important role in improving resilience.

The effect of lemon inhalation aromatherapy on pain, nausea, as well as vomiting and neurovascular assessment in patients for lower extremity fracture surgery: a randomized trial.

BACKGROUND: Complementary and integrative medicine may be effective for postoperative outcomes. This study aimed to determine the effect of lemon inhalation aromatherapy on pain, nausea, and vomiting and neurovascular assessment in patients for lower extremity fracture surgery. METHODS: This is a randomized clinical trial study. Ninety patients who had undergone lower extremity fracture surgery were randomly assigned to the intervention (lemon aromatherapy) and control groups. Lemon aromatherapy was started in the morning of the surgery and extended at two-hour intervals until the end of the surgery, in the recovery room, and 16 h after surgery. Numerical pain and nausea and vomiting scales, the Rhodes Index of Nausea, Vomiting, and Retching, and the WACHS Neurovascular Observation Chart were used to assess the outcomes before and after the intervention (in the recovery room and 4, 8, 12, and 16 h post-surgery). The data were analyzed using the Wilcoxon test, ANCOVA, and Repeated Measure ANCOVA. RESULTS: A significant difference was observed between the groups in terms of the intensity of pain (P < 0.001) and nausea and vomiting (P = 0.001) during the study period. Moreover, a significant difference was found between groups as to the frequency and severity of nausea, vomiting, and retching. The amount and duration of postoperative vomiting and nausea were significantly lower in the intervention group compared to the control group. In addition, lemon inhalation aromatherapy decreased the frequency of anti-emetic drug administration in the recovery room (P = 0.04) and 16 h post-surgery (P = 0.03). CONCLUSIONS: This study indicated that aromatherapy reduced pain intensity, postoperative nausea, vomiting, and retching, as well as the incidence of anti-emetic drug administration. Therefore, using lemon inhalation aromatherapy to relieve pain and reduce nausea and vomiting is suggested for lower extremity fracture patients who have undergone surgery. TRIAL REGISTRATION: This study was registered in the Iranian Registry of Clinical Trail (Number = 57,331, IRCT20130616013690N10, approved 24/07/2021) ( https://www.irct.ir/trial/57331 ).

The Effect of Interactive Virtual Psycho-Educational Interventions via Social Networks on Self-Efficacy and Anxiety Among Patients Infected with COVID-19 and Living in Home Quarantine: A Randomized Control Trial.

Background: Psycho-educational interventions might play a crucial role in the management of diseases. This study was conducted to determine the effect of psycho-educational interventions via social networks on self-efficacy and anxiety among Coronavirus Disease 2019 (COVID-19) patients in home quarantine. Materials and Methods: This randomized clinical trial was conducted on 72 COVID-19 patients, in Shiraz, Iran, in 2020. The patients were randomly assigned to an intervention and control group. Patients in the intervention group underwent psycho-educational interventions daily for 14 days. The data were collected using the Strategies Used by People to Promote Health (SUPPH) questionnaire and the State-Trait Anxiety Inventory (STAI) before and 2 weeks after the intervention. Results: After the intervention, the mean score of SUPPH was mean = 120.75 (16.56) and mean(SD) 111.27 (14.40) in the intervention and control groups, respectively. Moreover, after the intervention, the mean score of state and trait anxiety were 34.69 (10.75) and 38.31 (8.44) in the intervention group, and mean(SD) 45.75 (13.01) and 43.50 (8.44) in the control group, respectively. After the intervention, a difference was observed between the groups concerning the mean score of SUPPH (t70 = 2.58; p = 0.01), state anxiety (F1 = 16.52; p < 0.001), and trait anxiety (t70 = -2.49; p = 0.01). Conclusions: Considering the effectiveness of psycho-educational interventions in self-efficacy and anxiety, healthcare providers are recommended to use these interventions in COVID-19 patients.

The predictive role of hope and social relational quality in disability acceptance among Iranian patients under hemodialysis.

BACKGROUND: Patients undergoing hemodialysis face disabilities that its acceptance may influenced by several factors. This study aimed to determine the predictive role of hope and quality of social relationship on accepting disability amongst patients undergoing hemodialysis. METHODS: This cross-sectional study was conducted on 120 hemodialysis patients referred to hemodialysis centers in Nemazi and Shahid Faghihi hospitals and Imam Reza Clinic in Shiraz. Snyder Hope Scale, Acceptance of Disability Scale (ADS), and Social Relational Quality Scale (SRQS) were used for data collection. The data were analyzed through the Smart PLS-3 and SPSS software using Pearson's correlation and multiple linear regression analysis tests, and confirmatory factor analysis. RESULTS: Face, content, and construct validities and internal consistency of the Persian version of ADS and SRQS were confirmed. The patients' mean score of hope was 38.83 (SD = 4.35), which was not desirable. Their mean score of SRQS was 45.45 (SD = 3.87), which was at the moderate level. Nonetheless, the mean score of disability acceptance (66.01 (SD = 7.15)) was lower than expected. The results showed disability acceptance was associated with having good level of hope (ß = 0.44, p = 0.002) and social relationship (ß = 0.31, p = 0.04). CONCLUSIONS: Hope and social relational quality predicted the acceptance of disabilities. Therefore, designing interventions to promote hope and social relationship in hemodialysis patients may increase their disability acceptance.

The effect of positive thinking training on hope and adherence to treatment in hemodialysis patients: a randomized controlled trial.

BACKGROUND: Patients undergoing hemodialysis are exposed to psychological problems, such as despair, which in turn can be a trigger for them to abandon the treatment process. This study aimed to determine the effect of positive thinking training on hope and adherence to treatment in hemodialysis patients. METHODS: This randomized controlled trial was performed on 80 hemodialysis patients referred to two hemodialysis centers in Shiraz, Iran. They were randomly divided into an intervention and a control group. Eight sessions of positive thinking skills training carried out individually on the patients' bedsides. The primary and secondary outcomes were hope and adherence to treatment, respectively. The data were collected using Snyder Hope Questionnaire, End-Stage Renal Disease Adherence Questionnaire, laboratory tests, and weight measurements. Data were analyzed by Chi-square and Paired and Independent T-test using SPSS software version 18. RESULTS: After the intervention, the mean score of hope was significantly higher in the intervention group (42.1 ± 6.1) than in the control group (38.7 ± 6.5) (p = 0.024). Moreover, after the intervention, the mean score of adherence to treatment was significantly higher in the intervention group (1070.2 ± 80.1) compared to the control group (1018.4 ± 105.3) (p = 0.019). In addition, blood urea nitrogen, phosphate and inter-dialytic weight gain were lower in the intervention group compared to the control group after the intervention. CONCLUSIONS: The findings showed that positive thinking interventions could lead to improvement in hope and adherence to treatment in hemodialysis patients. Positive thinking training could be used in caring of hemodialysis patients to improve their hope and adherence to treatment. Trial registration RCT Registry: Iranian Registry of Clinical Trials; RCT registration number: IRCT20180915041044N1; Registration date: 19/12/2018.

The effect of a virtual child disease management programme on burden and social adjustment of caregivers of children with coagulation factor deficiencies.

INTRODUCTION: The use of virtual interventions is of interest to patients with chronic disease and healthcare professionals. This study aimed to determine the effect of virtual child disease management programme on burden and social adjustment of caregivers of children with coagulation factor deficiencies. Moreover, the effect of this intervention on children's acute pain and bleeds was assessed. METHODS: This clinical trial was conducted on 80 caregivers of children with coagulation factor deficiencies. The subjects were randomly assigned into the intervention and control groups. A comprehensive virtual child disease management programme was conducted for 8 weeks and caregiver' burden and their social adjustment were assessed with the HEMOCAB and social adjustment subscale of Bell Adjustment Inventory, respectively. Data were analysed using ANCOVA and Wilcoxon test. RESULTS: Before the intervention, both groups were similar regarding the caregivers' burden and social adjustment and children's acute pain and bleeds. However, a significant difference was observed between groups in concern to caregivers' burden (P < .001), women's and men's social adjustment (P = .001, P = .03), and children's acute pain and bleeds (P < .001) after the virtual disease management programme. CONCLUSION: This study showed that using a virtual child disease management programme reduced burden and improved social adjustment of caregivers of children with coagulation factor deficiencies. This intervention decreased frequencies of acute pain and bleeds in children. Therefore, using this effective intervention in clinical practice is warranted to decrease the caregivers' burden as well as acute pain and bleeds in children.

The effect of a self-management program on the quality of life of patients with scleroderma.

BACKGROUND: Scleroderma is a rare disease with complex disorders. It affects the quality of life with severe impacts on the skin and extensive complications in the internal organs, and does not have a definitive treatment. This study aimed to investigate the effect of a self-management program on the quality of life of patients with scleroderma. MATERIALS AND METHODS: This was a clinical trial in which 54 patients with scleroderma were randomly divided into two groups of 27 each (experimental and control groups). The data were collected using the Systemic Sclerosis Questionnaire. A self-management program was sent to the experimental group via a mobile phone application (WhatsApp) every day for three months. Statistical analysis was performed in Statistical Package for the Social Sciences V21. RESULTS: The Wilcoxon signed-rank test showed that the average overall quality of life score of the experimental group showed a significant increase after the implementation of the program (P value: 0.00). The average overall quality of life score of the control group also significantly declined after the intervention (P value: 0.00). The Mann-Whitney U test revealed that there was no significant difference in the overall quality of life score of the two groups before the intervention (P value: 0.31); however, after the implementation of the self-management program, a significant difference was observed between the two groups (P value: 0.00). CONCLUSION: According to the results, the self-management program can help improve the quality of life of patients with scleroderma.

The Predictor Roles of Spiritual Well-Being, Healthcare Professionals' Support and Shock Anxiety in Implantable Cardioverter-Defibrillator Device Acceptance.

Background: Acceptance of the implantable cardioverter-defibrillator (ICD) device may be affected by a variety of factors. This study aimed to investigate the predictor roles of spiritual well-being, healthcare professionals' support and shock anxiety in accepting ICD. Methods: This cross-sectional study was conducted on 100 patients with ICD. The data were collected by the Florida Patient Acceptance Scale, Florida Shock Anxiety Scale, Spiritual Well-Being Scale and Healthcare Professionals' Support Questionnaire. Results: The mean (SD) scores of patient acceptance, shock anxiety, spiritual well-being and healthcare professionals' support were 65.4 (13.56), 21.93 (8.95), 88.92 (11.78) and 76.41 (10.54), respectively. The results revealed higher acceptance among the participants with lower shock anxiety levels (r = -0.51, P < 0.001), higher mean scores of spiritual well-being (r = 0.33, P = 0.001) and higher healthcare professionals' support (r = 0.40, P < 0.01). Additionally, the results of linear regression indicated that spiritual well-being, healthcare professionals' support and shock anxiety predicted 36% of the patient acceptance variance (R = 0.61, R 2 = 0.38, adj R 2 = 0.36) and shock anxiety and healthcare professionals' support were the predictors of patient acceptance. Conclusion: The study results indicated that the patients' mean score of acceptance was relatively high. In addition, the mean scores of shock anxiety, spiritual well-being and healthcare professionals' support were low, moderate and relatively high, respectively. Conducting healthcare professionals' support interventions, spiritual therapy and reducing shock anxiety can help patients accept ICDs.

An Evaluation of the Association between Quality of Life and Psychological Issues in Patients with Automated Implantable Cardioverter Defibrillator.

Introduction: Implantable cardioverter defibrillator (ICD) plays a life-saving role via controlling malignant dysrhythmias. However, it may result in the incidence of psychological tensions in patients' lives, eventually leading to changes in their quality of life (QoL). To date, this association has remained unclear among Iranian population. Therefore, the present study aimed to determine the association between QoL and psychological issues in patients with ICD. Methods: Using convenience sampling method, this cross-sectional study was conducted on 96 patients referred to the pacemaker clinic of Shahid Faghihi hospital and Kowsar heart hospital affiliated to Shiraz University of Medical Sciences, Iran from September 2016 to January 2017. The data were collected using Depression, Anxiety, Stress Scale (DASS-21) and the Short Form-36 (SF-36) questionnaire, and analyzed in SPSS software version 13 using independent t-test, Pearson's correlation test, and ANOVA. Results: The mean (SD) score of patients' QoL was found to be 1672.02 (43.43). Moreover, the mean (SD) scores of depression, anxiety, and stress were 4.69 (0.46), 5.6 (0.47), and 7.51 (0.05), respectively indicating moderate depression, anxiety, and stress levels among the patients. A significant association was found between the patients' QoL and depression, anxiety, and stress. Conclusion: As an association was observed between the patients' QoL and depression, anxiety, and stress, performing some interventions to reduce the patients' psychological issues might improve their QoL.

Pain, Fatigue, Nausea, and Vomiting as the Predictors of Anxiety in Patients Undergoing Hematopoietic Stem Cell Transplantation: A Prospective Cohort Study.

The primary outcome was to assess the correlation between anxiety and pain, fatigue, nausea, and vomiting. The secondary outcome was to determine the predictive roles of pain, fatigue, nausea, and vomiting in anxiety among patients undergoing Hematopoietic Stem Cell Transplantation (HSCT). The present prospective cohort study was conducted on 200 patients treated by HSCT referred to the centers affiliated to Shiraz University of Medical Sciences. The data were collected using Spielberger Anxiety Questionnaire, Numerical Pain Scale, Brief Fatigue Inventory, and Rhodes Nausea and Vomiting Index. The data were analyzed using Spearman's test and multiple regression analysis. The means of state anxiety, trait anxiety, pain, fatigue, and nausea, vomiting, and retching were 41.67 (SD = 9.71), 43.78 (SD = 9.00), 3.79 (SD = 2.79), 4.23 (SD = 2.48), and 6.31 (SD = 7.53), respectively. The results showed that the participants with higher pain and fatigue scores had higher anxiety levels. Those with more nausea and vomiting had higher anxiety levels, as well. This indicated that fatigue, pain, severity and frequency of nausea, and type of HSCT were the predictors of trait anxiety. The results also showed the predictor role of pain, fatigue, and type of HSCT in state anxiety. The findings revealed a correlation between anxiety and pain, fatigue, nausea, and vomiting among the HSCT patients. The results also showed fatigue and pain as the predictors of anxiety among these patients. Yet, future studies are recommended to determine the other factors contributing to anxiety amongst HSCT patients.

The mediating role of Courageous coping in the relations between spirituality and social support with resilience among adolescents with hemophilia.

In addition to physical disorders, people with hemophilia face complex psychological problems. Hence, protective factors such as coping strategies, social support, and spirituality to improve psychological health should be determined. This study examined the role of courageous coping as a mediator in the interrelationships between spirituality as well as social support and resilience among adolescents with hemophilia. In this descriptive-analytical study, the participants were 372 adolescents with hemophilia aged 11-21 years. Connor-Davidson resilience scale, Jalowiec Coping scale, Perceived Social Support Scale, and spirituality scale were the instruments used in this study. The analysis results of Pearson correlation revealed a significant positive relationship between spirituality as well as social support and resilience. Also, it was determined that courageous coping is a thorough mediator between spirituality and resilience. The mediating role of courageous coping did not reach meaningful levels between social support and resilience, meaning that zero was included in bootstrap interval, CI 95% (ß =.026, CI [-.002, .089]). Social support, adopting a spiritual strategy, and using coping strategies played a crucial role among the adolescents to promote their level of resilience to cope with hemophilia.

The Effect of Benson's Relaxation Technique on Pain Intensity, Belief, Perception, and Acceptance in adult Hemophilia Patients: A Randomized Controlled Trial.

BACKGROUND: Most hemophilia patients experience pain in their lives. Some complementary interventions might affect pain belief. This study aimed to determine the effect of Benson's relaxation technique on pain intensity, pain belief and perception, and pain acceptance in hemophilia patients. METHODS: In this clinical trial study, 80 hemophilia patients were divided into an intervention (relaxation technique) and a control (routine care) group based on block randomization. This study was conducted in the hemophilia center of Shahid Dastgheib hospital affiliated to Shiraz University of Medical Sciences from October to December 2018. The intervention group listened to a voice containing relaxation technique twice a day for eight weeks. Numeric rating scale, pain belief and perception inventory, and chronic pain acceptance questionnaires were completed at the beginning and eight weeks after the intervention. Data were analyzed by SPSS 21 using independent t-test, Paired-t-test, Chi-square, Mann-Whitney U test, and ANCOVA. P-value <0.05 was considered as significant. RESULTS: After the intervention, the mean scores of pain intensity, pain belief and perception inventory, and pain acceptance in the intervention group were 4.26±2.17, -13.35±1.50, and 67.24±9.49 and in the control groups were 5.85±2.61, -2±1.70, and 56.57±11.04, respectively. After the intervention, a difference was found between the groups regarding the mean score of pain intensity (P=0.007), pain belief and perception inventory (P<0.001) and its subscales (P<0.05) as well as total pain acceptance (P<0.001). CONCLUSION: This study showed relaxation technique can be applied to reduce these patients' pain intensity, improve their pain belief and perception, and enhance their pain acceptance. TRIAL REGISTRATION NUMBER: IRCT20180311039037N1.

Association between perception of caring behaviors and self-efficacy in patients with cardiovascular disease at coronary care units: a cross-sectional study.

BACKGROUND: Assessing and improving patient self-efficacy are among the major roles of nurses. Nurses are also responsible for providing direct patient care, and they play a major role in improving patient care quality. Therefore, it is essential to evaluate nurses' care-giving behaviors. This study aimed to determine the association between caring behaviors and self-efficacy in patients with cardiovascular disease. METHODS: In this cross-sectional study, 400 patients with cardiovascular disease who were admitted to hospitals in Jahrom, southern Iran, were selected through a stratified sampling. The Caring Behaviors Inventory and the Strategies Used by People to Promote Health questionnaires were used to collect data. Data were analyzed using descriptive statistics, Kolmogorov-Smirnov test and Spearman correlation coefficient in SPSS ver. 22. RESULTS: Results showed significant relationships between perception of caring behaviors and self-efficacy (r=0.16, P=0.001) as well as subscales of respectful deference to others (r=0.12, P=0.01), assurance of human presence (r=0.12, P=0.02), and positive connectedness (r=0.18, P=0.001). Additionally, among the subscales of caring behaviors, "attentive to others' experience," with a mean of 5.17±1.10, was the highest priority and "positive connectedness," with a mean of 4.81±1.31, was the lowest priority for patients. The mean self-efficacy score was 73.94±29.78, and 169 patients (43.2%) had low self-efficacy. CONCLUSIONS: Given the positive relationship between perception of caring behaviors and self-efficacy in patients with cardiovascular disease, self-efficacy could be improved by paying more attention to patient care priorities and improving patient perception of caring behaviors.

Psychosocial, Spiritual, and Biomedical Predictors of Hope in Hemodialysis Patients.

BACKGROUND: Hemodialysis patients deal with some psychological and social problems. These problems may be the predictors of hope. This study aimed to determine the psychosocial, spiritual, and biomedical predictors of hope in hemodialysis patients. METHODS: This cross-sectional study was conducted on 350 hemodialysis patients in hemodialysis centers affiliated to Shiraz University of Medical Sciences. Adult Hope Scale, Depression Anxiety Stress Scales, Personal Resources Questionnaire-85, Spiritual Well-Being Scale, and biomedical markers were used for data collection. The data were entered into the SPSS 22 software and were analyzed using Pearson's correlation coefficient and linear regression analysis. RESULTS: The mean score of hope was 28.54 (SD=5.27). The mean scores of depression, anxiety, and stress were 17.87 (SD=7.62), 13.12 (SD=3.47), and 12.99 (SD=3.88), respectively. The mean scores of social support and spiritual well-being were 126.35 (SD=17.53) and 74.02 (SD=5.84), respectively. The means of biomedical markers including interdialytic weight gain, urea nitrogen, creatinine, phosphate, sodium, and potassium were 2.10 (SD=1.04), 51.55 (SD=13.10), 6.98 (SD=2.48), 4.71 (SD=1.08), 139.32 (SD=4.91), and 4.87 (SD=0.93), respectively. The results revealed a significant association between hope and depression, anxiety, stress, social support, and spiritual well-being (p<0.05). In addition, stress (ß=-0.14, p=0.01), anxiety (ß=-0.20, p=0.002), and social support (ß=0.49, p<0.001) were the predictors of hope. CONCLUSION: The hemodialysis patients reported moderate levels of hope, social support, anxiety, and depression. In addition, most of them adhered to dietary and fluid restrictions. Considering the association between hope and social support, spiritual well-being, anxiety, depression, and stress, using some interventions regarding the mentioned variables might increase hope among hemodialysis patients.

The Predictor Role of Perceived Social Support and Spiritual Intelligence in Hope Among Thalassemia Patients.

BACKGROUND: Thalassemia is a prevalent chronic blood disorder, which is accompanied with a wide range of challenges. This study aimed to determine the predictor role of perceived social support and spiritual intelligence in hope among thalassemia patients. METHODS: This cross-sectional study was conducted on 300 thalassemia patients. The data were collected using Miller hope scale, spiritual intelligence scale, and personal resource questionnaire. The data were analysed using Pearson's correlation coefficient and multiple regression analysis. RESULTS: The results indicated that the mean score of hope was 173.38 (standard deviation [SD] = 24.6). Besides, 86.7% of the patients showed high levels of hope. The mean score of spiritual intelligence was 134.66 (SD = 18.07). In addition, 91.7% of the patients showed moderate levels of spiritual intelligence. The mean score of social support was 127.87 (SD = 20.19) and the patients showed high social support levels. The results revealed a significant association between hope and perceived social support (r = 0.65, P < 0.001) as well as between hope and spiritual intelligence (r = 0.63, P < 0.001). Moreover, perceived social support (b = 0.43, P < 0.001) and spiritual intelligence (b = 0.37, P < 0.001) were the predictors of hope among thalassemia patients. CONCLUSION: Considering the study results, in addition to common treatments for thalassemia, policymakers' are recommended to pay attention to spiritual intelligence and more importantly social support to enhance thalassemia patients' hope.

The effect of lemon inhalation aromatherapy on blood pressure, electrocardiogram changes, and anxiety in acute myocardial infarction patients: A clinical, multi-centered, assessor-blinded trial design.

BACKGROUND: This study aimed to determine the effect of lemon (Limon Citrus) inhalation aromatherapy on Blood Pressure (BP), electrocardiogram changes, and anxiety in patients with Acute Myocardial Infarction (AMI). METHODS: In this clinical trial, 100 AMI patients were assigned to intervention (received lemon inhalation aromatherapy) and control (received paraffin) groups. Aromatherapy was conducted for three consecutive days. BP, electrocardiogram changes, and anxiety were assessed. RESULTS: A significant difference was observed between the two groups concerning systolic BP and percentage of ST-segment and T wave changes on the 3rd and 4th days after the intervention. A significant difference was also found between the two groups concerning heart rate and anxiety on the 4th day after the intervention. CONCLUSION: As lemon inhalation aromatherapy in AMI reduced systolic BP, anxiety, and percentage of ST-segment and T wave changes and regulated heart rate, using this kind of aromatherapy is suggested in coronary care units. CLINICAL TRIAL REGISTRY: The study was registered in the Iranian Registry of Clinical Trials (IRCT registration number: 33151, 2018/09/22).