Clinical reasoning skill of nurses working in teaching medical centers in dealing with practical scenarios of King's model concepts.

BACKGROUND: The present study was conducted to determine clinical reasoning of nurses working in teaching medical centers in dealing with practical scenarios of King's concepts. METHODS: The study population in this cross-sectional descriptive-analytical study comprised 133 nurses. Data were collected using scenarios based on the King's model. Data were analyzed in SPSS-16. FINDINGS: Mean age of the participating nurses was 27.71 ± 8.1 years.The clinical reasoning score was less than average in most participating nurses, and had a significant relationship with education(P < 0.05), service ward(P < 0.001)and organizational position(P < 0.05). In the multivariate analysis of factors relating to clinical reasoning, higher education level (B = 9.5, P = 0.018) and organizational position (B = 4.3, P = 0.017) were predictors of clinical reasoning score. DISCUSSION: Existing nursing models such as King's, which is closely related to clinical reasoning, can be used more in educational and clinical systems, and as a clinical guide for promoting the clinical reasoning of nurses and students.

Combined training in addition to cortisol reduction can improve the mental health of girls with precocious puberty and obesity.

Background: Obesity and central precocious puberty (CPP) are associated with increased anxiety, depression, and anger in girls. The contribution of exercise as an efficacious component in decreasing anxiety, depression, and anger has been increasingly recognized. Objectives: This study aims to evaluate the effects of combined training on cortisol, anxiety, depression, and anger in overweight and obese girls with CPP. Methods: The study involved 30 girls aged 7-9 years diagnosed with CPP (undergoing triptorelin treatment) and dealing with obesity. In addition, these girls scored higher than the cut-off line for anxiety, depression, and anger. The participants were divided into two groups, with 15 individuals in each group. The exercise group engaged in 60 min of combined aerobic and resistance training three times per week for a duration of 12 weeks. On the other hand, the control group did not receive any training. Throughout the study, the serum cortisol levels were measured in both groups. Anxiety, anger, and depression questionnaires were also completed at three different stages, namely, baseline, 12 weeks, and 16 weeks (after a 4-week period of detraining). Results: In the exercise group, there was a significant decrease (P < 0.05) in cortisol serum levels and anxiety, depression, and anger scores. These changes were observed consistently during detraining (P > 0.05). However, in the control group, only the depression score significantly decreased (P < 0.05). Conclusions: Based on the results, it can be concluded that combined training is a method to improve the mental health of CPP girls. Clinical Trial Registration: https://en.irct.ir/trial/61990, identifier IRCT20170411033378N10.

The E3/E4 ubiquitin ligase UFD-2 suppresses normal and oncogenic signaling mediated by a Raf ortholog in Caenorhabditis elegans.

Signaling by the kinase cascade composed of Raf, MEK, and ERK is critical for animal development and is often inappropriately activated in human malignancies. We sought to identify factors that control signaling mediated by the Caenorhabditis elegans Raf ortholog LIN-45. A genetic screen showed that the degradation of LIN-45 required the E3/E4 ubiquitin ligase UFD-2. Both UFD-2 and its partner, the ATP-dependent segregase CDC-48, were required for the developmental regulation of LIN-45 protein abundance. We showed that UFD-2 acted in the same pathway as the E3 ubiquitin ligase SCFSEL-10 to decrease LIN-45 abundance in cells in which Raf-MEK-ERK signaling was most highly active. UFD-2 also reduced the protein abundance of activated LIN-45 carrying a mutation equivalent to the cancer-associated BRAF(V600E) variant. Our structure-function studies showed that the disruption of LIN-45 domains that mediate protein-protein interactions, including the conserved cysteine-rich domain and 14-3-3 binding motifs, were required for UFD-2-independent degradation of LIN-45. We propose a model in which UFD-2 and CDC-48 act downstream of SCFSEL-10 to remove LIN-45 from its protein interaction partners and facilitate proteasomal targeting and degradation. These findings imply that UFD-2 and CDC-48 may be important for Raf degradation during normal and oncogenic Ras and MAPK signaling in mammalian cells.

Mothers participation in caring for hospitalized children with acute gastroenteritis: A quasi-experimental study.

AIMS: To identify informational and practical deficits of mothers of hospitalized children with acute gastroenteritis and to determine the effect of intervention on enhancing mothers' participation in providing care. DESIGN: This study was a two-group pre- and post-test quasi-experimental study. METHODS: Sample size was eighty mothers of hospitalized children younger than 5 years with acute gastroenteritis in each group using consecutive sampling method. Based on the needs assessment, the training and practical demonstration were performed individually in the intervention group. The control group received usual and standard care. The care practice of mothers were observed before and three times after the intervention at a 1-day interval. The confidence level was 0.95. RESULTS: After intervention, there was a significant increase in the mothers' care practice in the intervention group and a significant difference between the two groups. The participatory care approach could enhance mothers' practice in providing care to the hospitalized children with AGE.

Usefulness of the SF-36 Health Survey questionnaire in screening for health-related quality of life among parents of children with cancer: Latent profile analysis.

Background: Poor health-related quality of life (HRQOL) of parents of children with cancer as their main caregivers can adversely affect child's HRQOL. Short Form-36 Health Survey (SF-36) is a widely used instrument to measure HRQOL. However, there are no clearly defined cut-off points for screening for parents with poor HRQOL. This study aimed to find appropriate cut-off points for the SF-36 questionnaire in a sample of parents of children with cancer using latent profile analysis to add another possibility to use it. Methods: In this cross-sectional study, a number of 108 couples (108 mothers and 108 fathers), who had children with cancer, were selected by simple random sampling method from the patients' files. The study was conducted at two settings, pediatric hematology/oncology wards of BESAT hospital (a hospital related to Hamadan University of Medical Sciences, Iran) in 2017. Latent Profile analysis (LPA) method was used to determine appropriate cut-off points for the SF-36 questionnaire. Data was analyzed by Mplus and R3.3.0 software. Results: Based on the results, scores ≤ 44, 45-63 and ≥ 64 for mental health, and scores ≤ 43, 44-59 and ≥ 60 for physical health classes indicate weak, medium, and good, respectively. These cut-off points showed acceptable accuracy in classification of individuals. For the total quality of life, correct classification rates were 88%, 65% and 53% for each class respectively. For mental health (physical health), they were 79(63), 50(62) and 52(63) for each class respectively. Conclusions: The cut-off points for the classes identified here can be useful in screening parents of children with cancer in clinical setting to provide clinical interventions to protect vulnerable parents from negative outcomes.

Facilitators and Barriers of Return to Work in Working People with Serious Mental Illness: A Qualitative Study.

Background: Among working people with serious mental illness (WPSMI), return to work (RTW) is controlled by several factors. Identifying these factors can help prevent long-term sick leave absence and work disability. We aimed to identify facilitators and barriers of RTW in WPSMI admitted to a psychiatric hospital and clinic affiliated with the Hamadan University of Medical Sciences, Iran. Methods: This qualitative study was conducted in 2020 on 27 participants with SMI and their families, supervisors, coworkers, managers, and mental health professionals (MHPs). The participants were selected through purposive sampling and subjected to semi-structured interviews. Forty interviews were conducted and analyzed using conventional content analysis. Results: Nine hundred initial codes were extracted and categorized into 34 subcategories and eight categories. Categories that emerged as facilitators of RTW include emotional availability, information availability and use, practical assistance of others, employment facilitation by the society, and supervisor's flexibility. Categories identified as barriers are imposed effects of mental illness, poor self-concept, and social obstacles. Conclusion: WPSMI experience some facilitators and barriers in RTW. Therefore, MHPs and politicians are recommended to consider these factors in vocational rehabilitation plans.

Exploring the return-to-work process in working people with serious mental illness.

BACKGROUND: Few studies examined the return-to-work (RTW) process in working people after recovery from serious mental illness (SMI). PURPOSE: The RTW process was explored in working people with SMI. METHOD: A qualitative study was conducted using the grounded theory. Twenty seven interviews were analyzed using Corbin and Strauss's approach (2015). RESULTS: The core category "syncing with an ordinary workstream" emerged with three categories: "proceeding RTW strategies," "staying at work strategies," and "relative adaptation with work." CONCLUSION: "Syncing with an ordinary workstream" can help researchers develop a new practice model to facilitate the RTW process in working people with SMI.

The psychosocial challenges of mothers of children with thalassemia: A qualitative study.

BACKGROUND: Caring for the children suffering from thalassemia is a stressful experience with various aspects making the mothers face various challenges. Thus, the present study aimed to explain the psychosocial challenges of mothers with thalassemia children based on their lived experience. MATERIALS AND METHODS: In this qualitative study, which was conducted using the phenomenological method, 14 mothers with thalassemia children were selected from two thalassemia treatment centers in Hamadan and Babol (Iran) in 2020 using the purposive sampling method. Data were collected using in-depth and semi-structured interviews and were analyzed by van Manen's phenomenological methodology. RESULTS: In the first stage of data analysis, 534 initial codes were extracted, which were reduced to 290 by comparison and integration. The primary themes turned into 24 secondary themes after clustering. By comparing the secondary themes, three main themes (i.e., "psychological distress," "bodily burnout," and "mothers' need to empathy and support") with 7 secondary themes (i.e., "emotional exhaustion," "mental strain," "social stigma," "acute psychosomatic reactions," "long-term psychosomatic consequences," "expectation of family support," and support needs outside the family) were extracted. CONCLUSION: The results indicated that mothers with thalassemia children experience several challenges in various aspects. Therefore, they require care interventions and psychosocial support.

Identifying Return to Work Perception in People With Serious Mental Illness: A Qualitative Study.

The current qualitative study sought to identify return to work (RTW) perception among people with serious mental illness (SMI) referred to a psychiatric hospital affiliated with Hamadan University of Medical Sciences. In total, 24 individuals were recruited, including working people with SMI, families, employers, and mental health team members who participated in in-depth, semi-structured interviews. Forty interviews were conducted. Interviews were analyzed based on the conventional content analysis approach. Accordingly, two themes were found, including The Need to Continue Working and Flexible and Supportive Strategies. The first theme included two categories: personal obligations and socioeconomic necessities. The second theme included three categories: coping with mental illness, requesting support from others, and coping with work conditions. Findings revealed that the need to continue working has a significant effect on RTW perception among people with SMI. [Journal of Psychosocial Nursing and Mental Health Services, 60(4), 11-20.].

Prevalence and Genotype Distribution of Human Papillomavirus Infection among 12 076 Iranian Women.

INTRODUCTION: Human papillomavirus (HPV) infection is one of the major health concerns of women in developing countries. This study gives an insight into the prevalence and genotype distribution of HPV infection and compares it with Pap smear results among Iranian women. METHODS: In this study, 12 076 Iranian women underwent routine examination from November 2016 to November 2018 using HPV Direct Flow CHIP System for HPV DNA typing. Cytology was undertaken for 5138 samples. RESULTS: Overall HPV prevalence was calculated at 38.68%. The most frequent HPV types were HPV 6, 16, 11, 62/81, 52 and 54. The most high-risk HPV (HR-HPV) types were HPV 16, 52, 18, 39, 31 and 51. These 2 groups represent approximately half of all HPV types detected, 47% and 55%, respectively. Among individuals who underwent cytological tests, 135 individuals (2.63%) were cytologically positive. In this group, 81 individuals (60%) were HPV positive, 62 (76%) of whom were HR-HPV positive, most frequently with HPV 16 (34%). CONCLUSION: This study highlights the urgent need for public education and early diagnosis using HPV screening tests to prevent cervical cancer.

The effect of peer support approach on communication skills of nursing students in pediatric clinical setting.

Peer support is a valuable teaching-learning approach to enhance deep learning in the clinical environment. The purpose of the present study was to investigate the effect of peer support on the communication skills of undergraduate nursing students when interacting with hospitalized children and their parents. This was a pre-and post-test quasi-experimental study with two groups. Through the cluster random sampling method, six practical groups of students who undertook a 3-week pediatric practicum were selected. Three groups were allocated to the experimental (n = 51) and control groups (n = 52). Two volunteer post-graduate students in pediatric nursing formed the peer group. First, the peers participated in three 45-min sessions using different scenarios about communication skills. They then tutored the intervention group to improve their communication skills. The communication skills with 5 children and 5 parents were observed for each undergraduate student via the checklist. The experimental group demonstrated significantly higher mean scores of the communication skills than the control groups in post-test (P < 0.001). Moreover, the mean scores of communication skills was significantly higher in post-test than pre-test in both the experimental and control groups (p < 0.001). Peer support approach promoted the communication skills of undergraduate nursing students in pediatric clinical setting.

A Comparison of the Effect of Visual and Auditory Distractions on Physiological Indicators and Pain of Burn Dressing Change Among 6-12-Year-Oldchildren: A Clinical Trial Study.

POURPOSE: This study aimed to compare the effect of audiovisual distraction on physiological indicators and pain of burn dressing change among 6-12 year-old children. DESIGN AND METHODS: The study was a single-blind clinical trial with a three-group that sample size was 120 children aged 6-12 years admitted to the burn ward of Hamadan Besat Hospital. Data collection tools were the Oucher pain scale, a Cheklist form of the physiological Indicators, and apulse oximetry device. The cartoons were shown for visual group and the melodic poems were played for the auditory group 2 min before the dressing until the end of the procedure (at 2-min intervals). Data were analyzed by SPSS-16 software one-way, variance analysis and post-hoc Bonferroni test. RESULTS: Therewere statistically significant differences between visual, auditory and control groups in the mean pain intensity scores at all measurement times, the mean arterial blood oxygen saturation percentage at all measurement times except for the10 min before the dressing and the start of the procedure and the mean heart rate at all measurement times except for 10 min before dressing (p < 0.001). Post-hoc tests showed that the difference in the mean heart rate was related to the difference between the visual and auditory distraction groups during and at the end of the dressing (p < 0.05), the visual and control groups at all measurement times (P < 0.001) and the auditory and control groups at all measurement times (p < 0.05). CONCLUSION: Audiovisual distraction is effective in reducing the fluctuations of physiological indicators and the burn dressing pain intensity in children at all times of measurement, especially during changedressing. PRACTICE IMPLICATIONS: The findings of this study are relevant to clinical practice because they suggest preparing children before and during a burning procedure situation.

A Qualitative Study Exploring the Experiences of Mothers Caring for Their Children with Thalassemia in Iran.

Background: Mothers of children with thalassemia usually experience many sufferings and challenges in caring of their children. The present study aimed to explore the experiences of mothers caring for their children with thalassemia. Methods: In this qualitative study, 14 mothers caring for their children with thalassemia in Hamedan and Babol Cities, Iran were selected using purposeful sampling, from December 2019 to August 2020. Data were collected through semi-structured face-to-face interviews. Graneheim and Lundman's approach of conventional content analysis was used for data analysis. Results: After data analyzing, four themes, including physical distress, psychological suffering, hellish life, and self-negligence, as well as nine categories, including the mother's physical problems, physical weakness, confusion, painful emotions, restless life, involvement in a painful caring process, turmoil in the family, neglect of one's health, and disregard for the occurrence of psychosomatic illnesses, were extracted. Conclusion: Our findings provide a broad range of context-specific challenges that mothers of thalassemic child faced during caring of their children that can affect different aspects of their life and health. Thus, mothers of children with thalassemia need various types of support such as social, emotional, and informational support during caring process of their children.

Dignity: The Cornerstone of Nursing Care Among Hospitalized Mothers of Infants in Neonatal Intensive Care Unit.

: One of the most important areas of nursing care delivery is "dignity." Because of the increase in hospitalized infants in neonatal intensive care units in recent years, this has led to an increased focus on "family care and maternal dignity." Given the importance of understanding the phenomenon of maternal dignity in order to improve cooperation in the care of their infants and promote family-centered care, this study aims to describe the lived experience of hospitalized mothers of infants within the context of dignity. This is a descriptive phenomenological qualitative research study. Twenty mothers were invited to participate in this study using purposeful sampling. The data were generated through individual, semistructured interviews and field notes were developed during the interviews. Data were analyzed using the Colaizzi method.Findings of the study were presented in 3 themes: "privacy," "respecting individual identity," and "authority," and 7 additional subthemes. Mothers in this study needed to take care of their infants in an environment where their personal privacy is preserved, their individual identity is respected, and they have sufficient authority in obtaining medical decisions. It is essential that healthcare teams and policy makers of health organizations provide an appropriate supportive environment in terms of promoting mothers' dignity in different dimensions and subsequently improving family-centered care.

Self-Efficacy, Self-Regulated Learning, and Motivation as Factors Influencing Academic Achievement Among Paramedical Students: A Correlation Study.

INTRODUCTION: Academic achievement is the most important indicator of the success of students in educational activities, but its nature is complex and multifactorial. The purpose of the present study was to determine self-efficacy, self-regulated learning, and motivation as potential factors influencing academic achievement among paramedical students. METHODS: In this correlation study, 400 undergraduate students were selected through a stratified random sampling method. The criterion for academic achievement was the student's grade point average. The data were analyzed using multiple linear regression equation, ANOVA, and independent t-tests. RESULTS: The mean score of the self-efficacy, self-regulated learning, and motivation was 62.18±9.3, 76.31±11.3, and 81.83±8.58, respectively. Self-regulated learning, self-efficacy, and motivation together accounted for 19.6% of the variance in academic achievement (p<0.001). Self-regulated learning had a direct relationship with academic achievement (p<0.001) and was the better predictor of academic achievement (b=0.337). A significant relationship between self-regulated learning and academic achievement was seen in operating room nursing, radiology sciences, anesthesiology (p<0.001), and laboratory sciences (p<0.01) students. CONCLUSIONS: Self-regulated learning was the better predictor of academic achievement. Self-regulated learning seems to encourage students to believe in their abilities and to be more motivated and self-learning in both classroom and practical settings.

Facilitators of Professional Communication Between Nurse and Opposite Gender Patient: A Content Analysis.

Introduction: Caring for a patient of the opposite gender is followed by many challenges. Hence, making an appropriate professional communication between the patient and the nurse is of great importance in order to provide a high-quality care to the patient and reduce tensions. Identifying positive factors in the formation of an appropriate professional communication can play an important role in preventing such challenges. Materials and methodology: The current study aimed to identify the facilitators of professional communication between nurse and opposite gender patient in Iran. A qualitative method and a conventional content analysis approach were used. A total of 25 nurses were included in the study by purposive sampling. Data were collected through unstructured and semi-structured interviews in hospitals of three provinces of Northwestern Iran, and were analyzed by Graneheim and Lundman method. Results: The results included seven categories and three main themes: prevention of misunderstanding, non-violation of therapeutic relationship boundaries, and observance of the socio-individual context. Discussion: Despite accepting the difficulties of nursing care for an opposite gender patient, the results of the present study showed that paying more attention to, and carefully watching, the mentioned factors could enhance the chance to establish a proper professional communication between a nurse and an opposite gender patient, which is crucial in providing a high quality care, also improving nurses' comfort in their work environment. Therefore, it is recommended to consider these factors in academic and in-service training of nurses.

Relationship Between Parental Stress and their Attitudes Towards Cochlear Implantation Outcomes in Children Referred to Besat Cochlear Implant Center in Hamadan 2018.

PURPOSE: This study aimed to investigate the relationship between parental stress and their attitudes towards post-cochlear implantation outcomes in children referred to Besat cochlear implant center in Hamadan during 2018. DESIGN AND METHODS: In this descriptive cross-sectional study, 100 parents of children with cochlear implantation were selected from Besat cochlear implant center in Hamadan through census method from April to October 2018. The data were collected using a demographic characteristic questionnaire, parental stress scale developed by Berry and Jones, and Parental Attitudes of Various Aspects of Cochlear Implantation. The data were analyzed using SPSS software (version 16) through correlation coefficient, one-way ANOVA, and t-test. P-value <0.05 was considered statistically significant. RESULTS: The results of this study indicated that parental stress negatively correlated with their attitudes towards the outcomes of cochlear implantation (r = -0.420), including the aspects of communication (r = -0.462), educational (r = -0.398), and social skills (r = -0.445), as well as services provided by the health care centers (r = -0.277), and the efficiencies of cochlear implantation center (r = -0.118) (P < 0.05). CONCLUSION: According to the results, parents with more positive attitudes towards the areas of communication, educational, and social skills, as well as services provided by the health care centers, and the efficiencies of cochlear implantation center experienced lower levels of stress. PRACTICE IMPLICATIONS: Nurses can measure the stress and attitudes towards cochlear implantation outcomes in children to accurately assess the needs of the family in order to improve their nursing process and advance the child's rehabilitation program.

The Relationship Between Severity of Epilepsy and Sleep Disorder in Epileptic Children.

OBJECTIVE: Sleep disturbances are one of the most common behavioral problems in childhood. Sleep problems have an even greater prevalence in children with epilepsy and are one of the most common comorbid conditions in childhood epilepsy. MATERIALS & METHODS: This descriptive-correlation study with the general goal of determining the effects of epilepsy on sleep habits of epileptic children was conducted in Hamadan, western Iran, in 2014. Sampling was done using convenience sampling techniques. Data were collected using the Early Childhood Epilepsy Severity Scale (E-Chess) and Children's Sleep Habits Questionnaire (CSHQ) and analyzed using SPSS and descriptive and inferential statistics. RESULTS: The mean score of sleep habits was 55/08±6/71. Bedtime resistance (12/14±2/93), parasomnias (11/02±1/84) and sleep anxiety (8/29±2/46) were the most frequent sleep disorders in the studied sample. Based on Pearson's r, there were significant positive bidirectional relationships between bedtime resistance (rs =0.129, P<0.019), parasomnias (rs =0.298, P<0.005), sleep-disordered breathing (rs =0.295, P<0.005), CSHQ total score (rs =0.144, P<0.022) on the one hand, and children's epilepsy severity on the other. CONCLUSION: Sleep problems should not be overlooked, and a comprehensive review of the sleep habits of this group of patients should be conducted.

The Impact of Addiction on Family Members Mental Health Status.

BACKGROUND: Effects of substance abuse frequently expand beyond the nuclear family. Extended family members can experience feelings of abandonment, anxiety, fear, anger, concern, embarrassment, or guilt. Thus, they may wish to ignore or cut ties with the person involved in substance abuse. The aim of this study was to compare the mental health status of families with and without substance abusers. METHODS: This cross sectional study was conducted among 114 family members with substance abusers (case group) and 114 without substance abusers (control group) in Hamadan city of Iran, in a time period from October to December 2016. Data collection tools included demographic and SCL-90-R questionnaires. Data were analyzed by t- test using SPSS software version 16. The significance level was considered less than 0.05. RESULTS: The mean age of participants in the case and control groups was 33±4.7 and 35±5.2 years. There was a significant difference in the mean of subscales which included somatization, interpersonal sensitivity, depression, anxiety and phobia in families with and without substance abusers (p< 0.001). In other words, the mental health status of family members with a substance abuser was lower than in the control group. Overall, 29.4% of family members with substance abusers and 16% without substance abusers were suspected to have mental disorders. CONCLUSION: Substance abuse is a disorder that can impact families in countless ways. Therefore, it is recommended that more attention should be given to this group toward planning mental health programs. Also, families should be screened by health professionals in regard to psychological needs and improvement of their mental health conditions.

Comparison of the Quality of Sleep and Intensity of Headache between Migraine, Tension Headache, and Healthy Children.

OBJECTIVES: Headache and sleep problems are commonly reported in children, and both can adversely impact the child's life. We aimed to compare the sleep quality and intensity of headache between school-age children with migraine as well as tension headache and healthy children. MATERIALS & METHODS: In this cross-sectional study, 198 children 6-12 yr old in three groups were enrolled from Aug 2015 to Mar 2016. Migraine and tension headache groups from the Outpatient Clinic of Imam Khomeini of Hamadan, western Iran and healthy group from elementary schools were randomly selected (66 children in each group). Data were collected using demographic questionnaire, Child Sleep Habits Questionnaire (CSHQ), Numeric Scale of Pain Intensity and Wong-Baker Faces Pain Rating Scale. The data were analyzed using SPSS by descriptive statistic and multivariate ANOVA, one way ANOVA, Chi-square, Kruskal-Wallis and linear regression tests. RESULTS: Approximately, 45.5% of children with migraine and 37.9% of them with tension headache had experienced severe headache. Only a significant relationship was seen between mean scores of headache intensity and sleep quality in migraine group (P<0.05). There was a significant difference in mean scores of sleep quality among three groups (P<0.001). CONCLUSION: The children with migraine experienced more unsuitable sleep in duration of severe headache. Highlighting the co-morbidity between intensity of headache and sleep problem of children with migraine and tension headache is important to improve treatment strategies and to know the impact of headache on their normal life.