Moral distress among critical care nurses before and during the COVID-19 pandemic: A systematic review.

Moral distress has emerged as a significant concern for critical care nurses, particularly due to the complex and demanding care provided to critically ill patients in critical care units. The ongoing COVID-19 pandemic has introduced new ethical challenges and changes in clinical practice, further exacerbating the experience of moral distress among these nurses. This systematic review compares the factors influencing moral distress among critical care nurses before and during the COVID-19 pandemic to gain a comprehensive understanding of the impact of the pandemic on moral distress. For this systematic review, PubMed, Scopus, ProQuest, Web of Science, medRxiv, bioRxiv, Embase, and Google Scholar were all utilized in the search. The search covered articles published from 2012 to December 2022, encompassing a 10-year timeframe to capture relevant research on moral distress among critical care nurses. In total, 52 articles were included in this systematic review. The findings indicate that personal, caring-related, and organizational factors can influence nurses' moral distress. Before the pandemic, factors including futile and end-of-life care, conflicts with physicians, nurse performance and authority, poor teamwork, decision-making regarding treatment processes and patient care, limited human resources and equipment, medical errors, patient restraints, and nurses' age and work experience affect critical care nurses' moral distress. Similarly, during the COVID-19 pandemic, factors contributing to moral distress include futile and end-of-life care, fear of contracting and spreading COVID-19, decision-making about treatment processes, poor teamwork, and being female. This study revealed that the factors contributing to moral distress were approximately similar in both periods. Futile care and end-of-life issues were critical care nurses' primary causes of moral distress. Implementing prevention strategies and reducing these underlying factors could decrease this major issue and improve the quality of care.

The effect of gamification-based training on the knowledge, attitudes, and academic achievement of male adolescents in preventing substance and internet addiction.

BACKGROUND: Preventing addiction through training takes precedence over treatment and plays a crucial role in enhancing the well-being of adolescents. Utilizing inclusive and participatory methods can significantly enhance the effectiveness of education. Numerous studies have demonstrated that gamification, as an interactive and comprehensive approach, has the potential to boost teenagers' motivation to engage in learning and contributes to better comprehension. AIM: This study aimed to assess the impact of gamification-based training to prevent substance and internet addiction on the knowledge and attitudes of male adolescents. Additionally, the study examined this educational program's effects on male adolescents' academic achievement. METHODS: This study employed a quasi-experimental design with a control group. One hundred fourteen male adolescents were randomly assigned to the intervention or control groups. They completed a pre-intervention questionnaire assessing addiction-related knowledge, attitudes, and academic achievement. Subsequently, the intervention group received the gamification-based drug and internet addiction prevention training. Post-tests were conducted immediately after the training and again one month later for both groups. RESULTS: Before the intervention, there were no significant differences in knowledge of substance and internet addiction, attitudes toward substances and the Internet, and academic achievement between the intervention and control groups (P > 0.05). However, after the intervention, the intervention group demonstrated significantly higher scores in knowledge of substance and internet addiction, attitudes toward substances and the Internet, and academic achievement compared to the control group (P < 0.001). CONCLUSION: The current study highlights the positive impact of gamification-based training on enhancing male adolescents' knowledge, attitudes, and academic achievement.

Development and assessment of validity and reliability of a checklist to evaluate the Circulating and Scrub Skills of Operating Room Novices (CSSORN checklist).

BACKGROUND: Assessment of circulating and scrub skills is an important issue in operating room (OR) programs. However, there is a lack of well-designed tools that are specifically developed for this purpose. Hence, this study aimed to develop and determine the validity and reliability of a checklist to measure the circulating and scrub skills of OR novices. MATERIALS AND METHODS: This cross-sectional methodological study was conducted among 124 OR technology students who were selected during three consecutive academic years (2019-2020 to 2021-2022). The developed checklist was evaluated with face validity, content validity (quantitative and qualitative), construct validity (known-groups validity), criterion-related validity (concurrent and predictive validities), internal consistency (Kuder-Richardson 20, KR-20), and inter-rater reliability (intra-class correlation coefficient, ICC). Known-groups validity was evaluated by comparing the difference between the checklist scores of first-semester and third-semester students using independent samples t-test. Additionally, concurrent and predictive validities were evaluated by ICC through measuring the correlation between the total score of checklist and grades of a multiple-choice test and two clinical apprenticeship courses, respectively. Data were analyzed in the Statistical Package for Social Sciences software. RESULTS: After reconciling the preliminary checklist in terms of face and content validities, a checklist with 17 sub-scales and 340 items called "Circulating and Scrub Skills of Operating Room Novices (CSSORN)" was developed. Regarding the known-groups validity, the third-semester students had higher scores compared to the first-semester students (p < 0.001 in most sub-scales). Besides, the total score of checklist showed a significant correlation with the criteria of concurrent and predictive validities (ICC = 0.64, ICC = 0.72; P < 0.001). The KR-20 for the entire checklist was 0.90 (range: 0.60-0.93). The ICC for inter-rater reliability was also 0.96 for the entire checklist (range: 0.76-0.99, P < 0.001 in all sub-scales). CONCLUSION: The CSSORN had appropriate validity and reliability to be used for measuring the circulating and scrub skills of OR novices. To shed light on the findings, further testing of this checklist on larger populations and in different contexts is suggested.

Using objective structured clinical examination (OSCE) for circulating and scrub skills of first-semester operating room technology students: Is it valid and reliable?

Objectives: This study aimed to determine the validity and reliability of an Objective Structured Clinical Examination (OSCE) developed for the summative assessment of the practical credit of the course titled "Principles and Techniques of Circulating and Scrub Persons' Practice." Methods: This applied descriptive study was conducted on 63 first-semester undergraduate Operating Room (OR) technology students. Totally, 17 circulating and scrub skills were incorporated in four 7-min OSCE stations. The content validity of the examination was assessed by an expert panel (n = 14). Additionally, its concurrent validity was evaluated by Intra-Class Correlation (ICC) through measuring the correlation between the total score of OSCE and grade point average, grades of the practical and theoretical credits of the course that were obtained by multiple-choice tests, and the total grade of the course (achieved by the grades of the practical and theoretical credits tests). The Inter-Rater Reliability (IRR) was also calculated by the correlation between the scores recorded by two examiners at each OSCE station using ICC. Meanwhile, the internal consistency across stations (item-total correlation) and across items within a station was determined by Cronbach's alpha (α). Results: The OSCE was deemed to fulfill the content validity criteria. The total score of OSCE showed a significant correlation with the concurrent validity criteria (ICC = 0.66-0.85, p < 0.001). Besides, the IRR was significant for the total score of OSCE as well as for the score of each station (ICC = 0.90-0.98, p < 0.001). Likewise, a good level of internal consistency was found across stations (α = 0.63-0.93) and across items within a station (α = 0.78-0.92). Conclusion: The developed OSCE had appropriate validity and reliability. Thus, it can be used to assess the circulating and scrub skills of first-semester OR technology students.

Relationships Between Job Satisfaction of Operating Room Nurses and Hospital's Compliance With Protective Guidelines During the Covid-19 Pandemic: A Cross-Sectional Study, Iran.

PURPOSE: The Covid-19 pandemic is considered the biggest threat to human health in the recent century. During emergency surgeries, the possibility of infection of members of the surgical team with Covid-19 increases due to the direct contact with patients. The present study has been conducted aimed to investigate the relationships between job satisfaction of operating room nurses and the hospital's compliance with protective guidelines (guidance) during Covid-19 pandemic from the perspective of operating room nurses. DESIGN: This was a descriptive and cross-sectional study conducted from September 22, 2020 to April 21, 2021. METHODS: This study was conducted on 926 nurses working in operating rooms in 15 metropolises of Iran. The sampling method in this study was multistage clustering. The questionnaire was sent to the target group through social apps (WhatsApp and Telegram). The collected data were analyzed by SPSS software version 26 using descriptive and analytical statistics. FINDINGS: The mean age and job satisfaction of the participants were 28.81 ± 5.64 years and 51.15 ± 11.45, respectively. Participants (n = 259; 27.97%) reported very good job satisfaction. Also, the mean hospital's compliance with protective guidelines during Covid-19 pandemic from the perspective of operating room nurses was 42.29 ± 7.11. The results of the present study showed a significant relationship between job satisfaction and hospital's compliance with protective guidelines during Covid-19 pandemic (P-value ≤ .001). CONCLUSIONS: Optimization of infrastructure, improvement of management decisions and increasing human resources in a crisis can affect the quality of performance and job satisfaction of operating room nurses. The researchers suggest that health system managers can contribute to the safety and efficiency of the existing human resources by taking measures to increase job satisfaction.

Design and psychometric evaluation of the maternal perception of postpartum care in comprehensive health centers.

BACKGROUND: Mothers' perceptions of the quality and quantity of care they have received and their relationship with healthcare personnel significantly impact continuity of care and future referrals. This study evaluated the psychometric dimensions of the Iranian version of the Mothers' Perception of Postpartum Health Care questionnaire in comprehensive health centers. METHODS: We conducted a cross-sectional study in which the questionnaire was administered to 250 women from different comprehensive health centers. First, the questionnaire was translated verbatim from English to Persian. Then, we evaluated the face, content, structural validity, and reliability of the questionnaire. RESULTS: The results showed that this questionnaire's face, content, structure validity, and reliability were adequate. Cronbach's alpha coefficient for the entire questionnaire was 0.668. The interclass correlation coefficient was 0.688, which confirmed divergent validity. CONCLUSIONS: Mothers' Perception of Postpartum Health Care questionnaire in comprehensive health centers is valid and reliable for measuring maternal perception of these vital services.

INTRODUCCIÓN: La percepción de las madres con respecto a la calidad y cantidad de la atención que han recibido, así como de su relación con el personal de salud impactan significativamente en la continuidad de la atención y sus futuras derivaciones. Este estudio se diseñó para evaluar las dimensiones psicométricas de la versión iraní del Cuestionario de Percepción de las Madres sobre la Atención de la Salud Posparto en los centros integrales de salud. MÉTODOS: Se llevó a cabo un estudio transversal en el que se aplicó el cuestionario a 250 mujeres de distintos centros integrales de salud. En primer lugar, el cuestionario se tradujo de forma literal del inglés al persa. Después se evaluó la validez aparente, de contenido y de estructura, así como la confiabilidad del cuestionario. RESULTADOS: Los resultados mostraron que la validez aparente, de contenido y de estructura, así como la confiabilidad de este cuestionario son adecuadas. El coeficiente alfa de Cronbach para todo el cuestionario fue 0.668. El coeficiente de correlación intraclase fue 0.688, lo que confirmó una validez divergente. CONCLUSIONES: El Cuestionario de Percepción de las Madres sobre la Atención de la Salud Posparto en los centros integrales de salud es válido y confiable para medir la percepción materna sobre estos servicios vitales.

Design and psychometric evaluation of the maternal perception of postpartum care in comprehensive health centers / Diseño y evaluación psicométrica de la percepción materna de la atención posparto en centros de salud integral

Abstract Background: Mothers' perceptions of the quality and quantity of care they have received and their relationship with healthcare personnel significantly impact continuity of care and future referrals. This study evaluated the psychometric dimensions of the Iranian version of the Mothers' Perception of Postpartum Health Care questionnaire in comprehensive health centers. Methods: We conducted a cross-sectional study in which the questionnaire was administered to 250 women from different comprehensive health centers. First, the questionnaire was translated verbatim from English to Persian. Then, we evaluated the face, content, structural validity, and reliability of the questionnaire. Results: The results showed that this questionnaire's face, content, structure validity, and reliability were adequate. Cronbach's alpha coefficient for the entire questionnaire was 0.668. The interclass correlation coefficient was 0.688, which confirmed divergent validity. Conclusions: Mothers' Perception of Postpartum Health Care questionnaire in comprehensive health centers is valid and reliable for measuring maternal perception of these vital services.

Resumen Introducción: La percepción de las madres con respecto a la calidad y cantidad de la atención que han recibido, así como de su relación con el personal de salud impactan significativamente en la continuidad de la atención y sus futuras derivaciones. Este estudio se diseñó para evaluar las dimensiones psicométricas de la versión iraní del Cuestionario de Percepción de las Madres sobre la Atención de la Salud Posparto en los centros integrales de salud. Métodos: Se llevó a cabo un estudio transversal en el que se aplicó el cuestionario a 250 mujeres de distintos centros integrales de salud. En primer lugar, el cuestionario se tradujo de forma literal del inglés al persa. Después se evaluó la validez aparente, de contenido y de estructura, así como la confiabilidad del cuestionario. Resultados: Los resultados mostraron que la validez aparente, de contenido y de estructura, así como la confiabilidad de este cuestionario son adecuadas. El coeficiente alfa de Cronbach para todo el cuestionario fue 0.668. El coeficiente de correlación intraclase fue 0.688, lo que confirmó una validez divergente. Conclusiones: El Cuestionario de Percepción de las Madres sobre la Atención de la Salud Posparto en los centros integrales de salud es válido y confiable para medir la percepción materna sobre estos servicios vitales.

The effect of time management education on critical care nurses' prioritization: a randomized clinical trial.

BACKGROUND: Nurses are at the forefront of patient care, and time management skills can increase their ability to make decisions faster. This study aimed to assess the effect of a time management workshop on prioritization and time management skills among nurses of emergency and intensive care units. METHODS: This randomized clinical trial was performed with 215 nurses. The educational intervention about time management was held in the form of a workshop for the intervention group. The time management questionnaire was completed by both groups before, immediately after, and 3 months after the intervention. RESULTS: Most participants were female (n=191, 88%), with a mean age of 31.82 years (range, 22-63 years). Additionally, the participants' work experience ranged from 1 to 30 years (mean±standard deviation, 8.00±7.15 years). After the intervention, the mean score of time management increased significantly in the intervention group, but no significant difference was observed in this regard in the control group. The results also revealed a significant difference between the intervention and control groups regarding the mean score of time management 3 months after the intervention (P<0.001). CONCLUSIONS: Time management training helped nurses adjust the time required to perform and prioritize various tasks.

Mothers' Perceptions of the Quality of Postnatal Care Provided in Health Centers and the Associated Factors: A Cross-Sectional Study.

Background: Postnatal care plays a great role in the health of mothers and their neonates. This study aimed to evaluate the mothers' perceptions of the provided postnatal care and the associated factors. Methods: In this cross-sectional study, the health centers of Sirik city in Hormozgan province, Iran, were selected using convenience sampling. The study was conducted on 160 mothers who had referred to the selected centers for postnatal care from 7 August 2018 to 2 August 2020 and had given birth to live full-term neonates (>37 weeks of gestation) 40 days to 12 months before sampling. The Mothers' Perceptions of the Quality of Postnatal care questionnaire was designed by the research team; it included 18 questions about mothers' perception of care. The collected data were analyzed using the SPSS software, version 21. Results: The mothers' mean score of perception was 69.84±16.04; most mothers rated the provided postnatal care and their relationship with the personnel as good or excellent. The mean total scores of the mothers' perceptions were not different based on their satisfaction with postnatal care (P=0.646) and time of the first referral after birth (P=0.251), but they were significantly different according to the number of referrals (P=0.023) and their satisfaction with the health personnel (P<0.001). Conclusion: The study results revealed that mothers had a good perception about postnatal care provided by health center staff. Hence, it is necessary to educate all health staff in this regard to provide high-quality postnatal care to all mothers who refer to these centers.

The effect of training program based on health belief model on burn prevention knowledge in mothers of children aged to 1-3 years: A randomized controlled.

PURPOSE: One of the effective models in health education is the health belief model that considers a person's behavior as a under the influence of knowledge and attitude. In the present study, we investigated the efficacy of a training program based on the health belief model in burn prevention knowledge in mothers of children aged between 1 and 3 years old. DESIGN AND METHODS: This single blind randomized Control Trial study was conducted on 64 mothers with a child aged between 12 and 36 months who were referred to the Health Centers of Shiraz, Iran, in 2018. Accordingly, using cluster sampling, 4 health centers were selected and then 2 centers were assigned to the intervention group and 2 other centers to the control group by randomization. The intervention group received six sessions of training. However, in order to observe the ethical principles, the educational content was provided to the control group at the end of the present study. Both groups completed health belief model questionnaire before, after the intervention, and by passing 2 months from the intervention. The collected data were compared between the two groups using SPSS software, version 25. RESULTS: We found no differences in the demographics of the two study groups (P > 0.05). Intragroup comparison in the intervention and control groups indicated a significant difference among the three intervals (both P = 0.001). As well, a difference was found between the intervention and the control groups immediately after the intervention and 2 months after the intervention (both P < 0.001). Additionally, in both groups, the relationship between mothers' knowledge score and each dimension of the health belief model was examined, which was a significant. (P = 0.001). CONCLUSION: Health belief model can be considered as an effective method for educating mothers in terms of the prevention of children's burn and the increased the mothers' knowledge. PRACTICE IMPLICATIONS: The health belief model was shown to have a good effect on educating mothers regarding child burn's prevention. So, due to this reason, it is recommended to use this model for burn's prevention training programs.

Comparison of the effect of electronic learning and blended learning on the empowerment of the caregivers of cancer patients under chemotherapy.

OBJECTIVE: Cancer is a chronic disease that affects individuals as well as their families. E-learning is a common method of education for patients and caregivers. The present study aimed to compare the impact of E-learning and blended learning on the empowerment of caregivers of cancer patients under chemotherapy. METHODS: This clinical trial was performed in the main chemotherapy center of Shiraz University of Medical Sciences during October 2018-December 2020. A total of 123 caregivers of cancer patients who were under chemotherapy were selected through simple random sampling and were divided into two intervention groups and one control group. The empowerment of the caregivers was evaluated using the caregivers' empowerment questionnaire in all three groups at the beginning of the study, immediately after the intervention, and 1 month after the intervention. The data were analyzed by descriptive statistics and statistical tests using the SPSS software, version 22. RESULTS: The results revealed no significant difference between the two groups regarding the knowledge score (p = 0.3). However, the first intervention group had a better attitude compared to the two other groups after the intervention (p = 0.003). Moreover, the mean score of performance increased significantly in both intervention groups (p = 0.000). No significant differences were observed among the three groups in terms of the demographic data, knowledge, attitude, and performance (p > 0.05). CONCLUSION: The results indicated that both electronic and blended learning affected the attitude and performance of the patients' caregivers. Therefore, blended learning can be applied for enhancing the empowerment of caregivers.

Effect of a self-care training program using smartphones on general health, nutrition status, and sleep quality in the elderly.

BACKGROUND: Self-care training programs can be an important means for educating the elderly in behaviours that promote health and the quality of life. Since sleep disorders, and problems related to eating patterns and general health, become more apparent with age, we aimed to investigate the effect of a self-care training program using smartphones on general health, nutritional status, and sleep quality of the elderly. METHODS: In this randomized quality improvement trial with a pretest/post-test design, 54 healthy and independent elderly were enrolled and randomly allocated to intervention and control groups. The interventions included 21 sessions of self-care training that were presented virtually using smartphones. RESULTS: Significant differences before and after the intervention were observed for the intervention group with respect to measures of general health, nutrition, and sleep quality. CONCLUSION: Training in health-promoting self-care behaviours, delivered by smartphone, should be considered as a major strategy for maintaining and promoting health among the elderly.

Comparison of the effect of training academic honesty using two workshop and virtual training methods on the knowledge and attitude of M. S. students.

BACKGROUND: Nowadays, one of the most important challenges of the universities and higher education centers is academic dishonesty among students. Academic dishonesty is done through cheating, deception, and plagiarism, which creates serious educational, studious, and social problems for the students and society. The purpose of this study was to compare the effect of virtual and workshop training on the knowledge and attitude of M. S. students in terms of plagiarism. MATERIALS AND METHODS: This research was an applied interventional study of quasi-experimental type having pretest and posttest and the participants of this study included 90 M. S. nursing students of Medical Science University of Shiraz in the southwestern part of Iran. RESULTS: The comparison of the three groups indicated that virtual and workshop training, both, developed the knowledge and attitude of students regarding plagiarism; however, the comparison between two methods did not indicate a statistically significant difference. CONCLUSION: Both virtual and workshop training methods had an effect on increasing students' knowledge and attitude. Regarding the positive effect of training academic dishonesty using two workshop and virtual training methods, both can be used as efficient and effective methods in training dimensions depending on the condition and facilities to prevent and reduce plagiarism in students.

Knowledge about the effects of electrosurgery smoke among operating room nurses during COVID-19 Pandemic: A Cross-Sectional Study.

BACKGROUND: Electrosurgery smoke is the smoke emitted from tissue cauterization when using the electrosurgery device. Accordingly, in this smoke, more than 80 harmful toxins have been discovered. In the current study, we aimed to investigate the level of knowledge reported by the operating room nurses on the effects of electrosurgery smoke during the current COVID-19 pandemic. METHODS: This descriptive, survey-based cross-sectional study was performed on 533 OR nurses in all the referring hospitals of COVID-19 infection. The required information were collected using a questionnaire regarding the knowledge on the side effects of electrosurgery smoke. The obtained data were then analyzed using t-test and ANOVA by SPSS software. RESULTS: Most of the included participants (93.6%) had a low level of awareness and only a small number of them (0.4%) had a good level of knowledge on the effects of electrosurgery smoke. As well, a significant relationship (P˂0.05) was found between the level of knowledge reported by the OR nurses and the type of hospital (educational or private). Most of the studied hospitals used no electrosurgery smoke reduction equipment during electrosurgery. CONCLUSION: The level of knowledge reported by the OR nurses was generally poor. It is recommended that managers and health officials try to increase the level of awareness of OR nurses during the COVID-19 pandemic by providing standard and protective equipment as well as holding some well-organized and related training courses.

Empowering health volunteer's through participatory action research in a comprehensive healthcare center.

BACKGROUND: Health volunteers act as the link between the society and the healthcare system and are a symbol of people's participation in the health maintenance and promotion. Despite the important role of health volunteers in the health system, it seems that they experience several problems. The aim of this study was empowering health volunteers through an action research. METHODS: This participatory action research was conducted through two continuous cycles of reflection and acting for change over 20 months, in a comprehensive health center in Southern of Fars province in Iran. Participants included 25 health volunteers; two instructors and an academic researcher as facilitator. In the first cycle the participants discovered the challenges of health volunteers, prioritized them, designed an action plan, and implemented it. At the end of this cycle, evaluation was done with the participants' cooperation. The second cycle began with reflecting on the results of the first cycle and then after designing and implementing second action plan, final evaluation was done. RESULTS: Qualitative content analysis in the first phase led to the emergence of four categories, including role confusion, inadequate volunteer training, deficits in attracting and keeping volunteers, and being unfamiliar to the public. After the implementation of the action plan the participants learned through reflection and immersing in action. Finally, quantitative and qualitative data showed improvement of knowledge and performance, satisfaction, effectiveness of programs and improvement in volunteer's competence. CONCLUSIONS: Clarification of volunteers' roles, supporting volunteers to improve their knowledge and skills with coherent planning based on their educational needs, are appropriate management plans to attract and retain volunteers. By presenting their services to the society, they will be empowered and motivated to continue.

Effectiveness of an Educational Intervention to Increase Human Papillomavirus Knowledge and Attitude in Staff and Nursing Students.

PURPOSE: To evaluate the effect of education about human papilloma virus and its vaccine on awareness and attitude of healthcare workers and nursing students. DESIGN: This was a quasi-experimental study. METHODS: The sample size was 250 (155 healthcare workers and 95 students), and both groups received educational intervention. Questionnaires were used to collect data before, after, and also 3 months following the intervention. FINDINGS: The mean age of participants was 30.1 ± 10.23 years. Results showed a significant increase in knowledge (P < .001), overall attitude (P = .000), and perceived behavior (P < .001) of the participants after the educational intervention. CONCLUSION: Educational intervention was effective in knowledge, attitude, and behavior of students and healthcare workers. CLINICAL EVIDENCE: Educational intervention can be one of the strategies to prevent individuals from acquiring the virus and to increase vaccine compliance.

Validation of the Iranian Version of the Hospital Ethical Climate Survey.

BACKGROUND AND PURPOSE: The aim of this study was to determine validation of the Iranian version of the Hospital Ethical Climate Survey (HECS). METHODS: This is a methodological study with a cross-sectional design that was conducted in 2016. A forward-backward translation method was used to translate the questionnaire from English to Persian and face, content, and construct validity as well as reliability were assessed. RESULTS: The factor structure of the HECS through explorative Principal Component Analysis (PCA) confirmed five factors that explained 64.7% of total variance. The overall Cronbach's alpha coefficient was .86 and the Cronbach's alphas for five of the subscales were between .63 and .92. CONCLUSIONS: The Iranian version of HECS has adequate validity and reliability for measuring the hospital ethical climate in the Iraniansociety.

Effect of education about andropause health on level of the knowledge and attitude of men referring to the education and training retirement center of Shiraz.

Introduction and objective: With the world's older population continuing to grow, andropause (male menopause or late-onset hypogonadism) is considered as one of the most important issues of this era. In this study, we aimed to assess the effect of andropause health education on the level of knowledge and attitude of retired men.Methods: This controlled trial was conducted on 80 retired men (40 in intervention group, 40 in control group), who had been employed by the Department of Education, Shiraz, Iran. Data collection tool was a 38-item questionnaire, designed by the researcher, on participants' knowledge and attitude about andropause. Data were analyzed using SPSS software, version 22 and statistical tests such as independent and paired t tests were used.Findings: There was no significant difference between the intervention and control groups before the intervention. There was a significant difference in knowledge and attitude scores in each group immediately and 1 month after the intervention. The mean score of knowledge in the intervention group increased from 2.92 ± 1.68 before to 16.22 ± 1.34 after the intervention, and the attitude score increased from 14.9 ± 1.08 to 28.52 ± 1.44. Comparison of the two groups and repeated score analysis showed that there was a significant difference between the two groups over the time (p < .001).Conclusion: Educational intervention improved the knowledge and attitude of retired men toward andropause, which can have a positive impact on the timely recognition and proper treatment of the complications of andropause.

Role-play versus lecture methods in community health volunteers.

BACKGROUND: Considering the key role of health volunteers in promoting community's health, their effective training is of particular importance. Training can be more effective through cooperative and learner-centered methods. Role-play is among the cooperative methods with numerous advantages. Considering the positive impact of training via various methods, we aimed to compare training through role-play and lecture on health volunteers' health knowledge in selected comprehensive health centers of Shiraz, Iran. METHODS: This quasi-experimental study was conducted on all health volunteers in four comprehensive health centers selected via random cluster sampling during the second half of 2017. The participants were divided into intervention and control groups and took part in the pretest based on the book entitled "Promotion of Breastfeeding". Based on the pretest results, health volunteers trained the participants in three educational sessions. The two groups were evaluated again immediately and two months after the intervention. RESULTS: The mean age of the participants was 49.97 ±â€¯8.1 and 46.52 ±â€¯10.74 years in intervention and control groups, respectively. Most participants were married (94.8%) and had diplomas (92.1%).A significant difference was seen between both groups in knowledge scores at the three time points (P < 0.001). A significant difference was found between the two groups regarding knowledge scores immediately and two months after the intervention (P < 0.001), indicating the effectiveness of training through role-play. CONCLUSION: The advantages of role-play, including development of communication skills and active listening, resulted in the learners' enthusiasm and motivation. This method was accompanied with higher educational output as well as longer knowledge persistence. Role-play increased cooperation and group discussions performed after the role-play promoted the transfer emotional experiences.

Challenges faced by health volunteers in comprehensive health centers in the southwest of Iran: A qualitative content analysis.

Introduction:Health volunteers are employed to execute governmental health promotion programs in most countries around the world. The present study aimed to assess the challenges of health volunteers program to provide a better understanding of the present situation. Methods:This study was conducted using a qualitative approach. 14 participants were selected purposively selected from two comprehensive health care centers in the southwest of Iran. The data were collected through 14 semi-structured interviews, 2 observations, and 3 diaries and analyzed using content analysis. Results:Data analysis resulted in emergence four themes, namely role confusion, the inefficiency of volunteers training, the inefficiency of attraction and maintenance of volunteers, and being unknown to people. Unfertilized capacity is the main theme extracted from all themes. Conclusion:Health volunteers' perfect accomplishment of roles will have a positive impact on the provision of primary healthcare services and health objectives. Hence, comprehensive planning based on the needs of health volunteers will change them into a strong arm in the health system. Thus, managerial support and precise planning seem to be necessary for facing these challenges.