Effect of eye shield and ear muffs on pain intensity during venous blood sampling in premature infants: a clinical trial study.

BACKGROUND: Today, due to the side effects of drugs, there is a greater desire to use non-pharmacological interventions to relieve pain caused by painful procedures. Using non-pharmacological interventions in combination is more effective than using them alone in relieving the pain of infants. Reducing sensory and environmental stimuli such as visual and auditory stimuli is one of the non-pharmacological methods to relieve pain. The aim of this study was to investigate the effect of using eye shield and ear muffs on pain intensity during venous blood sampling of premature infants. METHODS: In this clinical trial study, 148 premature neonates admitted to the Neonatal Intensive Care Unit of Rouhani and Children Hospitals in Babol were randomly assigned to four groups of 37. Fifteen minutes before intravenous blood sampling until 15 min later, in the first group, eye shield; in the second group, ear muffs, and in the third group, eye shield plus ear muffs were used. In the fourth group (control), blood sampling was performed routinely. NIPS pain scale and demographic questionnaire were used to collect the data. RESULTS: The results showed that during the venous blood sampling was a significant difference between the mean pain intensity of neonatal in the eye shield plus ear muffs group (3.14 ± 0.71), the ear muffs group (4.43 ± 1.21), the eye shield group (5.41 ± 1.04).) and the control group (5.94 ± 0.84) (P = 0.001). Moreover, after the venous blood sampling, there was a significant difference between the mean neonatal pain intensity in the eye shield plus ear muffs group (1.19 ± 0.39), the ear muffs group (1.43 ± 0.50), the eye shield group (1.33 ± 0.37) and the control group (1.89 ± 0.90) (P = 0.001). CONCLUSIONS: In this study, the pain severity during and after venous blood sampling in the ear muffs plus eye shield was lower than in other groups. Therefore, a combination of ear muffs and eye shield is recommended as a better pain reliever when performing venous blood sampling in premature infants.

Comparison of the effect of two methods of sucking on pacifier and mother's finger on oral feeding behavior in preterm infants: a randomized clinical trial.

BACKGROUND: Oral feeding problems will cause long-term hospitalization of the infant and increase the cost of hospitalization. This study aimed to compare the effect of two methods of sucking on pacifier and mother's finger on oral feeding behavior in preterm infants. METHODS: This single-blind randomized controlled clinical trial was performed in the neonatal intensive care unit of Babol Rouhani Hospital, Iran. 150 preterm infants with the gestational age of 31 to 33 weeks were selected and were divided into three groups of 50 samples using randomized block method, including non-nutritive sucking on mother's finger (A), pacifier (B) and control (C). Infants in groups A and B were stimulated with mother's finger or pacifier three times a day for five minutes before gavage, for ten days exactly. For data collection, demographic characteristics questionnaire and preterm infant breastfeeding behavior scale were used. RESULTS: The mean score of breastfeeding behavior in preterm infants in the three groups of A,B,C was 12.34 ± 3.37, 11.00 ± 3.55, 10.40 ± 4.29 respectively, which had a significant difference between the three groups (p = 0.03). The mean rooting score between three groups of A, B, and C was 1.76 ± 0.47, 1.64 ± 0.48, and 1.40 ± 0.90 (p < 0.001) respectively. Also, the mean sucking score in groups of A, B and C was 2.52 ± 0.76, 2.28 ± 0.64 and 2.02 ± 0.74 respectively, which had a significant difference (p = 0.003), but other scales had no significant difference between the three groups (P > 0.05). The mean time to achieve independent oral feeding between the three groups of A, B, C was 22.12 ± 8.15, 22.54 ± 7.54 and 25.86 ± 7.93 days respectively (p = 0.03), and duration of hospitalization was 25.98 ± 6.78, 27.28 ± 6.20, and 29.36 ± 5.97 days (p = 0.02), which had a significant difference. But there was no significant difference between the two groups of A and B in terms of rooting, sucking, the total score of breastfeeding behavior and time of achieving independent oral feeding (P > 0.05). CONCLUSION: Considering the positive effect of these two methods, especially non-nutritive sucking on mother's finger, on increasing oral feeding behaviors, it is recommended to implement these low-cost methods for preterm infants admitted to neonatal intensive care unit. TRIAL REGISTRATION: Trial Registration: IRCT, IRCT20191116045460N1 . Registered 11 January 2020- prospective registered.

The effect of participation education on maternal role adaptation in mothers with premature infants in the neonatal intensive care unit.

BACKGROUND: The birth of a premature infant, hospitalization, and separation from the family cause disruption on maternal role adaption. This study was conducted with the aim of investigating the effect of participation education on maternal role adaption in mothers of premature infants hospitalized in the neonatal intensive care unit. MATERIALS AND METHODS: This semiexperimental study was conducted with the participation of 129 eligible mothers with premature infants into three groups of 43 (face-to-face education, virtual education, and control). Data collection was done using a checklist measuring adaptation to the maternal role. Data were analyzed by descriptive statistical and multiple linear regression tests at a significance level of P < 0.05. RESULTS: The mean age of mothers was 30.8 years, the mean gestational age of infants was 31.7 weeks, the mean birth weight was 1781.4 g, and the most common (84.5%) reason for hospitalization of infants was respiratory distress. Multiple linear regression analysis showed that the total score of maternal role adaptation at the time of discharge was significantly different in the two groups of virtual education (134.362 ± 0.925) (P < 0.001) and face-to-face education (132.421 ± 0.928) (P = 0.005) with the control group (128.286 ± 0.924). CONCLUSION: The implementation of educational programs is a suitable solution to improve maternal role adaption. Therefore, it is recommended that managers and healthcare planners consider codified and regular educational programs in order to increase the ability of mothers, in order to adapt to the maternal role.

Effect of bitter orange blossom distillate on anxiety and sleep disorder in mothers with infants admitted to neonatal intensive care unit: A Randomized controlled clinical trial.

OBJECTIVE: Mothers of neonates admitted to the intensive care unit are prone to sleep disorders due to stress and anxiety. Some herbs have anti-anxiety and sedative properties. This study aimed to investigate the effect of bitter orange blossom distillate on anxiety and sleep disorders in mothers with infants admitted to the neonatal intensive care unit. METHODS: This randomized controlled clinical trial was conducted from 2021 May 15 to 2022 February 2, on 60 mothers with NICU-admitted infants in one of the medical teaching centers affiliated with Babol University of Medical Sciences, Iran. Permuted block randomization was used to assign the mothers to the experimental (bitter orange blossom distillate syrup) and control groups (syrup prepared from water and sugar). Given the impossibility of blinding the participants, allocation concealment was used to prevent the researcher from predicting the future allocation of the samples to the groups. In addition, the statistical consultant received coded data pertaining to the type of intervention in each group. A demographic questionnaire, the Spielberger State and Trait Anxiety Inventory (STAI), and the General Sleep Disorder Scale were employed to collect data. We assessed the level of anxiety and sleep disorder (in both groups before the intervention and again after the last day of the intervention). Data were analyzed using SPSS V22 software. A P-value less than 0.05 were considered significant. RESULTS: The mean and standard deviation of the sleep disorder score in the intervention group from (50.26±5.81) to (44.70±6.94) and in the control group from (50.46±6.95) to (48.53±8.62) changed. The covariance test showed that bitter orange blossom distillate syrup has a significant effect on the improvement of sleep disorders (P = 0.01, Effect size = 0.09), but there was no significant difference in the State and Trait anxiety level of mothers (P = 0.122, 0.144 and Effect size = 0.04, 0.03) respectively. CONCLUSIONS: Due to the positive effect of bitter orange blossom distillate syrup on sleep disorders of mothers with hospitalized babies, this low-cost and low-risk intervention is recommended. TRIAL REGISTRATION: This study is registered at clinicaltrials.gov as Trial ID = IRCT20201209049666N1.

The effect of instructing mothers in attachment behaviors on short-term health outcomes of premature infants in NICU.

BACKGROUND: The birth of a pre-mature infant and subsequent hospitalization and separation from the family can impair maternal and neonatal attachment and quality of maternal care. This study aimed to assess the effect of instructing mothers in attachment behaviors on short-term health outcomes of pre-mature infants admitted to neonatal intensive care units (NICUs). MATERIAL AND METHODS: In this quasi experimental study, 80 mothers of pre-mature infants who were admitted to NICUs at two referral health centers in northern Iran were studied in two groups in 2018. Attachment behaviors were taught to mothers in the test group during four consecutive sessions. Mother-infant attachment behaviors were evaluated at both the beginning and the end of this study using a checklist derived from Avant's Maternal Attachment Assessment Strategy. Moreover, infants' short-term health consequences were investigated in two groups. SPSS 18 statistical software was used for data analysis. RESULTS: On average, it took respectively 34.90 ± 12/65 and 31/15 ± 14/35 days for the infants in the control and the intervention group to reach full oral feeding and 38/5 (38/4-42/11) and 37 (31/85-42/14) days to gain the minimum weight required for discharge. Moreover, the mean length of stay for the infants in the control and the intervention group was 41/80 ± 13/86 and 39/02 ± 16/01 days, respectively (P > 0/05). CONCLUSION: Instructing mothers in attachment behaviors clinically improved short-term health-related outcomes. Hence, this intervention is recommended to be incorporated in the care program for mothers with pre-mature infants.

Shedding light on the causes of academic procrastination among nursing students: A qualitative descriptive study.

BACKGROUND: Academic procrastination is a complex phenomenon and a common behavior among nursing students. Due to procrastinating behaviors, students cannot show their real performances in learning processes. In order to stop this behavior, it is crucial to know the most common causes of procrastination in the first place. The aim of this study was to identify a variety of different possible factors influencing academic procrastination among nursing students. MATERIALS AND METHOD: A qualitative study method with the content analysis approach was conducted from October 2019 to March 2020. Participants were 67 nursing students and 8 nursing educators from 3 nursing schools in Iran. Face-to-face semi-structured interviews and focus group discussions were used for data gathering. An inductive approach to content analysis was used for data analysis. RESULTS: Five categories and 24 subcategories emerged from the data analysis: "student-related factors," "educator-related factor," "assignment characteristic-related factors," "institution-related factors," and "nursing work-related factors." CONCLUSIONS: The present study showed that nursing students' academic procrastination can have a wide range of causes and a comprehensive effort is needed to address the problems. The result of our study will be useful to nursing students, educators, and nursing administrators in relation to what constitutes nursing students' academic procrastination, as well as how nursing education can play an effective role in decreasing tendency to procrastination.

Ophthalmologic outcome of premature infants with or without retinopathy of prematurity at 5-6 years of age.

PURPOSE: Vision is the main source of sensory information to the brain in most species of living and human beings and is one of the most important senses for the normal physical and mental development of children. Retinopathy of Prematurity (ROP) is one of the leading causes of blindness and visual impairment worldwide. Refractive errors such as myopia, astigmatism, and anisometropia are common in premature infants with or without ROP. METHODS: A prospective cohort study was performed on the population of premature infants. Screening for Retinopathy of Prematurity in neonatal period was performed according to the protocol of ophthalmologic examination and between 4 and 6 weeks after birth by retinal specialist. The case group included 90 children with or without ROP during infancy. Primary and measurable outcomes in the studied children, including visual acuity, refractive errors, strabismus, and amblyopia, were assessed by an optician and retina ophthalmologist. RESULTS: In our study, at the age of 5-6 years, 26.67% of case group and 48.89% of control group had visual impairment. Amblyopia 3.33%, strabismus 6.67% and refractive errors 16.67% were found in the case group. In control group amblyopia was reported 12.22%, strabismus 6.67%, and refractive errors 30%. In this study, visual impairment was higher in the control group than in the case group. CONCLUSION: Considering the high prevalence of visual impairment in the control group children who were all without ROP, it is necessary to emphasize the importance of careful visual examination of the children at a younger age and remind them of the importance of visual impairment.

Evaluating the impact of a multimedia training versus lecture training on attitudes and practices in paediatric nurses in children pain management: A randomized controlled trial.

Aim: The aim of this study was to evaluate the effect of a multimedia training on pain management attitudes and practices of paediatric nurses. Design: A single-blind randomized trial. Methods: Paediatric nurses (N = 120) from a public hospital randomly allocated into two groups, lecturing and multimedia training groups. Nurses in the control group received four one-hour training sessions. In the intervention group, the same educational content was used as a film with text, audio and animation and presented as a multimedia CD. In both groups, using a questionnaire, we measured pain management attitudes and skills at baseline and then 1 week and 1 month after the training over. Data were analysed in SPSS20 software, and p < .05 was considered statistically significant. Results: The mean of attitude scores of the lecturing group was 104.74 one week after the study and 109.40 one month later versus 74.72. The above-mentioned scores in the multimedia group were 112.72 and 115.04, respectively, versus 78.70 (p < .001). Also, the mean scores of nurses' performance in the lecturing group before, 1 week and 1 month after the study were 12.48, 26.60 and 28.22, respectively, versus 12.58, 28.68 and 28.98, in multimedia group; this difference was statistically significant (p < .05).

Underlying risk factors and their relationship with extent of coronary vessel involvement in patients undergoing coronary angiography in North of Iran.

BACKGROUND: Coronary artery disease (CAD) is one of the most progressive and life-threatening diseases and is the first leading cause of death affecting both genders in Iran. The present study aimed to determine the extent of coronary vessel involvement and relevant relationship with several underlying risk factors. METHODS: In this cross-sectional study, 1452 patients undergoing angiography who met the inclusion criteria were recruited consecutively in Babol, Iran during 2016. Data collection was performed through a questionnaire including demographic and clinical characteristics and information on underlying diseases via an interview with the patient and looking into the patients' records. RESULTS: Of these patients, 459 (31.6%) had normal coronary arteries, 220 (15.1%) suffered from non-obstructive CAD and 773 (53.3%) had one, two or three-vessel obstructive involvement. The results of multiple logistic regression showed that the chances of having coronary artery involvement in patients with diabetes (OR=1.55, p=0.012), age> 60 years old (OR=3.52, P=0.001), male gender (OR=2.54, P=0.001), history of heart attack (OR=3.16, P=0.001), and history of hospitalization because of cardiac problem (OR=1.51, P=0.021) significantly increased. CONCLUSIONS: Diabetes, male gender, age over 60 years old, history of myocardial infarction and history of hospitalization due to cardiac problem were related to the extent of coronary vessels involvement. Therefore, it is recommended to practice preventive measures more extensively in this regard.

Mothers' strategies in handling the prematurely born infant: a qualitative study.

INTRODUCTION: Family, especially mother, is faced with numerous challenges by experiencing a premature birth. Since knowing about mother's efforts regarding prematurely born infant helps us in our comprehensive understanding of the impact of this incident on the family system and its performance. The present study was carried out to explore the mothers' strategies regarding prematurely born infant. METHODS: In a conventional qualitative content analysis, data was collected through purposive sampling by semi-structured deep interviews with 18 mothers who had prematurely born infant during 2012-2013 in the teaching hospitals of the north and northwest of Iran. All the interviews were recorded, typed, and finally analyzed. RESULTS: Data analysis resulted in the extraction of categories of "asking for help, elevating capacity and reducing personal responsibilities and commitments". These categories were revealed in mothers respectively by the different sub-categories of "religious appeal and relying on beliefs, seeking information from the treatment and caring team, participating in infant's care, companionship and support of family and friends","focusing on positive thinking and imagination, patience and strength " and "ignoring some routine affairs and reducing role-related activities and duties". CONCLUSION: Considering the uniqueness of the mother's role in responding to the needs of infants, healthcare system should consider mothers as real target in the intervention strategies in order to promote health and quality of life, so maybe this way, the burden of care and management of critical situations caused by a premature birth on the mother can be reduced.

Continuous and multiple waves of emotional responses: Mother's experience with a premature infant.

BACKGROUND: In recent years, there has been a rise in the number of premature births. Mothers of these newborns experience a high degree of stress over time. Since a more comprehensive understanding of this phenomenon can help the healthcare teams in detecting the deficiencies and needs of such newborns' mothers for a better and more effective intervention, the present study was carried out to describe the mothers' experiences in the area of premature birth. MATERIALS AND METHODS: The present study is a qualitative study with a content analysis approach. The data collection process included 15 semi-structured and in-depth interviews with the mothers delivering premature babies during 2012-2013 in the medical educational centers of north and northwest of Iran. A purposive sampling method was used. All the interviews were recorded, typed, and finally analyzed using a qualitative content analysis with a conventional method. RESULTS: Data analysis led to the extraction of continuous and multiple waves of emotional responses in mothers with premature birth. This has been revealed in mothers by the different categories of affective reactions, symptoms of anxiety, and mood disturbances including decline in performance, individual shortcomings, and mental irritation. CONCLUSIONS: Mothers' unpreparedness and unexpected childbirth make them encounter the multiple and continuous waves of emotional responses, which will consequently lead to decline in performance, individual shortcomings, and mental irritation among them. Therefore, in order to prevent the negative and long-term consequences of such reactions, it is recommended that more attention should be given to support these mothers as the main caregivers of such infants.