Background: Nursing and Midwifery Studies (NMS) (eISSN: 2322-1674) has published 483 articles between 2012 and 2024, all indexed in the Web of Science (WoS), with 219 articles (2019-2024) also indexed in Scopus. Objectives: This bibliometric study aimed to map the journal's intellectual structure, publication trends, citation patterns, altmetric impact, and thematic evolution over time. Methods: This applied scientometric investigation retrieved bibliographic, citation, and altmetric data for 483 NMS articles from WoS, Scopus (219 articles), and ResearchGate. Author names and institutional affiliations were standardized prior to analysis. Performance analysis (including publication output, citation impact, and usage metrics) and science mapping (keyword co-occurrence, and author, institution, and country collaboration networks) were performed using VOSviewer. A total of 2,065 raw author keywords were consolidated into 981 unified terms and subsequently clustered into five major thematic groups. Results: Original research articles accounted for 86% of publications. The mean citation count per cited article was 8.4 in WoS (79.3% cited; maximum 81 citations), 4.2 in Scopus (73.51%; maximum 48), and 15.45 in ResearchGate (81.57% indexed; average reads: 683.26; maximum 55,429). Thematic clustering revealed five dominant research areas: nurses' mental health (stress: 40 occurrences; burnout; COVID-19), chronic disease management (quality of life: 38; anxiety: 37), maternal and women's health (pregnancy, midwifery), nursing education (students: 40), and patient care. Kashan University of Medical Sciences emerged as the most productive institution, contributing 134 articles and engaging in collaborations spanning 37 countries. Conclusion: This analysis highlights the evolving scientific landscape of NMS, emphasizing its strong potential for continued growth in high-impact areas such as mental health and COVID-19 research. Strengthening international collaborations, organizing thematic special issues, and enhancing altmetric engagement are recommended strategies to advance the journal's visibility and trajectory toward Q1 ranking.
Background: The high prevalence of health risk behaviors among adolescents remains a major public health concern, leading to significant long-term consequences for individuals and society. Life skills education is recognized as an effective strategy to equip adolescents with the competencies required to make informed and healthy life decisions.Objectives: This systematic review aimed to evaluate the effectiveness of community-based life skills education in preventing risky health behaviors among adolescents.Methods: A systematic literature review was conducted in accordance with the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Comprehensive searches were performed in Scopus, PubMed, ProQuest, EBSCO, and Google Scholar using the keywords “adolescent,” “teen,” “youth,” “health risk behaviors,” “sexual behavior,” “substance abuse,” “Human Immunodeficiency Virus,” “tobacco dependence,” “youth empowerment,” “life skills education,” and “community,” combined with the Boolean operators “AND” and “OR.” Eligible studies included adolescents aged 10–24 years, community-based life skills interventions, and outcomes related to sexual behavior, substance abuse, and HIV/AIDS prevention. Randomized controlled trials, quasi-experimental, and observational studies published in English between 2014 and 2024 were included. Two independent reviewers assessed methodological quality using the JBI critical appraisal tool. Of 1,107 identified records, 17 studies met the inclusion criteria.Results: Multicomponent interventions integrating life skills training, social empowerment, family support, and economic incentives were effective in improving knowledge, attitudes, and self-efficacy while reducing engagement in risky behaviors. Variations in outcomes were influenced by social context, implementation fidelity, and program design.Conclusion: Community-based life skills education is an effective approach for promoting healthy behaviors and reducing risk among adolescents, although its impact may be limited in high-risk or socially disadvantaged groups.
Dear Editor Leukemia profoundly affects not only the diagnosed child but also the entire family. Siblings of children with leukemia are often referred to as “silent survivors.” During a health crisis, these siblings are frequently marginalized and experience consequences that extend beyond psychological challenges such as anxiety, depression, and guilt. These effects also influence their social interactions, academic performance, and personal identity development. Unfortunately, the psychosocial needs of siblings are often overlooked in many treatment and care strategies.[1]ChallengesChildren with siblings affected by leukemia face numerous challenges, particularly when treatment is prolonged. These difficulties include reduced parental attention, disruption of family routines, increased responsibilities at home, and the emotional strain of concern for their ill sibling. Additionally, they experience a range of emotions, including jealousy, guilt, anger, and feelings of neglect, which may adversely affect their psychosocial development. The absence of dedicated psychological support and insufficient parental guidance on addressing the emotional needs of healthy children further exacerbate these challenges. Consequently, many siblings experience lower academic performance, fewer social interactions, and difficulties in forming their own identities.[2]Potential SolutionsAddressing the psychosocial challenges faced by siblings of children with leukemia requires a comprehensive, evidence-based, interdisciplinary approach involving coordinated collaboration among nurses, psychologists, physicians, school counselors, and parents. The first step is the early identification of psychological and behavioral issues in siblings through thorough psychosocial assessments conducted by nurses and therapists specializing in family dynamics. Incorporating standardized screening tools into routine care is essential for monitoring anxiety, depression, posttraumatic stress, and evaluating the quality of family interactions. Following identification, comprehensive intervention programs should be developed and implemented to enhance resilience, strengthen coping strategies, and foster emotional security for healthy siblings.[3]These programs should include individual and group therapy sessions to help siblings process emotions, acknowledge unspoken grief, boost self-esteem, and acquire stress management skills. Educational interventions for parents should emphasize emotional awareness, stress management, equitable attention among children, prevention of neglect toward healthy siblings, and improved family communication.[4]Integrating psychosocial support into nursing practice is also critical, which requires training nurses to provide meaningful emotional support to healthy family members during hospitalization, ongoing treatment, or critical emergencies. Collaboration with schools and counselors ensures academic and social support, prevents educational setbacks, and provides a safe space for siblings to express psychological concerns.[4]Developing interdisciplinary clinical protocols that encompass comprehensive family-centered care is vital. These protocols should recognize psychosocial support for healthy siblings as an integral component of the overall treatment plan. Establishing dedicated psychosocial support units within pediatric oncology centers, staffed by specialists in child and family mental health, would significantly strengthen these efforts. Additionally, community-based initiatives such as sibling peer support groups, partnerships with non-profit organizations, and public awareness campaigns highlighting the family impact of leukemia can enhance social resilience and reduce stigma.[5]ConclusionSiblings often experience anxiety, guilt, isolation, and profound emotional distress in silence. The psychosocial consequences of these experiences can exert long-term effects on their emotional development, mental health, and family dynamics. Therefore, it is essential for healthcare providers, institutions, parents, and policymakers to acknowledge the importance of comprehensive psychosocial support that extends beyond the patient to encompass the entire family, with particular attention to the unique needs of siblings. The primary purpose of this letter is to raise awareness and advocate for the integration of family-centered psychosocial care into both clinical practice and healthcare policy.
Background: Pregnancy is commonly accompanied by sleep disturbances, which can adversely affect both maternal and fetal health. Although a variety of interventions have been proposed, there is no consensus regarding the most effective approach.Objectives: This systematic review and meta-analysis aimed to evaluate the effectiveness of interventions designed to improve sleep quality and reduce insomnia during pregnancy.Methods: A comprehensive search of PubMed, MEDLINE, Embase, Web of Science, and CENTRAL databases was performed for studies published between January 2000 and March 2025. Only randomized controlled trials (RCTs) involving pregnant women aged 10–49 years were included. Study selection adhered to PICOS criteria, focusing on interventions targeting sleep quality or insomnia outcomes. Data were pooled using a random-effects model in STATA, and effect sizes were calculated as standardized mean differences (SMD) with 95% confidence intervals (CI), assessing both efficacy and heterogeneity.Results: Eleven RCTs, encompassing a total of 1,176 participants, met the inclusion criteria. Pooled analysis demonstrated that sleep interventions significantly improved sleep quality compared with controls (SMD=–0.81; 95% CI=–1.09 to –0.52; P<0.001). Among the various interventions evaluated -including complementary medicine, water-based exercise, aerobic exercise, cognitive behavioral therapy, and acupuncture- sleep health behavior education showed the most pronounced and sustained improvement, particularly evident at two months post-intervention.Conclusion: Sleep health behavior education appears to be the most effective and durable intervention for enhancing sleep quality during pregnancy. While other approaches, such as acupuncture, cognitive behavioral therapy, and exercise, produced benefits, their long-term effects were inconsistent. These findings support the integration of structured behavioral sleep education into prenatal care as a cost-effective, accessible, and sustainable strategy to improve maternal sleep health.
Background: Effective self-management is crucial for pregnant women at risk of gestational diabetes mellitus (GDM). The Self-Management Behavior Scale, designed to evaluate health behaviors in chronic conditions, is a key tool for this assessment. Objectives: This study aimed to develop and validate a self-management behavior scale tailored for pregnant women at risk of GDM. Methods: A cross-sectional study was conducted among 225 pregnant women identified as at-risk and receiving antenatal care at Vajira Hospital and Bangkok Metropolitan Administration hospitals. Participants were selected using a stratified sampling strategy. Participants were classified as "at-risk" based on GDM criteria and underwent the Glucose Challenge Test between 24-28 weeks of gestation (from the Maternal and Child Health Record Book, 2023). Self-management behaviors were assessed using an 18-item questionnaire. Inclusion criteria comprised at-risk pregnant women who provided informed consent, whereas those with severe cognitive impairments were excluded. Structural validity was evaluated via confirmatory factor analysis using Mplus software. Reliability was assessed using Cronbach's alpha, and construct reliability was examined through CR and H coefficients. Results: Participants had a mean age of 29.68 +/- 6.59years, mean gestational age of 25.5 weeks, and mean first-pregnancy blood glucose level of 136.95 mg/dL. The scale demonstrated excellent internal consistency (Cronbach's alpha=0.95). Second-order factor analysis supported construct validity. The model exhibited good fit indices: chi(2)/df=1.83 (P<0.001), CFI=0.959, TLI=0.950, SRMR=0.045, and RMSEA=0.061. Individual items showed factor loadings ranging from 0.37 to 0.94 (P<0.01), and second-order components had standardized loadings between 0.83 and 0.96, with "Setting Goals for Self-Management" exhibiting the highest loading (beta=0.964). The construct accounted for 81.7% of the variance and demonstrated a reliability coefficient of 0.957. Conclusion: The developed 18-item scale encompassing five dimensions is valid, reliable, and appropriate for assessing self-management behaviors among pregnant women at risk of GDM.
Background: Spiritual sensitivity is a fundamental component of holistic nursing care, given the diversity of patients' cultural backgrounds and religious beliefs. With the growing Muslim population globally, particularly in Indonesia, delivering Islamic nursing care that addresses the spiritual needs of Muslim surgical patients is crucial for enhancing their spiritual well-being. Despite this, nurses continue to encounter challenges in providing spiritually competent care tailored to Muslim patients. Objectives: This study explores the perspectives of Muslim scholars on spiritually sensitive nursing care for Muslim perioperative patients Methods: An exploratory-descriptive qualitative design was employed. Nine Muslim scholars from Aceh, Indonesia, were recruited through purposive sampling between June 2023 and January 2024. Data were collected using semi-structured interviews and analyzed through conventional content analysis. Lincoln and Guba's criteria were applied to ensure trustworthiness of the data. Results: Analysis yielded three main themes and ten categories: 1) the importance of Sharia-based perioperative nursing care, including its meanings and benefits; 2) the integration of Sharia values into perioperative nursing practices, encompassing facilitation of patients' worship activities, enhancement of motivation, maintenance of privacy, application of Sharia principles in communication, and medication use; and 3) the competencies required of Sharia perioperative nurses, including knowledge, attitudes, and skills. Conclusion: The findings highlight the importance of incorporating Islamic nursing principles in the care of Muslim surgical patients and highlight the need for nurses to strengthen competencies in this domain. These insights provide a foundation for further initiatives and offer a framework to improve spiritually sensitive care for Muslim perioperative patients.
Background: Inclusive maternity care is critical for achieving equitable health outcomes, particularly in remote regions where access and cultural barriers persist. Midwifery education plays a central role in preparing students to deliver such care; however, comparative evidence between diploma and undergraduate programs in Indonesia remains limited.Objectives: This study aimed to compare final-year diploma and undergraduate midwifery students’ perceptions of inclusive maternity care in Southwest Papua.Methods: A cross-sectional survey was conducted between June 2024 and January 2025 among 143 students (68 diploma, 75 undergraduate) selected via stratified random sampling. Data were collected using a validated questionnaire that assessed inclusivity across six domains: accessibility, equality and non-discrimination, respect and dignity in care, effective communication, patient-centred care, and cross-sectoral collaboration. Data were analyzed with independent t-tests and chi-square tests.Results: Undergraduate students demonstrated significantly higher scores in understanding (mean 4.2 vs. 3.8, P=0.02) and preparedness (mean 4.0 vs. 3.7, P=0.04) for inclusive care, whereas diploma students more frequently reported limited hands-on training as a primary barrier (73.5% vs. 60.0%, P=0.04). No significant differences were observed across the six domains, though both groups identified communication -particularly with patients with disabilities- as the weakest aspect, with agreement rates of 62.7% (undergraduate) and 55.9% (diploma).Conclusion: Educational level influences students’ readiness but does not significantly affect overall attitudes toward inclusivity. Enhancing practical exposure, disability-sensitive communication skills, and institutional support is essential to translating inclusive maternity care policies into practice in Indonesia’s underserved regions.
Background: Balancing work and family responsibilities remains a pervasive challenge in nursing, attracting significant international research attention. Difficulties in managing these demands, combined with workplace pressures, can adversely affect nurses' professional commitment. Objectives: This study examined the association between work-family conflict and professional commitment among nurses in Iran. Methods: From September to December 2023, a cross-sectional study was conducted with 270 nurses employed in medical-surgical units in Tehran, Iran. Participants were selected using a quota sampling method. Data collection involved a demographic questionnaire, the Work-Family Conflict Scale, and the Nursing Professional Commitment Scale. Statistical analyses were performed using SPSS version 25. Results: Among the participants (n=270), 215 (79.6%) were women, and 156 (57.8%) were unmarried, with a mean age of 31.41 years (SD=7.56). A significant negative correlation was observed between work-family conflict and professional commitment (r=-0.27, P<0.001). The mean work-family conflict score indicated a moderate level (61.58 +/- 11.57), while the mean professional commitment score was in the upper-moderate range (83.72 +/- 16.02). Higher professional commitment was noted among nurses aged over 40 years, those working morning shifts, and those with permanent employment status (P<0.05). Conclusion: The findings suggest that work-family conflict undermines nurses' professional commitment and efficiency. Healthcare administrators should implement supportive strategies and family-friendly policies, identify nurses experiencing high levels of work-family conflict, and design interventions aimed at mitigating these conflicts to enhance professional commitment.
Background: Quality of life (QOL) extends beyond physical well-being and is influenced by numerous factors. Job burnout has emerged as a growing concern among nurses in both developed and developing countries. Objectives: This study aimed to investigate the mediating role of general health (GHQ) in the relationships between work-life balance, sleep quality, QOL, and job burnout among hospital nurses. Methods: Data were collected from 300 nurses working in hospitals in Kashan, Iran, in 2024 using random sampling. Participants completed self-administered questionnaires assessing demographic characteristics, sleep quality, QOL, general health, job burnout, and work-life balance. Structural equation modeling (SEM) was employed to examine the proposed relationships among these variables. Results: The mean (SD) scores for QOL, general health, job burnout, work-life balance, and sleep quality (QOS) were 60.41 (17.96), 27.49 (14.33), 50.64 (17.04), 74.80 (15.20), and 11.35 (6.56), respectively. SEM results indicated that the proposed model demonstrated a good fit: P < 0.001, root mean square error of approximation (RMSEA) = 0.01, comparative fit index (CFI) = 0.92, Tucker-Lewis index (TLI) = 0.90, chi(2)/df = 1.72, and standardized root mean squared residual (SRMR) = 0.04. Conclusion: The findings suggest that hospital managers can enhance nurses' general health by improving sleep quality, promoting work-life balance, and reducing job stress, thereby mitigating job burnout and ultimately improving overall QOL.
Background: Parkinson's disease (PD) is a progressive neurological disorder that impairs motor function (MF) and reduces quality of life (QOL). Although animal studies suggest that chamomile extract may enhance MF and muscle endurance in PD models, its effects in humans remain unexplored. Objectives: This study evaluated the impact of chamomile extract on MF and QOL in individuals with PD. Methods: In 2022, a double-blind, randomized, placebo-controlled trial was conducted in Kashan, Iran, including 50 patients with PD, randomized into two groups via block randomization. One group received chamomile extract capsules, while the other received wheat flour capsules, for 28 days. Data were collected at baseline and after the intervention using a demographic questionnaire, the Short Parkinson's Evaluation Scale for Outcomes in Parkinson's Disease (SPES/SCOPA), and the Parkinson's Disease Questionnaire (PDQ-39). Analyses followed intention-to-treat (ITT) principles and complete-case approaches, employing Kolmogorov-Smirnov, Chi-square, Fisher's exact, Mann-Whitney U, Wilcoxon signed-rank, and Quade's tests. Results: Baseline QOL scores did not differ significantly between groups (chamomile: 92.02 +/- 11.27; placebo: 88.46 +/- 15.88; P=0.56). Post-intervention, QOL improved in both groups, although the between-group difference was not statistically significant (67.94 +/- 31.50 vs. 63.12 +/- 32.15; P=0.68). The chamomile group had a higher baseline MF score than the placebo group (65.16 +/- 6.59 vs. 59.32 +/- 10.42; P=0.03). By the end of the study, MF scores declined in both groups, without significant between-group differences (56.07 +/- 16.2 5 vs. 54.77 +/- 21.8 0; P=0.31). Conclusion: Compared with placebo, chamomile extract was associated with modest improvements in MF and QOL. The observed changes in the placebo group may reflect psychological effects. Further studies with larger samples, higher dosages, and extended followup are warranted.
Background: Patient autonomy is a fundamental principle of nursing ethics and is prominently highlighted in the Code of Ethics for Nurses. However, there is a notable gap in the existing literature regarding patients' actual versus preferred perceptions of the respect for their autonomy within nursing care. Objectives: This study aims to compare patients' actual and preferred perspectives on the observation of their autonomy during nursing care. Methods: A cross-sectional analytical study was conducted on 231 patients hospitalized at an educational hospital in Saveh, Iran, from February to June 2023. Data were collected using a patient autonomy questionnaire developed by Lemonidou et al., (2003) which assessed two dimensions: information received and patient involvement in nursing care, in both preferred and actual versions. Data analysis was performed using SPSS software (version 22). Descriptive statistics, paired t-tests, independent t-tests, one-way ANOVA, and Pearson correlation coefficient tests were utilized. Results: The mean scores for the information received by patients regarding their actual and preferred viewpoints were 26.0 +/- 7.6 and 26.43 +/- 6.43, respectively, with no significant difference observed. In contrast, the mean scores for patient involvement in nursing care were 22.29 +/- 5.06 for the actual viewpoint and 24.51 +/- 4.9 for the preferred viewpoint, revealing a significant difference (P<0.05). The most substantial gap between actual and preferred perspectives was noted in the item concerning "choosing pain relief methods" (P<0.05). Conclusion: The findings indicate that patients perceive their autonomy as insufficiently respected in nursing care, particularly in relation to decision-making about treatment options. Given the critical importance of autonomy in patient care, it is recommended that nurses receive enhanced training on ethical principles through in-service programs. This approach would better acknowledge and integrate patients' rights and preferences into their care.
Background: Vaccination is a routine procedure that can induce pain and discomfort in infants, highlighting the need for effective pain management strategies. Objectives: This study aimed to evaluate and compare the effects of aromatherapy using breast milk and rose water on pain levels and physiological responses in infants following pentavalent vaccination. Methods: This triple-blind randomized controlled trial involved 111 infants recruited from health centers in Khorramabad, Iran, between 2021 and 2022. Eligible participants were two months old, exclusively breastfed, and had dry diapers prior to vaccination. Using stratified block random sampling, infants were assigned to one of three groups: one receiving breast milk aromatherapy, another receiving rose water aromatherapy, and a control group. Aromatherapy was administered by placing a cotton ball containing five drops of either breast milk or rose water near the infant for one minute before and three minutes after the pentavalent vaccination. Pain intensity was measured using the Modified Behavioral Pain Scale (MBPS), while pulse rate and oxygen saturation (SpO(2)) were monitored through pulse oximetry. Crying duration was recorded with a stopwatch. Data analysis was conducted using chi-square tests, paired t-tests, repeated measures ANOVA, one-way ANOVA, and Tukey's post hoc tests. Results: Both intervention groups exhibited significantly lower MBPS scores and shorter crying durations compared to the control group (P<0.05). Furthermore, the rose water group demonstrated significantly higher SpO(2) levels than the other groups (P<0.05). However, no significant differences in pulse rate changes were observed among the groups (P>0.05). Conclusion: Aromatherapy using both breast milk and rose water effectively alleviated pain and reduced crying duration in infants undergoing pentavalent vaccination. Notably, rose water is particularly recommended for mitigating vaccination-induced pain in infants.
Background: Approximately 159 million children under the age of five, representing 24% of this demographic, experience stunted growth. Various interventions can be implemented to mitigate stunting, including nutritional assistance, improved sanitation facilities, poverty reduction, food security initiatives, and women's empowerment.Objectives: This systematic review aims to evaluate the effectiveness of women's empowerment on children's nutritional status and stunting reduction, as well as to identify specific indicators of women's empowerment that influence these outcomes.Methods: We conducted this systematic review following the PRISMA (2020) guidelines. The study protocol was approved by PROSPERO, with registration number CRD42022375020. Inclusion criteria encompassed primary intervention research presented as full-text articles (including preprints) and complete summary estimates. Studies were excluded if they contained incomplete or imprecise quantitative data or were unpublished. No language restrictions were applied, and the final search was conducted on April 23, 2025. A comprehensive search was performed across six databases: PubMed, ScienceDirect, Scopus, ProQuest, Wiley Online Library, and Web of Science, in addition to Google Scholar. The Joanna Briggs Institute (JBI) was utilized to assess the quality of the studies. Ultimately, 22 articles met the inclusion criteria and were descriptively synthesized based on title, year, study design, sample size, indicators, and outcomes.Results: The review identified 22 eligible studies, comprising 20 cross-sectional studies and two case-control studies. Quality assessment was conducted using the Joanna Briggs Institute criteria for both study types. All included studies evaluated the impact of women's empowerment on children's nutritional status and stunting.Conclusion: Women's empowerment demonstrates potential in improving children's nutritional status and reducing stunting; however, further evidence is required to substantiate its effectiveness. Policymakers and health professionals should prioritize women's empowerment programs within communities. As healthcare providers, nurses can leverage their skills to educate and empower women, ultimately enhancing children's nutritional status and reducing stunting.
Background: The 30-degree lateral sleeping position has been shown to enhance sleep quality in older adults with stroke by improving oxygen flow and reducing vascular pressure. The 30-Degree Lateral Sleeping Position Control Pillow (R) is essential for maintaining this position during sleep. Objectives: This study aims to evaluate the effectiveness of the 30-Degree Lateral Sleeping Position Control Pillow (R) on sleep quality in older adults who have experienced a stroke. Methods: This quasi-experimental study utilized a non-equivalent control group design and was conducted in Indonesia from January to August 2024. Participants were selected using consecutive sampling. Eligible individuals were assigned to either the intervention or control group based on their order of enrollment, with the first half designated for the intervention group and the latter half for the control group. Inclusion criteria included older adults with stroke who did not exhibit severe hemiparesis or hemiplegia, were literate, could communicate verbally, and were cooperative. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI). The intervention involved utilizing the pillow for four weeks during nighttime sleep. Data analysis was performed using t-tests, Chi-Square tests, Wilcoxon Signed Rank tests, Mann-Whitney U tests, and Cohen's d, employing SPSS version 27. Results: A total of 112 participants completed all outcome assessments, evenly divided between the intervention group (n=56) and the control group (n=56). The Wilcoxon test revealed no significant difference in sleep quality between the two groups prior to the intervention (Z=-0.294, P=0.769). However, results from the Mann-Whitney U test indicated that sleep quality was significantly better in the intervention group (85.7%) compared to the control group (66.1%, Z=-2.419, P=0.001). The Cohen's d value of 2.066 indicated a very large effect size. Conclusion: The use of the 30-Degree Lateral Sleeping Position Control Pillow (R) significantly improves sleep quality among older adults with stroke. Healthcare providers should consider incorporating this pillow into care plans for older adults experiencing sleep disturbances as part of a comprehensive strategy to enhance overall sleep quality.
Background: Pregnant women in correctional facilities face increased risks of health complications, yet many struggles to engage in self-care despite the availability of basic healthcare services. Emotional and psychological barriers stemming from incarceration -such as isolation, distrust, and a lack of emotional safety- often hinder their ability to utilize care effectively. Objectives: This study aimed to explore the reasons behind pregnant inmates' reluctance to engage in pregnancy self-care through a feminist lens. Methods: This qualitative study, conducted from January to March 2024 at a women’s correctional facility in Indonesia, employed purposive sampling to select participants. Six inmates who were either currently pregnant or had been pregnant within the past year were interviewed. Data were collected through unstructured in-depth interviews and observational methods. Thematic analysis was employed to interpret the data, with trustworthiness ensured through prolonged engagement, triangulation, member checking, and reflexivity. Results: The primary theme identified was "trapped in emotional turmoil", reflecting the fear of moral judgment from family members and feelings of betrayal among pregnant inmates. These women grappled with the tension between their lived experiences and societal expectations of motherhood. Furthermore, the unpredictable and inconsistent authority exhibited by prison and healthcare staff fostered distrust and a sense of neglect. These emotional challenges exacerbated the inmates’ feelings of isolation and powerlessness, complicating their ability to care for themselves and maintain mental well-being during incarceration. Conclusion: The study revealed that pregnant inmates' reluctance to engage in pregnancy self-care is deeply rooted in emotional wounds shaped by patriarchal norms, moral judgment, and institutional distrust. A feminist perspective highlights how the voices of these women are often silenced within a system that neglects their emotional needs, thereby reinforcing their withdrawal from self-care practices.
Background: To enhance the quality of maternal care, it is essential to monitor the performance of caregivers through appropriate indicators. Objectives: This study aims to evaluate the Maternity Care Quality in Maternity Unit Scale (MCQ-MUS) using confirmatory factor analysis. Methods: A cross-sectional study was conducted in 2023 among 390 caregivers in the labor ward at Shiraz University of Medical Sciences, Iran. Participants were selected through convenience sampling. The factor structure identified in the exploratory factor analysis of the MCQ-MUS for low-risk women was further analyzed using confirmatory factor analysis. Both convergent and discriminant validity were assessed. Results: The fit indices supported the adequacy of the MCQ-MUS model for low-risk women: chi 2/df = 2.41, CFI = 0.88, GFI = 0.93, AGFI = 0.91, NFI = 0.89, IFI = 0.89, RMR = 0.093, and RMSEA = 0.088. Additionally, both convergent and discriminant validity were established, with Average Variance Extracted (AVE) values exceeding 0.50, thus meeting the Fornell-Larcker criteria. Conclusion: The MCQ-MUS questionnaire demonstrates an acceptable factor structure for low-risk women. Supported by favorable psychometric properties, including convergent and discriminant validity, it is an effective tool for assessing labor ward care quality.
Background: Aluminum phosphide (ALP) poisoning is a critical health issue that poses significant challenges for pre-hospital emergency responders.Objectives: This study aims to develop a clinical protocol for managing ALP poisoning in pre-hospital emergency settings.Methods: The research utilized the RAND-modified Delphi method, engaging 20 experts from Tehran, Mazandaran, and Babol Universities of Medical Sciences in Iran in 2023. Experts were selected based on specific eligibility criteria, including a minimum of five years of professional experience in the relevant field. The study progressed through five distinct phases: comprehensive library and electronic searches, thorough literature reviews, careful assessment of quality and content validity, data collection from a panel of experts, and the eventual publication of the finalized pre-hospital nursing care protocol. Data analyses were conducted using SPSS Statistics software (version 23) and Microsoft Excel (2016).Results: The 20 experts on the panel had a mean age of 47.5 years (±10.5) and an average of 13.15 years (±7.95) of professional experience. The developed protocol includes the following steps: Assessment: Prioritize safety, conduct symptom/risk screening, and perform ABCDE evaluations along with pain assessment on a scale from 0 to 10. Planning: Stabilize hemodynamics, alleviate poisoning symptoms, ensure adherence to medication and relaxation protocols, and develop discharge plans. Implementation: Secure the airway, prevent aspiration, perform gastric lavage (using saline and dextrose-insulin), adhere to the SSPS protocol, and educate patients about associated risks. Evaluation: Confirm efficacy through normalized vital signs, resolution of symptoms, patient/caregiver comprehension, emotional stability, and adherence to long-term care plans.Conclusion: This study employs the RAND/Delphi method to establish a pre-hospital protocol for ALP poisoning that emphasizes vital sign monitoring, hemodynamic stability, and pain management. A stronger consensus was observed among master's-level experts. Future phases will assess the clinical efficacy of this protocol and its educational impact on patient outcomes.
Background: Smoking cessation is a critical global public health objective, with community-based interventions emerging as effective strategies to enhance quit rates, particularly among underserved populations. Despite the variety of approaches available, comprehensive evaluations of these interventions are limited, hindering their optimal implementation across diverse settings.Objectives: This scoping review aims to evaluate the effectiveness of community-based smoking cessation interventions and identify key elements that contribute to improved quit rates across various populations.Methods: This scoping review followed the PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines to ensure methodological rigor and transparency. We searched the Scopus, PubMed, Web of Science, Ovid, and ProQuest databases for studies published between January 1, 2014, and August 20, 2024. Search terms included “community-based,” “smoking cessation,” and “intervention.” The screening process was streamlined using Rayyan AI for title, abstract, and full-text reviews. Studies were included if they involved empirical research on community-based smoking cessation interventions targeting adults aged 17 to 59 years. Inclusion criteria encompassed community-based interventions (e.g., educational programs, support groups, mobile health) with or without comparators. The primary focus was on smoking cessation outcomes such as quit rates and abstinence. Data were synthesized descriptively to summarize study characteristics, intervention types, and populations. Key findings were interpreted through narrative synthesis, highlighting common themes and patterns across the studies.Results: Out of 5,428 identified studies, 21 met the inclusion criteria. Peer coaching, group therapy, and digital platforms demonstrated substantial effectiveness, particularly when culturally adapted. Peer-led models utilizing motivational interviewing significantly improved quit rates in underserved populations by addressing access barriers and fostering supportive environments. Group therapy interventions enhanced quit rates through shared accountability and collective support, while digital platforms exhibited scalability, cost-effectiveness, and accessibility, especially in resource-limited settings.Conclusion: Community-based smoking cessation interventions are highly effective, particularly when tailored to specific population needs. Future research should focus on the cost-effectiveness of these strategies and explore hybrid models that integrate digital tools, peer support, and behavioral therapies to maximize quit rates among diverse, high-risk populations.
The domain of nursing care is inherently complex and multifaceted, characterized by continuous evolution, diverse stakeholders, and intricate systems influenced by numerous factors. A thorough examination of nursing care reveals that social and economic determinants, alongside ethical considerations, significantly impact health outcomes. Consequently, it is imperative for nurses to possess a deep understanding of these complexities to deliver effective care. Qualitative research methods serve as valuable tools for nurses seeking to gain insights into the healthcare environment. Among these methods, Carspecken's critical ethnography stands out as a powerful approach for exploring individuals' experiences within healthcare settings.[1] This method provides a profound lens through which the intricate social dynamics, inequalities, and cultural contexts of healthcare practices can be examined and illuminated. It is particularly relevant for addressing systemic issues that contribute to health disparities, enabling researchers to elucidate the cultural and social mechanisms that shape the behaviors and experiences of both patients and healthcare providers.[2]Traditional ethnography, rooted in the anthropological tradition, primarily employs a descriptive approach aimed at providing comprehensive insights into cultures and social dynamics. Its goal is to document and interpret cultural practices within specific social contexts, often utilizing methods such as participant observation, interviews, and artifact analysis to capture individuals' lived experiences in their natural environments. Ethnographers traditionally strive for objectivity, aiming to minimize personal bias and maintain a detached stance to ensure the reliability of their findings.[1] In contrast, Carspecken's critical ethnography operates within a different philosophical framework that prioritizes understanding and challenging social injustices, oppression, and hegemonic structures. This approach explicitly interrogates power relations and analyzes their manifestations in the lives of marginalized groups. Critical ethnography seeks not only to understand cultural practices but also to promote social change by highlighting inequalities and amplifying the voices of historically silenced populations. It acknowledges that researchers cannot remain wholly neutral and emphasizes the importance of reflexivity regarding the researcher's position and potential biases -arguing that personal engagement enriches the understanding of the complexities inherent in social interactions.[3] The application of Carspecken's critical ethnographic method in nursing research encompasses several stages that enable a comprehensive examination of the cultural and institutional practices influencing healthcare delivery. This method typically consists of three preliminary stages -such as formulating research questions and establishing the researcher’s positionality- and five primary stages that involve data collection through participant observation, interviews, and analysis of cultural artifacts. For instance, nursing researchers have employed this method to investigate disparities in nursing care experienced by critically ill patients in intensive care units (ICUs). Their findings illustrate how cultural biases, communication barriers, and ethical considerations can exacerbate health inequalities.[4] In another study conducted in an ICU setting, researchers applied the Carspecken method to uncover the cultural knowledge and ethical practices of nurses aimed at reducing health disparities. Following 300 hours of observation and semi-structured interviews with nurses, key themes emerged, including the enhancement of cultural competence and the supportive role nurses play within the healthcare environment. These insights reveal how nurses can adeptly navigate the complexities of patient care while addressing systemic barriers to access and quality in healthcare.[5]The findings derived from research utilizing Carspecken's critical ethnographic method hold significant implications for advancing health equity. Evidence indicates that nurses exhibiting high levels of cultural competence can mitigate health disparities through empathetic care, effective communication, and personalized patient interactions that consider cultural contexts. Specifically, the research underscores the necessity of providing culturally sensitive care that honors patients' beliefs and religious practices, fostering an environment where all patients feel valued and understood. Furthermore, this approach emphasizes the importance for healthcare managers and policymakers to prioritize cultural competence training and awareness programs within healthcare settings. By equipping nurses with essential skills to navigate cultural diversity, organizations can cultivate more inclusive environments that promote equitable health outcomes. This initiative is particularly vital in addressing systemic healthcare inequalities that disproportionately affect marginalized groups, thereby aligning with the overarching goal of achieving health equity.[6]In conclusion, the nursing profession, akin to other healthcare disciplines, bears a significant responsibility for addressing inequalities within the healthcare system. Nurses can actively contribute to mitigating these disparities through various strategies, including the implementation of impactful qualitative research. The utilization of critical ethnographic methods in nursing research offers a comprehensive framework for exploring the complexities of nursing practice and its cultural foundations. This approach provides essential insights that can facilitate transformative changes within healthcare settings and underscores the imperative for equitable care across diverse populations. Cultivating a culture of critical inquiry through methodologies such as ethnography not only enhances professional practice but also empowers individuals who have historically faced marginalization within the healthcare system. By adopting these principles, the nursing profession can advance toward a more inclusive, reflective, and socially responsive practice.
Background: Anxiety is a common response to perceived threats and is frequently managed with pharmacological interventions, which may have undesirable side effects and limited effectiveness. Non-pharmacological approaches also encounter challenges, including inadequate documentation and inconsistent results. Objectives: This study aims to evaluate the effects of hand and foot reflexology on anxiety levels in patients undergoing coronary angiography. Methods: This randomized controlled trial was conducted in 2024 at Shahid Beheshti Hospital in Kashan, Iran, and included 90 patients to evaluate the effect of reflexology on anxiety. Participants were randomly assigned to three groups: hand reflexology (P6 Point), foot reflexology (SP6 Point), and a control group that received a general hand massage. Anxiety levels were assessed using the Spielberger State Anxiety Inventory, along with hemodynamic indicators measured before, immediately after, and 30 minutes post-intervention. Data analysis was performed using SPSS Version 17, employing various statistical tests, including ANOVA, Kruskal-Wallis, ANCOVA, Friedman, repeated measures, and chi-squared tests. Results: Significant differences in age and education levels were noted among the groups (P<0.05). Both hand reflexology (P6 Point) and foot reflexology (SP6 Point) resulted in significant reductions in anxiety compared to the control group, with decreases of 4.33 and 2.83 units per unit increase in time, respectively. No significant change was observed in the control group. Conclusion: Both hand and foot reflexology effectively reduce anxiety, with hand reflexology demonstrating greater efficacy. It is advisable to prioritize hand reflexology when feasible and consider foot reflexology as a secondary option in conjunction with anxiety medications.
