Background: The number of vegan consumers has increased markedly over the past decade. Some individuals adopt this diet without adequate understanding of its core principles, often driven by secondary motives and misconceptions. These misunderstandings may result in adverse health outcomes, including nutritional deficiencies, when the diet is poorly planned. Understanding the sociocultural and educational context of the target population, particularly in regions such as Lar, Gerash, and Evaz in southern Iran, is therefore essential. Objectives: This study aimed to identify common misconceptions about the vegan diet among individuals referring to community health centers and to evaluate the need for targeted nutrition education as a preventive approach to reduce diet-related health risks. Methods: This qualitative study employed semi-structured interviews and purposive sampling to recruit vegan individuals from community health centers in Lar, Gerash, and Evaz. Data were analyzed using conventional qualitative content analysis based on the Graneheim and Lundman approach. Interviews were transcribed verbatim, managed with MAXQDA version 10, and analyzed concurrently with data collection until saturation was achieved. Results: Data from 32 participants, mean age: 40.21 (10.20) years, yielded four main themes: misconceptions about the vegan diet, consequences of unresolved misconceptions (including nutritional deficiencies), proposed solutions, and implementation strategies. Several misconceptions conflicted with fundamental dietary principles and, in some cases, led to unintended negative health effects. Conclusion: While the vegan diet has potential health benefits, inadequate understanding of its objectives may increase health risks. Targeted nutrition education, professional guidance, and supportive public health policies are recommended to promote informed adherence and prevent diet-related harm.
Potentially inappropriate drug prescribing (PIP) represents one of the biggest challenges of modern clinical practice, especially in the context of an aging population and an increasing prevalence of chronic diseases. Potentially inappropriate prescribing includes prescribing drugs when the risks of use exceed the potential clinical benefits, prescribing a drug that is not indicated for a given diagnosis, and omitting a clinically indicated drug [1]. This concept includes polypharmacy - the simultaneous administration of five or more drugs - as well as potentially harmful drug interactions and inappropriate dosing [2]. Explicit and implicit criteria have been developed to identify PIPs. Explicit criteria are based on lists of drugs that are generally considered inappropriate for certain populations, most often elderly patients. The Beers criteria of the American Geriatrics Society were the most widely applied and include categories of drugs that should be avoided regardless of diagnosis, drugs that are inappropriate for certain diseases or syndromes, and drug combinations that should be avoided [3]. The European alternative is the STOPP/START (Screening Tool of Older Person's Prescriptions / Screening Tool to Alert doctors to Right Treatment) criteria, which, in addition to detecting potentially inappropriate drugs (STOPP), also indicate clinically justified drugs that have been omitted (START) [4] [5]. Implicit criteria are based on clinical judgment and take into account individual patient characteristics. The most widely known implicit instrument is the Medication Appropriateness Index (MAI), which evaluates each drug according to 10 parameters: indication, effectiveness, dosage, proper administration, drug interactions, drug-disease interactions, unnecessary duplication, length of therapy, patient acceptability, and therapy costs [6].The prevalence of PIPs worldwide varies with the criteria used and the population studied, but is estimated at 20%-50% among hospitalized elderly patients [7]. Meta-analyses indicate that PIPs are particularly prevalent in nursing homes, with incidence rates exceeding 40% [5][8]. The clinical consequences of PIPs are multiple and serious. Inadequately prescribed drugs are associated with adverse effects (AEs), many of which are preventable – it is estimated that 28% to 56% of AEs that lead to hospitalization originate from PIPs [7]. Elderly patients are especially at risk of falls, cognitive impairment, cardiac arrhythmia, and gastrointestinal bleeding. In addition to direct clinical consequences, PIPs contribute to prolonged hospitalization, rehospitalizations, and increased health care costs [2]. The costs of treating PIPrelated side effects in developed healthcare systems reach billions of euros per year, underscoring the exceptional public health importance of this problem [7]. In some countries, including Great Britain, Australia, Canada, and the USA, nurses with specialized education have a legally defined right to prescribe drugs (nurse prescribing) [9]. This right can be exercised as independent prescribing, in which the nurse takes full responsibility for diagnosis and therapy, or as supplementary prescribing, based on the clinical plan established by the doctor [9]. In many countries, current regulations do not permit independent prescribing of drugs by nurses, but nurses are assigned important roles in pharmacotherapy monitoring and evaluation, drug administration, and patient education [10]. Nurses have a number of validated instruments at their disposal to recognize PIPs. The Beers criteria and the STOPP/START criteria are available as practical checklists for daily use [3,4]. The MAI provides a structured framework for evaluating each individual therapy [6]. Electronic Clinical Decision Support Systems (CDSS), integrated into hospital information systems, automatically warn of potential drug interactions, contraindications, and inappropriate doses, providing nurses with valuable real-time support [11]. The use of pharmacotherapeutic databases (e.g., Micromedex, Lexicomp) represents an additional resource in the daily clinical evaluation of therapy. When a nurse recognizes a potentially inappropriate medication, clear and structured communication with the prescribing physician is necessary. For this purpose, the SBAR (Situation, Background, Assessment, Recommendation) technique is recommended, as it enables the effective transfer of clinical information and the proposal of an alternative solution [12]. The nurse has a professional and ethical obligation to advocate for the patient's safety, document the assessment and the steps taken, and, if the initial communication did not elicit an appropriate response, report the situation to the competent physician or clinical pharmacist [10]. In case of immediate danger to the patient, the nurse is authorized to temporarily postpone the administration of the drug and urgently consults the responsible doctor, with mandatory documentation of all actions taken [10]. Systematic education of nurses about PIPs should be an integral part of the initial educational program and of continuous professional education. Studies show that intervention programs combining theoretical lectures, case studies, and simulation exercises lead to statistically significant improvements in nurses' knowledge and skills in recognizing PIPs [13]. A multidisciplinary approach, which includes the collaboration of nurses, physicians and pharmacists within pharmacotherapy teams, has proven to be particularly effective in improving the quality of prescribing [14]. Continuing professional development should include modules dedicated to recognizing PIPs, applying relevant criteria and tools, and communicating in an interprofessional team. Artificial Intelligence (AI) brings transformative opportunities to the field of PIP recognition and prevention. Machine learning algorithms, by analyzing large datasets of clinical data, can identify prescribing patterns that indicate potential errors and risks much faster and more accurately than manual reviews [15]. Integrating AI into CDSS systems enables personalized alerts to nurses based on the individual patient profile – taking into account renal function, body mass, comorbidities, and concomitant Slobodan Janković. PCNM. 2026;66(6) 3 Preventive Care in Nursing and Midwifery Journal therapy [11,15]. Research indicates that such systems reduce the frequency of clinically significant drug interactions and potentially harmful prescriptions, contributing at the same time to the relief of nurses from routine checks [15]. However, it is important to emphasize that AI should be seen as a tool to support the nurse's clinical judgment and not to replace it – critical thinking and communication skills remain indispensable elements of safe pharmacotherapy. Inappropriate prescribing of drugs is a complex but solvable problem of modern medicine. Nurses, as the most numerous and closest professional group to patients on the healthcare team, play a key role in recognizing, preventing, and addressing this problem. The application of validated criteria, structured communication, continuous education, and the use of modern digital tools - including artificial intelligence - provide a strong framework for improving the safety of pharmacotherapy. The development of legislation that would grant nurses greater authority in pharmacotherapy, along with adequate education and supervision, represents an important next step towards safer, better health care.
Background: Heat and moisture exchanger (HME) filters are essential for mechanically ventilated patients but can hinder aerosol delivery. Objectives: This study compared jet nebulizer placement positions relative to the HME filter on pulmonary parameters. Methods: This double-blind randomized controlled trial assessed 86 patients for eligibility. After excluding 13, 73 were randomized into two groups: the intervention group (n=36), where the nebulizer was placed between the patient and the HME filter, and the control group (n=37), where it was placed between the ventilator and the HME. During the trial, 3 patients died (intervention: 1, control: 2), resulting in a final analysis of 70 patients (35 per group). Parameters were measured at baseline and at 90 minutes after each of four bronchodilator doses administered over 24 hours. Data analysis included repeated measures ANOVA via SPSS v.22. Results: Significant within-group time effects were found for mean airway pressure (MAP), SpO₂, lung compliance (Cst), and airway resistance (Raw) (P<0.05). Tidal volume (VT) and minute ventilation (MV) showed no significant temporal changes (P>0.05). The time×group interaction was significant only for Raw and SpO₂ (P<0.05). Between-group analysis revealed significant differences in VT, MAP, SpO₂, Raw, and MV (P<0.05), but not for Cst (P=0.222). Conclusion: Nebulizer placement relative to the HME filter affects temporal changes in Raw and SpO₂. Considering small-to-moderate effect sizes, differences are primarily physiological; thus, placement should be guided by clinical status and specific protocols.
Background: Preventable medical errors are a major concern in clinical care, highlighting the importance of effective nursing education for clinical decision-making. Recently, AI-based educational strategies have emerged, but their actual impact on nursing students has not been systematically assessed. Objectives: This systematic review aimed to synthesize the available evidence on the impact of AI‑based educational programs on clinical decision‑making and medical errors among nursing students. Methods: This systematic review was conducted according to PRISMA 2020. PubMed, Scopus, Web of Science, Cochrane CENTRAL, and Embase were searched for relevant studies (2019–2024). Eligible studies were randomized controlled trials (RCTs) and quasi-experimental designs comparing AI-based interventions with traditional education in undergraduate nursing students. Study selection, data extraction, and quality appraisal (RoB-2 and ROBINS-I) were performed independently. Due to substantial heterogeneity among the included studies, a narrative synthesis was performed. Results: The initial search identified 1,487 records, of which 16 studies involving approximately 1,590 nursing students met the inclusion criteria. AI‑based interventions, mainly virtual patient simulations and adaptive learning systems, significantly enhanced clinical decision‑making skills in all included studies. Moreover, most studies assessing medical errors (9 of 10) reported notable reductions in medication miscalculations and diagnostic inaccuracies. Overall, the methodological quality of the included studies was rated as moderate to good. Conclusion: AI-based education shows strong potential to improve clinical judgment and promote patient safety in nursing students. Careful, context-sensitive integration into nursing curricula is recommended, with future research needed to address methodological heterogeneity and long-term effectiveness.
Background: Abortion is considered a major public health issue, especially in low- and middle-income countries. There is a lack of recent global trend analyses stratified by Sociodemographic Index (SDI) that comprehensively assess maternal mortality, incidence, and disability-adjusted life years. Objectives: This study examines global disparities in maternal mortality, incidence, and disability-adjusted life years (DALYs) related to abortion and miscarriage. Methods: This secondary data analysis utilized the Global Burden of Disease (GBD) 2021 dataset to extract maternal mortality ratios (MMRs), incidence rates, and disability‑adjusted life years (DALYs) related to abortion and miscarriage from 1990 to 2021, all reported with 95% uncertainty intervals (UIs). Analyses were conducted using age‑standardized rates and among women aged 15–49 years, stratified by Socio‑Demographic Index (SDI) categories. Temporal trends in age‑standardized rates were assessed using Joinpoint Regression Software (version 4.8.0.1). Results: Over the 31‑year period, Joinpoint trend analysis showed a significant global decline in all indicators. DALY rates decreased from 104.39 to 25.73, maternal mortality ratios declined from 36.07 to 12.92, and incidence rates decreased from 1603.84 to 1001.64 per 100,000 population. High‑ and high‑middle‑SDI countries experienced the steepest and most significant declines, whereas low‑SDI countries showed the smallest reductions and continued to bear the highest burden in 2021. Conclusion: Maternal mortality, incidence, and DALY rates related to abortion and miscarriage have substantially declined worldwide. While high and high-middle SDI countries experienced the steepest declines, substantial inequalities persist, with low-SDI countries continuing to bear a disproportionately high burden in 2021. These persistent disparities highlight the need for continued action.
Background: Critical shortages of skilled birth attendants due to brain drain have compromised the delivery of respectful, person-centred maternity care in Nigeria. Integrating doula support services has been proposed to complement midwifery care and bridge this gap. This study quantified stakeholders' views on effective approaches for disseminating and implementing these services in Bayelsa State. Objectives: This cross-sectional study aimed to: 1) assess stakeholders' knowledge of doula services, 2) identify their preferred dissemination and implementation strategies, and 3) examine associations between knowledge and demographic/professional characteristics. Methods: A descriptive cross-sectional census survey was conducted among 101 maternal health stakeholders (midwives and nursing directors) from two tertiary hospitals and two health governance bodies in Bayelsa State. Data were collected using a validated, researcher-structured questionnaire. The analyses included descriptive statistics and inferential statistics (Chi-square test and odds ratios). Results: All 101 participants (100%) correctly defined a doula's role. Over 97% agreed on community-based outreach strategies using health talks and tailored messaging. For implementation, there was unanimous (100%) agreement on the need for government policy, standardized training, and clear referral pathways. Midwives were the preferred clinical leaders (92.1%). Overall, 92.1% of stakeholders had good knowledge, which was significantly associated with more years of work experience (OR: 1.13; p=0.045). Conclusion: Stakeholders strongly endorse a scalable implementation model featuring policy integration, midwife-led coordination, culturally adapted community dissemination, and a structured framework for training, referral, and supervision. This model presents a viable strategy to mitigate workforce shortages and institutionalise respectful maternity care in Bayelsa State.
Background: Pre-hospital emergency medical services play a vital role in saving patients' lives, and women's participation in this field is increasing; however, qualitative evidence regarding the lived experiences and occupational challenges of female emergency medical technicians (EMTs) in Iran remains limited. Objectives: This study aimed to qualitatively explore these challenges, identify participant-proposed solutions, and develop a phased policy framework. Methods: This conventional content analysis research involved 32 participants, who were purposively chosen from women in pre-hospital emergency operations across Iran between September and December 2024. Data collection was carried out through face-to-face, semi-structured, and in-depth interviews lasting between 30 and 60 minutes until data saturation was reached. The gathered data were analyzed following the methodology proposed by Graneheim and Lundman. Additionally, MAXQDA software version 2010 was utilized for data organization. Results: Analysis revealed three primary themes characterizing the occupational challenges of female EMTs: (1) Socio-cultural challenges, including fear of public non-acceptance, cultural sensitivities in patient care, lack of family acceptance, and issues with culturally appropriate uniforms; (2) Physical-Ergonomic challenges, primarily difficulties in moving patients and handling heavy equipment; and (3) Organizational-Supportive challenges, where job satisfaction was closely tied to the level of managerial support. Despite these challenges, participants reported positive public reception and strong collegial relationships. Conclusion: Effective reform requires leveraging existing public legitimacy to enable institutional change. A phased strategy encompassing awareness initiatives, workplace adaptation, and inclusive infrastructure investment is essential for achieving a more equitable and effective pre-hospital emergency medical system.
Background: Emotional expressivity and tolerance of ambiguity are psychological factors linked to adjustment in chronic illness. Chronic kidney disease (CKD), characterized by long-term treatment and uncertainty, may significantly impact these variables. Identifying differences between patients and healthy individuals can inform targeted psychological support. Objective: This study compared emotional expressivity and tolerance of ambiguity between adults with CKD and healthy controls. Methods: In this cross-sectional study, 180 CKD patients were purposively recruited from renal care centers in Zanjan (spring-summer 2024). A matched group of 180 healthy individuals was selected via convenience sampling. Participants completed the Emotional Expressivity Questionnaire (EEQ) and the Multiple Stimulus Types Ambiguity Tolerance Scale-II (MSTAT-II). Group comparisons were performed using independent samples t-tests, with Cohen’s d for effect sizes (α=0.05). Results: Emotional expressivity was significantly lower in the CKD group (M=48.5, SD=13.4) than in controls (M=52.4, SD=9.7), with a mean difference of -3.9 (95% CI: -6.4 to -1.4; p=0.002) and a moderate effect size (d=0.33). In contrast, no significant difference was found in tolerance of ambiguity between CKD patients (M=40.9, SD=9.86) and controls (M=39.43, SD=8.72), with a mean difference of 1.47 (95% CI: -0.36 to 3.30; p=0.56) and a small effect size (d=0.16). Conclusion: While ambiguity tolerance was similar between groups, CKD patients exhibited notably reduced emotional expressivity. This underscores the emotional burden of CKD and highlights the need for integrative care models that promote emotional awareness and expression as part of standard clinical management.
Background: Understanding the characteristics of patients and temporal patterns of emergency department visits is crucial for improving service management and optimizing resource allocation. Objectives: This study aimed to characterize the demographic and clinical profiles of patients and determine the reasons and temporal patterns of visits to the emergency department of Al-Hakeem Hospital in Najaf, Iraq, in 2025. Methods: This cross-sectional study was conducted on patients visiting the emergency department during a consecutive three-month period in the spring of 2025. Data on demographics, clinical profiles, visit patterns, diagnoses, and treatment were collected using a structured form. Data were analyzed using SPSS version 23, along with descriptive statistics, Chi-square test, Fisher’s exact test, and Kruskal-Wallis test. Results: The mean patient age was 33.75 years. The majority were uninsured, married, urban-residing males, arriving most frequently at night via private transport. Common presentations included abdominal pain/fever/vomiting (25.5%) and trauma (13.9%), with food poisoning being the predominant diagnosis. Most patients were triaged as semi-urgent (67.1%) and had no comorbidities. Average consultation time and ED length of stay were 25.17 minutes and 3.3 hours, respectively. The majority recovered. Visit time (morning, afternoon, night, midnight) showed significant associations with multiple variables such as residence, marital status, occupation, insurance status, triage level, chief complaints, diagnosis, disease severity, physical activity, and performed tests (P < 0.05). Conclusion: Temporal patterns and individual characteristics have a significant influence on ED visits. These findings can help optimize staffing during peak hours, target training for common conditions, and improve resource planning for uninsured patients.
Background: Spontaneous abortion is a physically and psychologically distressing event, often necessitating psychological support in subsequent pregnancies to mitigate adverse mental health outcomes. Objectives: This study aimed to evaluate the effectiveness of individual cognitive-behavioral therapy (CBT) counseling in reducing stress and improving the quality of life among pregnant women with a history of spontaneous abortion. Methods: A parallel-group randomized controlled trial was conducted with 72 pregnant women at 6–10 weeks of gestation, all of whom had a prior spontaneous abortion and exhibited stress symptoms. Participants were randomly assigned to an intervention group (n=36) receiving 10 individual CBT sessions or a control group (n=36) receiving routine prenatal care. Stress and quality of life were assessed at baseline, post-intervention, and two-month follow-up. Nonparametric statistical analyses were performed, with significance set at p < 0.05. Results: Post-intervention, the CBT group showed a significant reduction in stress levels compared to controls (from 28.3 to 19.9 post-intervention and 19.7 at follow-up; p < 0.001). Significant improvements were also observed in psychological, social, environmental, and general health domains of quality of life (e.g., overall QoL increased from 60.4 to 70.8; p < 0.001). These benefits were largely maintained at the two-month follow-up, though no significant change occurred in the physical domain. Conclusion: Individual CBT counseling is an effective intervention for reducing stress and enhancing quality of life in pregnant women with a history of spontaneous abortion, supporting its integration into prenatal mental health care for this vulnerable group.
Welcome to the fourth issue of Volume 15 of the Preventive Care in Nursing and Midwifery Journal. In this edition, we present a diverse collection of original research spanning clinical care, mental health, women's health, and emergency medicine [1-9], highlighting the interdisciplinary nature of modern healthcare. The issue opens with Amiri et al.'s study on the role of dignity and psychological first aid in enhancing psychiatric health [1]. This article emphasizes the importance of humane, respectful approaches in mental health crises, arguing that incorporating psychological first aid principles can significantly improve patient outcomes and therapeutic alliances. A significant portion focuses on women's health. Azadi et al. demonstrate the effectiveness of cognitive behavioral counseling for pregnant women with a history of spontaneous abortion, showing that targeted interventions can substantially reduce stress and improve quality of life in this vulnerable population [2]. Jimmy Agada and Wankasi Idubamo examine implementation strategies for doula support services in Nigeria, identifying key barriers and facilitators to inform policy decisions in resource-limited settings [4]. Masaebi et al. provide global analysis of maternal mortality trends using GBD 2021 data, revealing significant disparities between developed and developing regions that demand policy attention [8]. Mental health is further explored by Khanbabaei and Sobhi, comparing emotional expressivity in chronic kidney disease patients versus healthy controls [3]. Their findings highlight the often-overlooked emotional challenges faced by individuals managing chronic physical conditions, suggesting the need for integrated care models. In emergency and critical care, Halool et al. analyze emergency department trends in Iraq, providing crucial epidemiological data for optimizing resource allocation and improving emergency care systems [5]. Sookhak et al. identify workplace challenges for female pre-hospital emergency personnel, documenting issues related to safety, discrimination, and work-life balance while proposing vital policy directions [6]. Khezerlou et al. investigate nebulizer placement in mechanically ventilated patients, offering practical, evidence-based guidance for improving medication delivery efficiency [7]. Concluding this issue, Mohamadi and Jalali present a systematic review on AI-based educational programs' impact on nursing students' clinical decision-making, identifying both opportunities and challenges in implementing AI-based educational strategies [9]. Collectively, these articles demonstrate our journal's commitment to publishing rigorous research with direct implications for clinical practice and policy formulation across diverse healthcare settings [1-9]. We hope these studies will spark discussion, inspire further research, and contribute to a more effective healthcare system. We thank all contributors who made this issue possible.
Dignity is a core principle in psychiatric care, profoundly affecting individuals with mental health challenges [1,2]. Psychiatric illness inherently jeopardizes one's sense of self-worth, a threat amplified by stigma and social rejection. This letter briefly highlights common challenges to patient dignity in psychiatric settings. It emphasizes how Psychological First Aid (PFA) can serve as a practical tool to uphold dignity in direct patient encounters [3]. Sadly, neglect and abuse of people with psychiatric conditions are alarmingly common even within care settings [3,4]. During hospitalization, patients' dignity is often stripped away by practices that clearly violate the Patients’ Bill of Rights. Examples include prolonged isolation beyond guidelines, forced labor, and use of physical restraints without objective criteria [4,5]. A critical issue is the use of physical restraint, a measure that severely damages dignity. This action is often based on staff’s subjective judgment rather than objective criteria, allowing staff emotions to influence the duration of restraint. Consequently, patients' basic needs (such as hunger, thirst, or hygiene) are often inadequately addressed during these vulnerable times, further compromising their dignity [5]. Patients consistently identify autonomy, respect, and confidentiality as key pillars of their dignity [3, 4, 6]. Neglecting these principles can lead to fear, hostility, feelings of worthlessness, and overall psychological distress [3]. Psychological First Aid (PFA) offers an efficient and supportive framework designed to quickly reduce immediate psychological distress and strengthen coping skills [7, 8]. It is crucial to understand that PFA, which is not a form of psychotherapy, should be seen as a direct, immediate, point-of-care intervention that actively preserves patient dignity by reducing distress, enhancing autonomy, and ensuring immediate attention to basic needs through a series of measurable and tangible actions. The effectiveness of PFA relies on its simple, person-centered approach, which provides measurable steps to counteract the dignity violations detailed above. For example, its core mission to Champion Safety and Comfort directly fulfills a fundamental ethical need: creating a safe, calm, and predictable environment. This practice immediately respects the patient's dignity and is a direct countermeasure to the fear and humiliation reported in institutional settings. Additionally, the Targeting Practical Needs principle is essential. By identifying and promptly addressing basic needs (such as food or warmth) during vulnerable times, such as when a patient is under restraint or isolation, PFA directly challenges the most concrete dignity violations (such as neglecting hygiene or hunger) often reported during coercive actions. The model further promotes Restoring Autonomy and Control by prioritizing deep, active listening, listening without pressuring the individual to share. This simple act of respecting the patient's right to communicate on their own terms fundamentally supports their sense of control, a vital defense against the helplessness often imposed by coercive care. Ultimately, the principle of Validating Through Non-Judgment helps the individual feel valued, accepted, and truly understood, providing the most direct and effective way to counteract the widespread stigma and social rejection that significantly undermine patient self-worth [7, 8]. To effectively enhance patient dignity, which must be the primary ethical goal, it is vital that front-line health professionals (primarily nurses and psychologists) deeply integrate PFA principles into their daily practice. Basic training is insufficient; practitioners urgently need ongoing professional development and a fundamental shift in mindset toward a genuinely patient-centered approach. This requires targeted strategies, including continuous PFA training and reflective practice, to consistently uphold dignity. Therefore, the key question remains: by prioritizing person-centered interventions like PFA, can the profession move beyond policy debates and actively ensure that the dignity of individuals with psychiatric disorders is protected and championed across all care settings? This letter argues that this goal is indeed achievable. Ethical Considerations N/A Acknowledgments N/A Conflict of Interest The authors declare no conflicts of interest. Funding No funding was received for this research. Authors' Contributions All authors contributed to the conception and design of the study and conducted the literature search. Amiri E and Azimzadeh R: drafted the manuscript. All authors critically revised it for important intellectual content, approved the final version, and agreed to be accountable for all aspects of the work. Artificial Intelligence Utilization ChatGPT (OpenAI) was used only for minor grammar, clarity editing, and limited translation support. The authors confirm full responsibility for the final version. Data Availability Statement N/A
Background: In addition to physical changes, pregnancy is associated with many psychological and social changes, which can have adverse effects on the consequences of pregnancy and even the future of the infant. Objectives: This study aimed to determine the effect of group counseling using a positive psychological approach on pregnant women's psychological capital. Methods: This randomized clinical trial was performed on 56 pregnant mothers visiting Zanjan health centers. Positive psychological interventions were performed twice a week for 8 sessions of 60 minutes. Data collection was performed using McGee's Psychological Capital Questionnaire in three stages: before, after, and six weeks after the intervention. and the data were analyzed using chi-square, independent t-test, Mann-Whitney, Friedman, and variance analysis with repeated measurements. Results: The mean scores of psychological capital and its subscales (self-efficacy, resilience, hope, and optimism) at post-test in the intervention group were significantly higher than the control group (P <0.05). The mean difference in scores six weeks after the intervention was significant in the Psychological Capital variable (P =0.049). However, no significant difference was observed in any of its subscales (P >0.05). Conclusion: Positive group counseling can improve psychological capital in pregnant women. Therefore, it is recommended that such interventions to promote mental health during pregnancy be considered by health policymakers.
We are writing this letter to highlight a critical and often overlooked issue in psychiatric care: the neglect of therapeutic architectural design as a fundamental component of patient recovery and safety. At the same time, attention to the physical environment has a historical background in nursing. For instance, a century ago, Florence Nightingale emphasized that a suitable environment plays a significant role in the prevention of harm and the recovery of patients [1]. This foundational principle remains alarmingly absent in modern psychiatric ward design. We contend that the physical environment of psychiatric wards is a crucial but often neglected component of psychiatric care, largely overlooked by policymakers, and this neglect results in insufficient attention and resources devoted to creating therapeutic and safe ward environments [2]. This practical approach is strongly supported by a recent qualitative meta-analysis by Schlee et al. (2022), which systematically reviewed the effects of therapeutic landscapes in psychiatric care. The study confirms that the physical (built and natural), social, and symbolic dimensions of the environment are fundamental to the health and recovery of service users and contribute to healthy workplaces for staff [3]. Moreover, recent research in psychiatric care shows that prevention is a key aspect of environmental design. Careful environmental design can help reduce risky behaviors, lower anxiety, and give patients more control. This preventive approach operates through several key mechanisms: For instance, reducing environmental stressors (such as lowering noise and providing calming visuals) directly lowers physiological arousal and anxiety, mitigating the risk of aggressive behavior. Furthermore, design elements that increase patients' perceived control (such as allowing them to personalize their space) can alleviate feelings of helplessness and institutionalization, thereby preventing critical incidents and reducing agitation. Finally, the proactive removal of environmental hazards (e.g., eliminating ligature points and breakable glass) constitutes a primary prevention strategy against self-harm and suicide attempts [4]. Successful global examples of therapeutic environmental design in psychiatric hospitals, such as the Eskenazi Hospital in the United States and Sydney Hospital, demonstrate how integrating healing gardens, natural elements, and social interaction spaces can significantly enhance patient recovery. These hospitals prioritize connection with nature, sensory stimulation, and flexible social environments, which reduce stress and accelerate healing. Such design approaches highlight the importance of incorporating therapeutic landscapes and environmental control in improving mental health treatments internationally [5]. Conversely, research from the Iranian context provides empirical support for these challenges. Qualitative studies have consistently documented poor ventilation, lack of open spaces, and an overall prison-like atmosphere due to locked doors, which, although reducing escape attempts, evidence indicates they significantly contribute to patients' feelings of confinement and institutionalization [6,7]. Further corroborating this, a study by Yahyavi et al. (2020) analyzing the experiences of residents in a psychiatric hospital highlighted profound patient dissatisfaction directly linked to inadequate facilities and the carceral environment [8]. A growing body of recent evidence continues to document significant environmental shortcomings in psychiatric ward design. These deficiencies, including unpleasant odors, lack of amenities, overcrowding, and inadequate facilities (such as narrow doors and unsuitable bathrooms), directly compromise patient safety, privacy, and dignity, which are fundamental rights [3,9,11]. Additionally, the absence of specialized and forensic psychiatric wards, along with limited community-based care, poses risks to both patients and staff [7]. Many wards also fail to meet safety standards, with hazards like breakable glass and exposed wiring, and lack measures to prevent suicide or other incidents [6]. These environmental issues not only reduce comfort but also increase preventable risks, including heightened anxiety, aggression, and likelihood of self-harm, demonstrating the critical preventive role of proper design (3-4). To address these issues, it is essential to promote architectural design regulations that prioritize patient safety, dignity, and privacy, while also supporting staff working conditions. Establishing specialized wards and expanding community care can further improve safety and quality of care. Improving psychiatric hospital environments requires better ventilation and access to open spaces to enhance air quality. Overcrowding should be reduced by optimizing ward design to ensure patient privacy and safety. Facilities need upgrading to meet safety standards, including removing environmental hazards. Creating a home-like atmosphere with comfortable furniture and recreational activities can aid recovery. Specialized wards and reconsideration of locked door policies will improve safety and dignity. Finally, expanding community-based services and strengthening regulatory oversight are essential for sustainable improvement. In conclusion, the evidence compellingly demonstrates that the physical environment of psychiatric wards plays a vital and undeniable role not merely as a backdrop, but as an active, preventive, and non-pharmacological intervention in mental health care. Ignoring this critical dimension undermines patient safety, dignity, and recovery outcomes. It is therefore imperative that health policymakers and healthcare administrators move beyond mere recognition of this issue and transition to decisive action. This must involve the development, mandatory implementation, and rigorous monitoring of evidence-based architectural standards specifically designed for psychiatric facilities. By proactively integrating therapeutic design principles, we can transform these wards from mere holding spaces into genuine healing environments that uphold fundamental human rights and significantly enhance the quality of care for some of the most vulnerable members of our society. Ethical Considerations N/A Acknowledgments N/A Conflict of Interest The authors declare no conflicts of interest. Funding No funding was received for this research. Authors' Contributions All authors contributed to the conception and design of the study and conducted the literature search. Amiri E and Azimzadeh R: drafted the manuscript. All authors critically revised it for important intellectual content, approved the final version, and agreed to be accountable for all aspects of the work. Artificial Intelligence Utilization ChatGPT (OpenAI) was used only for minor grammar, clarity editing, and limited translation support. The authors confirm full responsibility for the final version. Data Availability Statement N/A
Background: Metabolic syndrome is a cluster of metabolic risk factors associated with a multitude of determinants, including genetics, insulin resistance, adverse lifestyle habits, sleep disturbances, chronic inflammation, fetal and neonatal complications, circadian rhythm disruptions, obesity, and dietary patterns. Objectives: This qualitative study aimed to explore the determinants of food choices among individuals diagnosed with metabolic syndrome. Methods: Data were collected using a qualitative design and semi-structured interviews. Participants were recruited through purposive sampling from community health centers in the cities of Lar, Evaz, and Gerash. The sample consisted of 21 individuals (13 females and 8 males) with a confirmed diagnosis of metabolic syndrome, with a mean age of 40.29 years (SD = 18.41). Results: The analysis identified several key themes influencing food selection: considerations of nutritional value, the influence of taste and food appearance, conflicts regarding family dietary habits, the impact of media, dietary modifications driven by disease diagnosis, and awareness of processed foods. Participants highlighted the significance of nutritional information and expressed concerns about the accuracy of food labels. Conclusions: The findings underscore the complex interplay of factors shaping the dietary decisions of individuals with metabolic syndrome. Key implications for practice include educating this population on how to interpret food labels accurately and promoting healthier food options. Furthermore, ensuring the veracity of food labeling is critical, as it can empower individuals to make informed dietary choices, thereby potentially mitigating the prevalence and burden of metabolic syndrome.
Background: Hand hygiene is the most effective method for preventing infections, and nurses’ adherence to hygiene practices plays a vital role in patient safety. Objectives: This study aimed to assess hand hygiene adherence and its related factors among nurses in hospitals in Babylon City, Iraq, in 2025. Methods: A cross-sectional study was conducted with 150 nurses working in teaching hospitals in Babylon. Convenience sampling was used, and data were collected using a demographic form, a self-report questionnaire based on the WHO’s “My Five Moments for Hand Hygiene,” and a perceived factors questionnaire. Data were analyzed using SPSS v.23 through independent t-test, Mann-Whitney U, Kruskal-Wallis, and logistic regression tests, with significance set at p < 0.05. Results: The mean age of nurses was 27.91 (SD=4.4) years, and most were female (82.7%). Over half had attended infection control (53.3%) and hand hygiene training (59.3%) courses. About 51.3% had a moderate level of knowledge about infection control. Adherence to hand hygiene varied by situation, being highest after exposure to body fluids (90.7%) and after patient contact (86.7%), and lowest before patient contact (66.7%). Conclusion: Hand hygiene adherence was lower in preventive moments, with physical and organizational barriers identified as key challenges. Comprehensive interventions—reducing workload, ensuring access to skin-compatible antiseptics, and providing targeted education—are essential to enhance preventive behavior, improve compliance, and promote patient safety.
Preventive care in nursing and midwifery is more than adherence to technical protocols; it is a multidimensional practice rooted in human behavior, ethical awareness, psychological resilience, and system-level readiness. This issue of the Preventive Care in Nursing and Midwifery Journal highlights these dimensions, offering insights that bridge research and clinical practice. Infection prevention remains a cornerstone of patient safety. Despite widespread knowledge, adherence to hand hygiene before patient contact remains influenced by workload and organizational culture [1]. These findings underscore the need for preventive actions to receive structural support and a systemic approach. Psychological well-being emerges as another critical domain. Studies on infertility-related stigma illustrate how resilience buffers the impact of social and emotional stress [2]. Complementing this, structured positive psychological counseling during pregnancy enhances hope, optimism, and self-efficacy, emphasizing the role of mental health in preventive maternal care [3]. Ethical sustainability in nursing is equally vital. Exploring moral distress in pediatric nurses provides a framework for preventive ethics, guiding institutions to implement strategies before ethical strain evolves into burnout [4]. Health literacy also proves pivotal: maternal knowledge strongly influences breastfeeding self-efficacy and infant nutrition, highlighting education as a long-term preventive investment [5]. Professional preparedness and environment design further extend the preventive lens. Identifying core competencies for intensive care nurses ensures readiness in high-risk settings [6], while psychiatric hospital architecture can actively promote mental health and recovery [7]. Nutritional decision-making in metabolic syndrome illustrates how policy, patient education, and informed choice converge to prevent chronic disease [8]. Finally, rehabilitation nursing models offer structured frameworks to prevent complications, support independence, and maintain continuity of care for patients with chronic conditions or disabilities [9]. Collectively, these studies present prevention as a human-centered, evidence-informed endeavor, one that integrates technical competence, ethical sensitivity, psychological insight, and structural awareness. By reflecting on these insights, nurses and midwives are reminded that preventive care is not only about protocols but about fostering resilience, compassion, and responsibility across the care continuum.
Background: This study is necessary due to the lack of clarity regarding the various characteristics of moral distress. Objective: The objective of this study is to present evidence on the concept of moral distress, its causes, symptoms, characteristics, consequences, and the strategies proposed by pediatric nurses, using a hybrid concept analysis. Methods: This research employed a hybrid concept analysis model based on Schwartz-Barcott and Kim’s approach in three phases of theory, fieldwork, and final analysis to analyze the concept of Moral distress. In the theoretical stage, relevant articles in different databases, a combination of keywords related to “moral distress” and “pediatric nurse” was utilized in both Persian and English for studies published from 2014 to 2024. A total of 15 English and Persian texts were selected and analyzed. In the fieldwork stage, in-depth and semi-structured interviews were conducted with 12 nursing experts using purposive sampling. A final analysis was performed by combining the previous two stages in the final stage. Results: Main categories were extracted in the field of moral distress concept analysis in pediatric nurses, including Antecedent (Poor Teamwork, Communication, and Inadequate Human Resources and Equipment), Features (Moral Dilemma, Psychological Issues), and Consequences (Moral Courage, Burnout, Fear of Encountering Patients). Conclusion: Explaining the concept of moral dilemma leads to a better understanding of this issue and helps nurses to balance the difficulty of ethical decisions with meeting the patient's needs and managing their own emotions to improve the quality of patient care.
