Ensuring the quality of care requires measuring patient and family satisfaction. The purpose of this study was to determine the effect of the transitional care program on patient and family satisfaction during the transition from the intensive care unit to the general ward. Sixty-two candidates for transfer from the intensive care unit to the general ward participated in this non-randomized clinical trial. The convenience sampling method was used to select them. The control group received standard care and was monitored accordingly. In addition to routine care, the intervention group received the tailored multidisciplinary transitional care program included: 1-waiting for transfer, 2-support, gradual reduction of dependency and increase of autonomy, 3- communication and strengthening of the triad of care, and 4-continuation of integrated and need-based care. Patient and family satisfaction questionnaires were completed on the day of discharge. The results were analyzed using descriptive and inferential statistical tests. A significance level of p < 0.05 was applied. The results showed that the proposed transitional care program significantly increased the patient and family satisfaction in most sub-scales except for technical-professional care; however, the results should be interpreted cautiously considering the study’s limited sample size and single-center design. Therefore, nurses may implement this intervention as a suitable and applicable care plan, taking into account the different dimensions of patient and family satisfaction.

Assessing the professional ethics of midwifery educators is crucial for ensuring high-quality education and patient care. However, a comprehensive and validated instrument specific to this context is lacking, despite the unique ethical demands of their dual role in academia and clinical practice. To develop and psychometrically validate a comprehensive, context-specific instrument to assess professional ethics among midwifery educators. A sequential mixed-methods design. A sequential mixed-methods study was conducted across midwifery education settings in three phases. Item generation involved a literature synthesis and consultations with five midwifery faculty members, yielding an initial pool of 67 items. Content validity was assessed by panels of midwifery experts and students (n = 20) using the Content Validity Ratio (CVR), with a critical value of ≥ 0.62 for item retention; this process resulted in the removal of 10 items, leaving 57 items for psychometric testing. Exploratory factor analysis (EFA) was performed with 200 students, leading to the removal of 2 items and the identification of a six-domain structure. Following reliability analysis, an additional 3 items were omitted. The final 52-item instrument demonstrates strong internal consistency (Cronbach’s α = 0.94) and excellent test–retest reliability (ICC = 0.97), and requires 10–15 min to complete. A total of 225 participants were included across the phases (response rate: 100

Nursing competence relies on clinical reasoning (CR), which necessitates both cognitive and metacognitive skills. The effectiveness of CR in nursing practice depends on the enhancement of both cognitive and metacognitive skills. Comprehending and developing students’ learning behavior (LB) is crucial for enhancing these skills, as learning behavior has a direct impact on the way students manage their cognitive processes. Assessing CR competency and identifying educational factors are essential for designing effective training programs. This study aimed to investigate the association between CR competency and learning behavior among undergraduate nursing students. This cross-sectional descriptive study recruited 270 undergraduate nursing students from May 15, 2023, to May 30, 2024. The nurse clinical reasoning scale and the learning behavior questionnaire were used to assess undergraduate nursing students’ self-perceived CR competency and LB. The mean CR competency score (51.49 ± 10.71) indicated moderate competency, positively correlated with total LB score (r = 0.564, p < 0.001), and with subscales of LB (p < 0.001). Seventh-semester female students and strong enthusiasm for nursing exhibited higher CR competency scores. A hierarchical regression analysis revealed that student LBs (strategy, motivation, and satisfaction) were significantly associated with CR competency. These 3 variables account for 31.5

Self-directed learning is a crucial aspect of nursing education. Intelligence, as a factor that can be linked to self-directed learning and enhance students’ capacity for independent learning, is of significant interest. Consequently, this study aims to investigate the relationship between emotional intelligence, spiritual intelligence, and moral intelligence with self-directed learning among nursing students. This cross-sectional study was conducted on 300 nursing students during 2024. The data-gathering instrument consisted of five parts. The first part consisted of questions on demographic information and the rest parts were standard questionnaires included: Self-Directed Learning, emotional, spiritual and moral intelligence. Data were analyzed using the SPSS software. For statistical analysis independent t-test, Pearson correlation, and multiple regression were used. Participants were mostly female (74

BACKGROUND:Multiple sclerosis (MS), often leading to a lower quality of life (QoL) for patients compared to those with other chronic diseases. Self-efficacy and self-management play crucial roles in influencing the QoL of MS patients. OBJECTIVES:This study aimed to investigate the association of self-efficacy and self-management with MS patients' QoL. METHODS:The research entailed a descriptive-analytical study involving 210 MS patients selected through simple random sampling. Data was collected with four questionnaires, demographic information, the MSSMs-R, MSSS, as well as MSQOL-54 scales. The gathered data were analyzed using multiple regression model. RESULTS:The study sample consisted of 150 females (71.4%), with 43.3% having university-level education and 82.58% scoring 1-4 on the EDSS scale. The results indicate that Self-efficacy (Beta = 0.283 and 0.389) is the most significant positive predictor of QoL. Along with Health Maintenance Behavior (Beta = 0.278), it accounts for 34.0% of the variance in mental health and, when combined with social/family support, explains 29.7% of the variance in physical health. CONCLUSIONS:The study found a strong association between self-management and self-efficacy and the QoL in patients with MS. Strengthening self-management and self-efficacy skills is recommended to improve the QoL. Furthermore, further research into other factors affecting QoL is suggested.

The postpartum period is a critical phase that can impact maternal mental health and functional adaptation. This study evaluated the effect of midwife-led psychosocial counseling with family support on postpartum depression and maternal functioning among primiparous women. This randomized controlled trial enrolled 56 primiparous women aged 15–45 years who were recruited from healthcare centers in Tehran, Iran. Participants were selected through convenience sampling and randomly assigned to intervention and control groups using a four- block randomization protocol. The intervention group received three individualized 120-minute sessions of midwife-led psychosocial counseling, with a family member support person present; these sessions were administered at 3-5, 15-30, and 42 days postpartum. The control group received routine postpartum care. The Edinburgh Postnatal Depression Scale and the Barkin Index of Maternal Functioning were administered before, immediately after, and one month post-intervention. Repeated measures analysis revealed that depression scores declined over time in both groups; however, between-group differences were not statistically significant (P = 0.07, CI [-1.45-2.94]. Furthermore, repeated measures analysis indicated that maternal functioning improved significantly in the intervention group compared to the control group (p = 0.02, CI [0.58-7.03], η² = 0.075). Midwife-led psychosocial counseling with family participation significantly enhances maternal functioning in the early postpartum period. However, no statistically significant between-group effect was observed for postpartum depression, indicating that improvements in depressive symptoms may require longer follow-up or more intensive approaches. The study was registered in the Iranian Clinical Trials Registry with NO (IRCT20231209060304N1) on 2024/2/20.

Objective: This study aimed to evaluate the effectiveness of face-to-face and mobile-based educational interventions, grounded in the Health Belief Model (HBM), in promoting Pap smear acceptance. Methods: A three-arm randomized controlled trial was conducted among 135 women attending urban health centers under the supervision of the Zanjan Health Center in Alborz, Iran. Participants were randomly assigned to one of three groups: face-to-face education, mobile-based education via Telegram, and a control group receiving no immediate intervention. Statistical analyses included repeated measures ANOVA (RMANOVA) and analysis of covariance (ANCOVA) to adjust for confounding factors. The data collection period spanned from November 1, 2023, to September 5, 2024. Results: Both face-to-face and mobile-based interventions significantly improved awareness and HBM constructs compared to the control group. The mobile-based group demonstrated the greatest increase in perceived susceptibility and self-efficacy immediately post-intervention. Behavioral intention and actual Pap smear uptake also showed significant improvement in the intervention groups. However, perceived barriers did not differ significantly between the groups. Conclusions: Theory-based educational interventions—especially mobile-based strategies—effectively promote Pap smear acceptance. Their accessibility supports national screening efforts and aligns with global policies aimed at reducing disparities. Integrating mobile education into public health programs may enhance coverage and improve preventive outcomes.

Public university-affiliated dental clinics, in addition to their educational mission, provide general and specialized services to diverse populations at government-subsidized rates. Considering the importance of patient loyalty—and the factors influencing it, such as price, quality, and satisfaction—is crucial for the sustainable operation of these clinics. This study aimed to analyze the impact of price, quality, and satisfaction on patient loyalty in the dental clinic of a public university of medical sciences. This cross-sectional study was conducted at the dental clinic of Alborz University of Medical Sciences in Karaj, Iran, during 2023–2024. Data were collected from 190 participants using convenience sampling through four questionnaires: demographic information, perceived price and quality, patient satisfaction, and dental patient loyalty. Structural equation modeling (SEM) with PLS software was used for data analysis, and model fit indices (rms Theta, SRMR, and NFI) were employed to assess model quality. Additionally, relationships between variables were examined using SPSS version 22 with independent t-tests, ANOVA, chi-square tests, and Pearson’s correlation coefficient. Price, as well as the combined effects of quality and satisfaction, significantly influenced patient loyalty (P < 0.001). Furthermore, price had a significant effect on both quality and satisfaction (P < 0.001). Analysis of demographic variables showed that dental services provided by faculty members—compared to those provided by students—were associated with higher patient loyalty (P < 0.01). Patient loyalty in public university dental clinics is primarily driven by perceived service quality and satisfaction, with price serving as an important secondary factor. To enhance loyalty, clinic administrators should adopt integrated strategies that improve service quality (particularly through increased faculty supervision), optimize patient satisfaction, and maintain affordable pricing structures. These findings underscore the need for balanced attention to both clinical and non-clinical aspects of service delivery in academic dental settings.

Introduction: Intimate domestic violence causes psychological consequences in pregnancy and maternal competency. We aimed to assess the effect of domestic violence on mental health and maternal competency with the moderating role of mother-infant attachment behavior. Methods: This prospective longitudinal study was conducted on 254 primiparous mothers in the third trimester of pregnancy referring to selected health centers in Qazvin province, Iran. Data collection tools were questionnaires. Data were analyzed by SPSS and Smart Partial Lease Square3 software. Results: The results of the structural equations model showed that domestic violence has a positive and significant effect on mental health disorders (β = 0.87). Mental health disorder has a negative and significant effect on parental acceptance (β = -0.55). Domestic violence has a negative and significant effect on mother-infant attachment behavior (β = -0.83), also mother-infant attachment behavior is a moderator of the relationship between pregnancy violence and maternal competency (T-value = 3.17). Conclusion: The results revealed that domestic violence during pregnancy affects the mental health of pregnant mothers and maternal competency and mother-infant attachment behavior moderates this relationship. Therefore, it is recommended that mothers facing domestic violence be identified and receive psychological support and counseling, and also improve maternal competence and mother-infant attachment behavior in mothers exposed to violence.

Introduction Pregnancy, childbirth, and the postpartum period cause significant physical and psychological changes in mothers, leading to changes in their sexual self-concept and adverse effects on their sexual self-confidence and self-efficacy. Therefore, this study aimed to determine the effect of sexual education on postpartum women’s sexual self-efficacy and self-confidence. Method This randomized interventional study was conducted on 115 women who had given birth at least six weeks ago and attended healthcare centers. Using convenience sampling, the researchers randomly allocated the participants into two intervention and control groups through a block size of six. The intervention group received six 90-minute online training sessions based on the sexual self-concept model over one month, while the control group received routine care. To collect data, the self-efficacy and sexual confidence questionnaires by Buzwell and Rosenthal were used before the intervention, immediately after the intervention, and one month later. Results The study findings demonstrated no significant differences in demographic characteristics, sexual self-confidence, and sexual self-efficacy scores between the two groups before the intervention. However, the repeated measures ANOVA results revealed a substantial increase in sexual self-confidence and self-efficacy scores over time in the intervention group immediately after participating in the training sessions and one month later. Conclusion Considering the effect of training based on the sexual self-concept model on postpartum women, the researchers recommend using this model to improve their sexual self-efficacy and self-confidence after childbirth. Clinical trial registration This study is registered at the Iranian Registry Clinical Trial (IRCT20220530055025N1).

Parental competence is one of the essential components of raising ethical and healthy children. The mother's satisfaction with her maternal role significantly influences her cognitive responses and parenting behaviors. Having appropriate instruments to measure maternal satisfaction and identify and solve potential problems after childbirth can substantially contribute to maintaining and improving mother and infant health. This study aimed to evaluate the psychometric properties of the Parenting Sense of Competence (PSOC) Scale in mothers referring to the healthcare centers affiliated with Qazvin University of Medical Sciences. This cross-sectional psychometric study collected data from 254 mothers with 1.5-month-old infants referred to the healthcare centers in Qazvin Province. Data were analyzed using the item response theory (IRT) in SPSS 26 and Stata 17 software. The mean age (±standard deviation) of participants was 30.05 ± 5.7, and the overall Cronbach's alpha for the scale was 0.931. We used the graded response model (GRM) appropriate for Likert-type rating scales to fit the IRT. The discrimination parameter estimates showed that item 5 had a discrimination level <0.65, leading to its exclusion from the final analysis. In addition, the total information index confirmed that the scale was suitable in the trait range of -2.1 to 1.8. Compared with other common models for ordered responses based on general model fit indices, the GRM showed a better fit. The study results recommend applying the IRT models to improve and enhance the quality of questionnaires in various measurement fields.

Backgrounds and Aims: Patients with multiple sclerosis (pwMS) need self -management (SM) skills to manage their symptoms and problems. An essential step to SM improvement is accurate SM assessment using valid and reliable instruments. The aim of this study was to evaluate the psychometric properties of the Persian version of the Multiple Sclerosis Self-Management Scale-Revised (MSSMS-R). Methods: This cross-sectional methodological study was conducted from December 2021 to June 2022. The face, content, and construct validity of MSSMS-R were evaluated. Construct validity was evaluated through confirmatory factor analysis (CFA) and evaluating convergent and discriminant validity using the data obtained from 210 randomly selected MS patients. The reliability of the scale was also evaluated through the test-retest stability and the internal consistency evaluation methods. Results: The face validity was confirmed and the content validity ratio and index values of all items were more than 0.62 and 0.79, respectively. CFA revealed the acceptable construct validity of the scale after omitting items 21 and 22. In convergent and discriminant validity evaluation, the total score of MSSMS-R had significant positive correlation with the total mean scores of the Multiple Sclerosis Self-Efficacy Scale (r = 0.36; p < 0.001) and the physical health composite (r = 0.31; p < 0.001) and the mental health composite (r = 0.39; p < 0.001) dimensions of the 54-item Multiple Sclerosis Quality of Life scale and significant inverse correlation with the total mean score of the Beck Depression Inventory (r = -0.28; p < 0.001). The Cronbach's alpha values of the scale and its subscales were 0.86 and 0.65-0.90 and their test-retest intraclass correlation coefficients were 0.97 and 0.95-0.99, respectively. Conclusion: The Persian MSSMS-R is a valid and reliable scale and can be used in future studies for SM assessment among pwMS.

Background and Aim: Transferring a patient from the intensive care unit to the general ward is an anxiety-inducing process that is associated with feelings of insecurity, discomfort, dependency, and increased need. The most important goal of any care program is to satisfy the patient's needs and create a feeling of comfort. The aim of this study was to determine the effect of designed transitional care program on anxiety and general comfort of the patients undergoing coronary artery bypass graft during transfer from open-heart surgery intensive care unit to general ward. Materials and Methods: This study was a non-randomized clinical trial with a control group which included 62 patients who were candidates for transfer from the open-heart surgery intensive care unit of Imam Khomeini Hospital in Tehran to the general ward in 2021. The patients were selected by convenient method. The control group received the routine care and were followed up. The experimental group pursued the designed transitional care program in addition to routine care. This program had 4 dimensions: 1-waiting for transfer, 2-support, gradually reducing dependence and increasing independence, 3-communication and strengthening the care triad, and 4-continuity of integrated and need-based care which was implemented by selected and trained nurses in cooperation with the researcher, physician, patients and families for 5-7 days. Spielberger's anxiety Questionnaires and general comfort scale were completed before the transfer and on the day of the patient's discharge. Using SPSS version 26, the results were analyzed by Fisher's exact, Chi-square, paired and independent t-tests at a significance level of 0.05. Results: The results showed that the designed transitional care program could significantly reduce anxiety and increase the general comfort of the patients undergoing coronary artery bypass graft (p≤0.000). Conclusion: Considering the impact of the intervention on the variables under study, use of the designed program as a suitable care program during patient transfer can be suggested.

Analyzing the Quality of Objective Structured Clinical Examination in Alborz University of Medical Sciences

BACKGROUND:The relative darkening of the lower eyelid skin, which is often linked with dark circles, may make you seem fatigued and older than your real age. Considering the recommendations in the sources of Persian medicine regarding Artemisia absinthium L., the purpose of this clinical trial is investigating the effectiveness of cream prepared from the aqueous extraction of A.absinthium to remove periorbital dark circles. MATERIALS AND METHODS:The eye cream is made with 20% of aqueous extract of A.absinthium in the base of the cream. It was standardized based on Artemisinin via HPLC method. For the clinical trial, 60 patients equally enrolled in two drug and placebo groups. Erythema and Pigmentation were evaluated via a mexameter instrument. RESULTS:The cream is standardized, including 1.29±0.02 µg/mg Artemisinin in the product. Finally, 21 and 24 patients reached the end of study in drug and placebo groups, respectively. In these groups, the difference in the mean (SD) DE, DL, Erythema and Melanin factors before and after the research were significant (p0.05). However, the rate of reduction of DE, Erythema, and Melanin and rise of DL is greater in the treatment group than in the placebo group. Furthermore, the mean value of DE and DL factors before the research were significantly different in two groups (p0.001), but after the research did not show a significant difference. The mean value of Erythema factor in the two groups before (p=0.25) and after (p=0.5) did not show a significant difference. The mean value of Melanin after the research between two groups showed a significant difference (p=0.01). CONCLUSION:The results show that the cream prepared from the herbal composition of Persian medicine improves Infra Orbital Dark circle around the eyes.

AIM:Pregnancy prepares the mother for the transition to motherhood. Maternal concerns during pregnancy cause reduced time spent with the spouse and lack of social support; additional stresses such as marital conflicts could impact maternal competency. This study aimed to assess the predictive effect of marital conflicts with the mediating role of perceived stress and pregnancy concern on maternal competency.METHODS:This was a longitudinal study. It was done on 250 mothers referred to selected health centers in Alborz province. The sampling method was convenient. Marital conflicts, perceived stress, and pregnancy concerns questionnaires were completed in the third trimester of pregnancy, and the maternal competency questionnaire was completed 6 weeks after delivery. Data were analyzed by SPSS software and smart partial least squares.RESULTS:The results of structural equations showed that marital conflicts have a negative and significant effect on maternal competency (β = -0.14), marital conflicts have a positive and significant effect on perceived stress (β = 0.42), and marital conflicts have a positive and significant effect on pregnancy concern (β = 0.31). Also, perceived stress negatively and significantly affected maternal competency (β = -0.36).DISCUSSION:Results of the study showed the necessities for screening and identifying mothers with conflicts and assessing the perceived stress of mothers will improve the mental health of pregnant mothers and consequently increase maternal competency.

Plastics bags waste presets serious danger to human and animal health. A descriptive study was conducted on 250 consumers who were shopping in different stores of Kashan city in Iran in 2020 to investigate the consumers’ intention, attitude, subjective norms and perceived behavioral control towards reducing the consumption of plastic bags and using cloth bags based on the theory of planned behavior (TPB). Stratified sampling was applied to select the consumers to filled out a questionnaire developed based on the TPB in Farsi. A path analysis was used to investigate whether attitude, subjective norms, and perceived behavioral control would have any relation with the intention to reduce the consumption of plastic bags and to use cloth bags and whether the pathway model was acceptable. Results showed that certain demographic characteristics such as age and gender affects the perceived behavioral control. Employed consumers had stronger intention in using cloth bags. The path analysis results showed positive correlations between intention and other components of TPB such as attitude, subjective norms, and perceived behavioral control. There was a medium correlation between different dimensions of TPB. Weak correlation was observed between the attitude and perceived behavioral control and maximum correlation was observed between perceived behavioral control and intention. Employed and housewives consumers had strong intentions in using clothe bags. Attitude was not a strong determinant of intention and perceived behavioral control. Thus educational and awareness-raising programs should be accompanied by other reinforcing/ encouraging programs targeting at changing the intention directly. Employed individuals and housewives are more likely to change their behavior and benefit from such programs.

Human papillomavirus (HPV) infection, which often includes high-risk genotype infection, is one of the leading causes of cervical cancer. This cross-sectional research included 503 Iranian women referred to the gynecology clinic of Kamali Hospital in Karaj, Iran, for routine cervical cancer screening between 2020 and 2021. Cervical specimens were collected from all participants with a special brush and transported to the laboratory for cervical cytology diagnosis. Overall HPV incidence among Iranian women was 39.96%, of which 23.06% had high-risk HPV genotypes and 9.7% had low-risk HPV types. The risk associated with HR-HPV types was considerably associated with employment and marital status.

Background and Aim: Proper knowledge, attitude and practice of pregnant women about vaccination during this period will have a significant impact on their and their baby’s health. The aim of this study was to determine the knowledge, attitude and practice of pregnant women toward flu and Td vaccination. Materials and Methods: This study was a descriptive-analytical and cross-sectional study on 312 pregnant women referred to Imam Ali Hospital in Karaj with an age range of 15 to 40 years. Data were collected using a questionnaire. The method of sampling was convenience sampling. The data was analyzed using SPSS software. Results: The mean age of the women was 27.6±6.54 years. 198 (63.5%) of the subjects were housewives and 114 (36.5%) were employed. 248 (79.5%) and 282 (90.4%) of the subjects had appropriate attitudes and knowledge about vaccination with Td vaccines and Influenza, respectively. Also 293 (93.9%) and 137 (43.9%) of the subjects had practice well against both Td and Influenza vaccines. In women with higher education and better economic conditions, and in working women, the practice of both vaccines has become more suitable. As women get older, knowledge and practice about Td vaccination decreased. Also, the most common source of information for pregnant women about the vaccination program were 73.4% of health care workers, 12.5% ​​of the Internet, 10.3% of radio and television, 3.5% of friends and acquaintances, and 0.3% of family members, respectively. In the relationship between knowledge, attitude and practice towards Influenza and Td vaccination, there was a direct and significant relationship between them so that with increasing or decreasing one, the other also increased or decreased. Most of the relationship between awareness and practice items was related to Influenza vaccine (r=0.304) and the lowest relationship between knowledge with practice items was related to Td vaccine (r=0.146). Conclusion: In this study, it was found that with increasing awareness and attitude, vaccination has increased. Regarding Influenza vaccination, due to the significant relationship between the source of information and vaccination, it is recommended that more serious recommendations to be made by the health care staff to pregnant women regarding Influenza vaccination.