Advances in Nursing & Midwifery

Abstract
Introduction: Diabetes is one of the most common chronic diseases that is also highly
prevalent among adolescents. The present study was conducted to determine the
relationship between demographic characteristics and self-management in adolescents
with type 1 diabetes.
Methods: This descriptive-analytical study was conducted on 426 adolescents with
type 1 diabetes aged 13 to 18, and diagnosed for at least one year. The research tools
included a demographic information form covering the patients’ personal, family,
and health details, and the Self-Management of type 1 Diabetes in Adolescence
(SMOD-A) with five subscales of collaboration with parents, diabetes care activities,
diabetes problem-solving, diabetes communication, and diabetes goals. The content
validity of the measure was then evaluated by a group of experts and found to be
acceptable (SCVI = 98%). In the assessment of the measure›s reliability, the intraclass
correlation showed an overall Cronbach’s alpha of 0.88. The test-retest showed a
consistency of 0.73 for the measure.
Results: The results obtained showed that the presence of another diabetic member
in the family leads to higher levels of self-management in some dimensions, including
problem-solving, communication, and goals, yet to lower levels in some others,
including collaboration with parents and diabetes care activities. A direct relationship
was observed between the duration of time since the diagnosis and the scores obtained
by the adolescents. An inverse relationship was observed between the type of physician
in charge and the scores obtained in the subscales of collaboration with parents,
problem-solving, communication, and goals. The scores obtained were directly related
to having a school health record and having access to diabetic care tools at school.
Family income was found to be directly related to diabetes care activities and inversely
to problem-solving, communication and goals. P of ≤ 0.05 was considered significant
for all relationships.
Conclusions: Self-management was found to be moderate to good among Iranian
adolescents with type 1 diabetes; however, it could be further improved with the
support of both families and medical teams involved.

Abstract
Introduction: Ostomy is a surgical procedure performed to divert feces and urine
output in cases of anorectal anomalies. Although this procedure is a crucial intervention
with excellent treatment effect, it is associated with complications, such peristomal skin
lesions. This study aimed at evaluating the effect of providing ostomy care education to
mothers of infants with peristomal skin complications.
Methods: Forty mothers of neonates with intestinal stomies were informed about the
aim of this study and invited to participate. The sampling was conducted in accordance
with the quota sampling method. The participants were randomly and equally
allocated to the control and experimental groups. The mothers in the experimental
group attended a three-session educational program, whereas the mothers in the
control group received information about routine care methods used by the study
settings. The peristomal skin conditions of the infants in both groups were examined
before discharge and 30 days after discharge using the Telegram Software or in person,
according to an established checklist. Data were analyzed with the SPSS 21 software to
obtain descriptive and analytical statistics.
Results: Prior to discharge, the majority of the neonates in both groups had healthy
peristomal skin. In the control group, five neonates had acute dermatitis and one had
chronic dermatitis. In the experimental group, four neonates had acute dermatitis and
two had chronic dermatitis. The χ-square test showed that the two groups were not
significantly different (p-value = 0.94). After discharge, most of the neonates in the
experimental group had intact peristomal skin and only four neonates had chronic
dermatitis. In contrast, in the control group, only six neonates had intact peristomal
skin. The results of Fisher’s exact test indicated that the two groups of study were
significantly different (p-value = 0.013). In the experimental group, 16 and 14 neonates
had intact peristomal skin before and after discharge, respectively. In the control group,
14 and 6 neonates had intact peristomal skin before and after discharge, respectively.
The results of McNemar’s test revealed no significant differences in the experimental
group before and after discharge (p-value = 0.69), whereas the control group showed
significant difference in this context (p-value = 0.021).
Conclusions: Providing mothers with education on proper ostomy care significantly
decreased the occurrence of peristomal skin lesions in neonates with intestinal ostomies.

Abstract
Introduction: The decline in fertility and childbearing tendency in Iran is due to
various demographic, economic, social, and cultural variables. The present research was
conducted to review studies carried out on factors affecting the decline in childbearing.
Methods: This systematic review searched for articles published from 2011 to 2017
in all the available Iranian and foreign databases, including SID, Magiran, Irandoc,
Medlib, Pubmed, Google Scholar, Science Direct, and Proquest using the following
keywords, “childbearing”, “fertility”, “fertility decline” and “population decline”. The
search ultimately led to the inclusion of 53 studies.
Results: The main factors affecting the decline in childbearing discussed in the 53
reviewed articles were divided to three general categories: 1. Personal and family
factors, including aging, older age at marriage, current number of children, the
duration of marriage, the mean birth spacing, gender preferences, hopefulness, marital
satisfaction, and quality of life, 2. Socioeconomic factors, including social support,
education, occupation and social participation, especially of females, place of residence
and the effect of social networks, 3. Cultural factors, including modernity, urbanization
and industrialization, attitude change towards the value of children, changes in family
values and religion.
Conclusions: To intervene in the decline in childbearing and to increase the success
rate of the designed plans and strategies, policy-makers and planners should provide
strategies to deal with all the three noted groups of factors affecting childbearing.

Abstract
Introduction: The Objective Structured Clinical/Practical Examination (OSCE/OSPE)
is one of the best assessment methods for measuring the students’ realization of their
educational goals in cognitive, emotional, and psychomotor domains. Given that gender
may influence the evaluation of medical sciences examinations, the present study was
conducted to compare the female and male nursing students of Shahid Beheshti University
of Medical Sciences during years 2011 to 2015 in terms of their OSCE/OSPE scores for the
biochemistry laboratory.
Methods: This study had a comparative descriptive design. All of the students participated
in this study from 2011 to 2015 (census). Over these four years, 649 students took
this examination and their scores were recorded. The data collection tools included a
demographic information questionnaire and a researcher-made checklist. Pearson’s
Correlation Coefficient was calculated for determining both the criterion validity and the
internal consistency (r = 0.732). The Pearson correlation coefficient confirmed the testretest
reliability of the test (r = 0.88). The data were analyzed using the SPSS-22 software
with descriptive statistics, the independent t-test, the one- way Analysis of Variance
(ANOVA), and Scheffe’s post-hoc test.
Results: The scores of 361 female students and 288 male students were assessed in this
study. The mean score was 11.6 ± 1.83 in female students and 11.2 ± 1.75 in male students
(out of 14). The difference between the female and male students’ OSCE/OSPE scores in
biochemistry laboratory skills was significant (P = 0.02). Comparing the mean scores of
the female and male students in biochemistry laboratory skills according to OSCE/OSPE
by year of admission showed a significant difference between the genders in the students
admitted to the school during year 2012 (P = 0.01). There were also significant differences
between the age groups of < 20 and 25-29 and the other age groups in terms of the mean
OSCE/OSPE scores (P < 0.05).
Conclusions: There was a significant difference between the two genders in the mean
crude scores obtained and the female students had slightly higher scores. Future studies are
recommended to investigate the students of other disciplines, academic levels, and schools
to improve the generalizability of these findings.

Abstract
Introduction: Mothers’ participation in the Neonatal Intensive Care Unit is important
in promoting neonatal care and good outcomes for neonates and their mothers. The
present study was conducted with the aim of assessing the effect of empowering
mothers of hospitalized neonates on the level of their participation in neonatal care.
Methods: This quasi-experimental single-group study with before-after design
recruited 59 mothers of neonates hospitalized at the NICU, selected according to the
study inclusion criteria. Data were collected using educational needs questionnaire
and the maternal participation checklist. The questionnaire was completed by
mothers and the participation checklist by the researcher before the intervention. The
empowerment program was then implemented over 2 to 4 days.
Results: Comparison of participants› checklist scores before and after the
implementation of the empowerment program in 3 domains of care needs, information
needs, and bonding, and attachment needs, showed significant increases in the level of
mothers› participation. The comparison of checklist participation scores showed that
the Mean (M) and Standard Deviation (SD) of scores before and after performing the
mothers› empowerment were respectively 7.61 ± 3.66 and 12.38 ± 1.31 in the care
area, 1.47 ± 0.99 and 3.13 ± 0.66 in the information area, and 4.77 ± 1.42 and 5.70 ±
0.59 in the area of attachment and dependency.
Conclusions: Implementation of the empowerment program for mothers based on
their educational needs significantly increased mothers› participation in neonatal
care. This empowerment program could be applied for a broad range of population of
mothers at the intensive care units of neonates.

Abstract
Introduction: Medication errors are the most common type of medical errors that can
cause serious problems for public health and are considered a threat to patient safety.
This study was conducted to determine the effectiveness of patient safety training
on nurses’ medication errors at the emergency department of a hospital of Golestan
Province in Iran.
Methods: The present quasi-experimental study was conducted from March to
September 2016. The study population consisted of nurses working at a hospital
affiliated to Golestan University of Medical Sciences and a sample of 40 nurses at
the emergency department of this hospital were selected through a census. The
data collection tools used included a demographic questionnaire and Wakefield’s
Medication Error questionnaire for nurses (consisting of 21 domains), which were
used once their reliability was confirmed. A patient safety training program was
designed and implemented for the selected emergency nurses in the form of a twoday
workshop. The obtained data were analyzed using the SPSS-18 software with the
Wilcoxon test.
Results: Results showed that the rate of medication errors (80.62%) of nurses were
at a low level. The majority of nurses (80.62%) scored low in terms of the frequency
of medication errors; after the training, a significantly greater number of nurses scored
low in terms of this index (90.31%; P < 0.001). The analyses showed the effectiveness
of the patient safety training program for nurses in the two domains of wrong time
error and missed dose error (P < 0.001); however, the training had no significant effects in the other domains.
Conclusions: As patient safety training can be effective on nurses’ medication errors,
retraining courses on safe medication administration are necessary regarding nurses’
significant role in the prevention of medication errors.

Abstract
Introduction: Adaptation to the maternal role is an important factor for health of
mothers and infants. With regards to numerous stresses after childbirth and effect of
social support in modifying stresses, the present study was conducted for detecting the
correlation between adaptation to the maternal role and social support in primiparous
females.
Methods: This cross-sectional study was performed on 260 primiparous females, who
had referred to public health centers of Shahid Beheshti University of Medical Sciences
in Tehran, during year 2016. Data gathering tools included the «Demographic
Questionnaire», «Adaptation to the Maternal Role in Iranian Primiparous Women
Questionnaire», «Multidimensional Scale of Perceived Social Support», and
Edinburgh Postnatal Depression Scale. Data analysis was done using the SPSS software
(version 22) and it was based on descriptive statistics and statistical independent t-test,
Analysis of Variance (ANOVA), Spearman correlation, and linear regression. P value <
0.05 was considered significant.
Results: The score of adaptation to a maternal role had a significant correlation with
a total score of social support and its subscales (P = 0.001). Also, the adaptation to
a maternal role had a reverse significant correlation with the mother and father’s
education and the rate of family income, yet the results of the linear regression
demonstrated that only two variables, “social support” and “mother’s education”, were
significant in predicting the adaptation to a maternal role (P = 0.001), and they could
predict 15% of variance for adapting to a maternal role.
Conclusions: Social support is an effective factor for adaptation to the maternal role in
primiparous females. Therefore, providing an appropriate situation for these supports
is recommended. Also, it is required for health care providers to make sure about an
adaptation to a maternal role, especially in mothers with higher education.

Abstract
Introduction: The aim of this study was to explain how the spiritual leadership model
could be used as a paradigm for nursing leadership. Nursing leaders play a critical role
in the management of the health care system. Spiritual leadership is a new area that has
recently been considered in nursing management.
Methods: In this review article, electronic databases (PubMed, Scopus, Google
Scholar and Science Direct) were searched from September 2014 to July 2016 to find
relevant articles using keywords, such as spirituality, leadership, management, nurses
and motivation. In this regard, the articles that fulfilled the goals of the study that were
written in English or Persian, had their full texts accessible, and were published in the
intended time interval were entered in the study. The articles without authors’ names
and dates and non-scientific papers were excluded from the study. On the whole, a total
of 120 articles were obtained, of which 48 were selected and analyzed.
Results: A review of the literature focusing on spiritual leadership demonstrated that
the spiritual leadership model has been examined in different countries, various fields
of the industry, trade training, and the health system with positive individual and
organizational consequences. It seems that the characteristics of this style of leadership
fits the nursing profession as well. Of course, more large-scale future studies for testing
this model of leadership in the field of nursing will bring about more promising results.
Conclusions: Spiritual leadership could improve the organizational productivity and
employees’ satisfaction. Nursing leaders should have paid greater attention to this type
of leadership to achieve positive organizational outcomes; therefore, they need more
training in this issue..

Abstract
Introduction: Psychological disorders are the leading cause of disabilities, social
harms, and reduced quality of life in patients with Multiple Sclerosis (MS). This
qualitative study was conducted to describe the concerns of females with MS.
Methods: In this qualitative study, 16 females with MS at the reproductive age
with medical records at the MS Society of Tabriz were selected using the purposive
sampling technique and underwent semi-structured in-depth individual interviews.
All interviews were recorded, transcribed, and analyzed using conventional content
analysis.
Results: In this study, 23 codes were identified from transcribed interviews and
categorized to two sub-categories, fears and feelings. These two sub-categories formed
the main category, named concerns.
Conclusions: Regarding concerns of these patients, their regular health monitoring by
physicians and healthcare providers is recommended in an attempt to alleviate these
concerns.