Advances in Nursing & Midwifery

Abstract
Introduction: Multiple sclerosis is one of the most prevalent debilitating neurological diseases among
young people. Multiple sclerosis is a multifactorial disease in which both environmental and genetic
factors are involved. Despite numerous studies conducted in this field, it remains a challenging topic.
Therefore the present study aimed to explore the environmental factors associated with multiple
sclerosis.
Methods: This case-control study was conducted in 2020-21 in three geographical areas of Iran. A
total number of 445 subjects were included in the study, among whom 172 belonged to the case group
and 273 to the control group. The inclusion criteria for patients were the confirmation of the disease
by a neurologist, the age range from 15 to 50 years, full consciousness, not having acute or critical
conditions of MS disease. The inclusion criteria for healthy subjects were not having the MS, not having
any neuro-inflammatory peripheral disease, not having a cancer. The patient participants were
randomly selected from the medical records of the MS Association of each city. The control group was
randomly selected from among the people visiting the medical centers of each city. The collected data
were punched into SPSS 20. Descriptive and inferential statistics including mean, standard deviation,
frequency and chi-square were used to describe the research variables. Mann-Whitney U-test was used
to compare the mean of interval variables in two groups, and chi-square test was used to determine the
relationship between qualitative variables in two groups. A logistic regression analysis was used to
estimate the relationship between risk factors and the disease.
Results: There was a significant difference between the two groups in terms of the duration of
sunbathing , OCP, gender , history of blood transfusion , family history of MS , history of crisis , physical
activity before illness , history of accident , job, ethnicity, predominant type of cooking, consumption
of liquids and tea, salt consumption, Infant nutrition, consumption of vegetables and chicken,
consumption of canned food, dairy products, nuts and beans (p<0.05).Bivariate logistic regression
analysis of factors associated with multiple sclerosis showed that the most influential factors in the
disease were: positive family history, history of accidents and trauma, baby nursing, and a high-salt diet
(p <0.05).
Conclusions: The successful control of this disease depends on the identification of the complex
network of factors. Despite the many researches about the factors related to MS, it seems that this issue
has many complications and detailed and advanced studies should be done in this field. By better
understanding these factors, we can create preventative strategies to reduce the risk of developing MS,
develop more effective treatments, and lessen the burden of the disease on affected individuals and
society

Currently, the nursing care paradigm in confronting Emerging Infectious Diseases (EIDs)—such as COVID-19, pandemic influenza, and other novel viruses—has shifted from purely experiential practice to precise science and clinical evidence. Under these circumstances, the nurse serves not merely as a caregiver but as the frontline in identifying, controlling, and managing such crises. Nursing interventions must be executed based on the latest guidelines from the World Health Organization (WHO) and national protocols [1], following a distinct hierarchy of priorities.

The primary objective entails infection control and the severance of transmission chains; consequently, bio-safety takes precedence over all therapeutic interventions. Scientific evidence demonstrates that failure in infection control precipitates the collapse of healthcare systems. To this end, the rigorous implementation of standard isolation measures, tailored to transmission routes (droplet, airborne, contact), is imperative [2]. This includes the selection of appropriate Personal Protective Equipment (PPE)—specifically respiratory protection for airborne infections and fluid-resistant gowns for patients presenting with diarrhea caused by emerging viruses. Furthermore, modern nursing leadership is critical in navigating these crises [3].

Subsequent measures focus on the management of patient "cohorting." This involves segregating suspected cases from confirmed ones, and symptomatic patients from asymptomatic carriers, to prevent nosocomial infections. Furthermore, education and strict supervision regarding hand hygiene and PPE usage are emphasized, particularly the direct monitoring of "donning" and "doffing" procedures by other healthcare personnel, given that the highest risk of contamination occurs during the exit process.

Secondary Priority: Rigorous clinical surveillance and the early identification of clinical deterioration are paramount. Given that the clinical trajectory of emerging diseases is often unknown, modern nursing emphasizes the utilization of standardized screening tools. Through the application of early warning scores, regular monitoring of vital signs (every 4–8 hours or more frequently as indicated), and continuous screening, nurses can anticipate septic shock or respiratory failure prior to the onset of catastrophic events. Subtle changes in blood pressure or respiration may signal the onset of acute respiratory distress syndrome (ARDS). Therefore, precise monitoring of pulmonary function and targeted oxygen therapy are essential. This involves the use of accurate pulse oximetry and SpO2 monitoring, alongside the implementation of "Awake Proning" strategies for severely ill patients requiring oxygen. Research indicates that the prone position in conscious patients receiving oxygen therapy reduces the necessity for mechanical ventilation [4]. Concurrently, monitoring for thromboembolism and coagulopathies—by assessing limb appearance, skin (petechiae), and Glasgow Coma Scale (GCS)—facilitates the early detection of blood clots, which are highly prevalent in novel viral infections.

Tertiary Priority: Protocol-based pharmacological management and the control of adverse effects are critical. As treatments for emerging diseases are often experimental or combination therapies, the nurse's role in medication safety is vital. This involves the precise administration of antiviral or corticosteroid therapies, ensuring strict adherence to timing, and monitoring for side effects such as hyperglycemia or hepatic and renal dysfunction. Additionally, fluid management and detoxification are pursued to prevent fluid overload, which can lead to pulmonary edema, utilizing fluid balance scales and central monitoring for critically ill patients. In later stages, palliative care and the management of drug complications become the focus; should new treatments induce severe adverse effects, the nurse must be the first to identify symptoms and alert the specialist.

Quaternary Priority: Psychosocial and communicative support (stress and isolation management) is integrated into the care plan. Communicable infectious diseases are invariably accompanied by fear, social stigma, and isolation. Modern nursing regards mental health as equivalent to physical health. Interventions to mitigate isolation stress include facilitating patient-family communication via technology, providing calm and supportive status updates, and ensuring a tranquil environment within the isolation room. Furthermore, the management of psychiatric sequelae—such as sepsis-associated encephalopathy or drug-induced delirium—is implemented using ICU delirium assessment scales. The prevalence of mental health symptoms among healthcare workers and patients during such pandemics is significant, necessitating proactive psychological support [5]. Establishing a regular sleep-wake cycle by minimizing light and noise at night, alongside providing psychological support to families through regular, transparent reports (even telephonically) to alleviate their anxiety—which directly impacts the patient's mental health—is essential.

Quinary Priority: The issue of self-care and nurse resilience (Sustainability of Care) is addressed. It is axiomatic that an exhausted and impaired nurse cannot provide scientific care. Therefore, nurses must attend to self-care by managing energy and work schedules, adhering to ergonomic principles, and ensuring rest between shifts to prevent medical errors induced by fatigue. Monitoring staff health is also a crucial supportive measure; conducting regular screening tests and vaccinating healthcare personnel based on occupational safety principles significantly contributes to the nurse's capacity for self-care.

In summary, evidence-based nursing in emerging infectious diseases represents an integration of "clinical expertise," "current research," and "patient preferences." The prioritization of actions commences with environmental safety, progresses to precise physiological monitoring, and culminates in psychosocial support. Through this approach, the specialist nurse not only saves the patient’s life but also breaks the chain of transmission within the community and preserves the healthcare system from collapse.

Introduction: Hostile attribution, interpreting a partner's ambiguous actions as
malicious, significantly contributes to marital conflict by perpetuating negative
interaction cycles and eroding trust. This investigation aimed to explore the
association between hostile attribution and divorce proneness in women, specifically
examining the mediating influence of self-differentiation.
Methods: This study adopted a cross-sectional correlational design. Data were
gathered from a convenience sample of 350 married women residing in Karaj, Iran,
during 2024. Participants completed a battery of standardized self-report measures,
specifically the Hostile Attribution Scale, the differentiation of Self Inventory, and the
Divorce Propensity Questionnaire. The collected data underwent statistical analysis
using Structural Equation Modeling (SEM) to thoroughly assess the hypothesized
direct and indirect relationships among the variables.
Results: Findings indicated a significant positive correlation between hostile
attribution and divorce proneness (r=0.40, P<0.001). Additionally, hostile attribution
was negatively correlated with self-differentiation (r=-0.30, P<0.001). Furthermore,
self-differentiation was negatively correlated with divorce proneness (r=-0.50,
P<0.001). Crucially, self-differentiation emerged as a statistically significant mediator
in the relationship between hostile attribution and divorce proneness. The structural
model demonstrated good fit (χ²/df=1.78, CFI=0.94, RMSEA=0.045).
Conclusions: These results suggest that hostile attribution contributes to a
diminished capacity for self-differentiation, which, in turn, increases a woman's
predisposition to divorce. Understanding this psychological pathway is vital for
developing targeted interventions aimed at fostering healthier relational cognitions
and enhancing marital resilience.

Abstract
Introduction: Given the widespread use of e-learning during the COVID-19 pandemic and the post-pandemic period—particularly in the critical field of medical sciences—examining students' perspectives on factors influencing e-learning quality is essential. The present study was conducted to investigate medical sciences students' perspectives on the factors affecting e-learning quality.
Methods: In this descriptive cross-sectional study, 854 medical sciences students at Alborz University of Medical Sciences, Karaj, Iran, were selected using convenience sampling between January and May 2022. The data collection instrument was a researcher-developed questionnaire comprising two sections: demographic information and factors influencing e-learning quality. After data collection, the data were analyzed using SPSS version 20, employing descriptive and inferential statistics at the P ≤ 0.05 significance level.
Results: The mean score for instructor-related factors was 141.64 ± 19.41 (range: 35–175); for factors related to the educational content delivered, it was 55.32 ± 7.84 (range: 13–65); and for factors related to facilities, equipment, and infrastructure, it was 26.52 ± 3.63 (range: 6–30). Based on the results of the Friedman test, the highest-ranked domain was "factors related to facilities, equipment, and infrastructure". Among all dimensions, the items with the highest mean scores were as follows: teaching skills, mastery of the subject matter, ability to integrate theoretical and clinical content during instruction to facilitate better understanding, clear presentation of key and practical points in the instructional content, alignment between the amount of educational content and the learning objectives, scientific accuracy of the content, and inclusion of up-to-date material, the functioning microphone and uninterrupted audio, adequate internet speed, and availability of online class recording.
Conclusions: The development of adequate technical infrastructure, targeted investment, and the establishment of clear standards for evaluating learners' performance are essential for the effective utilization of e-learning. It is recommended that educational authorities and policymakers focus their efforts on enhancing the infrastructure of educational platforms and improving internet speed and quality. Additionally, organizing training workshops for faculty members on the principles of designing and conducting online classes, as well as producing standard electronic content, can contribute to improving instructors’ teaching competencies and better addressing students’ learning needs.

Abstract
Introduction: Marital satisfaction and justice are crucial components of a healthy marriage, yet little is known about the psychological factors that may influence this relationship. Understanding the role of anxiety in the relationship between marital satisfaction and justice can provide valuable insights into the dynamics of marital relationships and inform interventions to improve marital well-being. This research aims to investigate the direct and indirect effects of marital justice on marital satisfaction, with anxiety as a potential mediator, among married students.
Methods: This descriptive study employed structural equation modeling (SEM). A sample of 356 married students from Azad University, Ahvaz, Iran, was selected in 2023 using stratified random sampling. Research instruments included the Marital Satisfaction Scale, Marital Justice Scale, and State-Trait Anxiety Inventory. Data were analyzed using SEM with SPSS-26 and Amos-26 statistical software.
Results: The results indicated that marital justice had a significant negative correlation with anxiety (β=-0.21, P=0.002). Additionally, both marital justice (β=0.25) and anxiety (β=-0.19) were significantly correlated with marital satisfaction (P<0.01). The results also indicated an indirect relationship between marital justice and marital satisfaction through the mediation of anxiety (P=0.011).
Conclusions: The study found a strong negative correlation between marital justice and anxiety, indicating that increased marital fairness leads to decreased anxiety. Additionally, the research confirmed that marital justice positively impacts marital satisfaction both directly and indirectly by reducing anxiety levels.

Introduction: The elderly population’s doubling, the prevalence of chronic diseases, and the increase in the number of deaths constitute the current and the future image of global health. The increase in the demand for Home Health Care (HHC) has attracted the attention of not only governments, but also economic enterprises for the development of HHC centers. This study aims to investigate and collect HHC quality evaluation indicators in the existing studies through conducting a scoping review study.
Methods: This study is a scoping review that investigates the extent of the research conducted in the field of HHC quality indicators and written based on the PRISMA-ScR Checklist. The inclusion criteria consisted of the study’s being written either in English or in Farsi, the study’s focusing on the structure and process of HHC monitoring or the results regarding HHC quality monitoring. Therefore, descriptive, multi methods and mix methods studies were included in the study. The search was conducted on studies that were published between January 1, 2000 to March 31, 2022. The data extracted from the included studies were re-examined by all the authors. The quality of extracted review studies was checked with PRISMA checklist, qualitative studies with COREQ and descriptive studies with STROBE checklist.
Results: Out of 4977 extracted publications, 37 were finally included in the present study. Based on the findings of the included studies, HHC quality evaluation indicators were classified into three areas: structure (Appropriate physical space, equipment, and sufficient facilities- Effective document management system- Supply, and development of workforce), process (Patient-Centered Approach-Establishing safety and reliability- Efficient and timely support -Continuous Quality Improvement) and outcome (Functional Indicators-Clinical Indicators-Social indicators).
Conclusions: This scoping review identified a comprehensive set of quality indicators for evaluating Home Healthcare (HHC), categorized into structure, process, and outcome domains. Common indicators include hospital readmission rates, unplanned emergency visits, functional status, symptom management, and patient satisfaction. Tools such as RAI-HC and OASIS are widely used for standardized assessment. The Efficiency Index (EI) helps compare service quality across HHC providers and informs policy decisions. Additionally, local, culturally-sensitive tools -especially for regions with religious considerations- should be developed and psychometrically validated. Ensuring appropriate infrastructure, effective documentation, and skilled workforce is also essential for quality care.