Exploration of Breastfeeding Practices in India: A Systematic Review

Introduction: Breastfeeding is essential and a unique way of providing food to infants for development and healthy growth. Various breastfeeding practices are followed in different regions of India. Objective: This study aims to collect the information for practices related to prelacteal feed, early initiation of breastfeeding, exclusive breastfeeding, and weaning in India. Materials and Methods: A systematic search was conducted in PubMed, MEDLINE, Embase, Google Scholar, Clinical key, the Cochrane Library, and Science Direct databases to identify studies on practices related to the initiation of early breastfeeding, prelacteal feed, Exclusive Breastfeeding (EBF) practices, and weaning as outcomes. Quality assessment of each study was done by the Newcastle-Ottawa scale. Results: Twenty-four studies were included in this systematic review. Seven studies reported an early initiation of breastfeeding within 1-6 hours of birth. Six studies reported various prelacteal foods given to infants, such as tea, boiled water, honey, sugar, jaggery, or glucose with plain water and diluted animal milk. Four studies stated that exclusive breastfeeding was a suboptimal practice, often continued for less than six months for reasons like working mothers (not enough time for breastfeeding), traditional beliefs, and inadequate milk output. Four studies explored the causes of early onset of weaning, and the most common reasons were initiation of supplementary feeding before six months, insufficient breastmilk, and lack of knowledge. Conclusion: Overall, the results of the individual studies indicate that unhealthy breastfeeding practices such as prelacteal feeding, suboptimal exclusive breastfeeding, and early initiation of weaning practices were prevalent and almost the same across India.

Effect of Shared Decision-making on Decisional Conflict and Uptake of First-trimester Screening Tests

Introduction: Several factors influence women’s decision to take First Trimester Screening (FTS) tests. These factors are associated with the ambivalence of women toward undergoing screening tests. Objective: This study aimed to investigate the effect of Shared Decision-Making (SDM) about undergoing FTS on Decisional Conflict (DC) immediately after consultation and uptake of FTS. Materials and Methods: This quasi-experimental study was conducted on 200 pregnant women (100 women in the intervention and 100 in the control groups) referred to health centers for prenatal care in 2019. They were selected by the block randomization sampling method. The control group received the routine care and the intervention group, in addition to routine care, attended a 90-min long consultation session based on SDM. The women were contacted via phone at 14 weeks of pregnancy to collect data on their undertaking prenatal screening tests. The demographic characteristics form and O’Conner’s decisional conflict scale were filled out immediately after the consultation session for the intervention group. The obtained data were analyzed by the Chi-square, Fisher exact-test, Mann-Whitney U, and linear regression tests. The P value less than 0.05 was considered statistically significant. Results: There was no significant difference between the two groups regarding women’s demographic characteristics, except for education level, job, and insurance coverage. The Mean±SD DC score was significantly lower in the intervention group (7.35±8.55) compared to the control group (27.32±13.81) (95%CI; 16.80-24.19, P=0.001). In addition, there was a significant difference between the two groups in terms of undergoing the offered FTS (P=0.04). The DC scores ≥25 were associated with a decreased chance of undergoing FTS (P=0.02). Women were less likely to undergo FTS when they were self-employed (OR=0.15, 95%CI; 0.03-0.71, P=0.01). Conclusion: The SDM consultation can help women experience significantly lower levels of DC. Furthermore, factors such as self-employment can prevent women from undergoing FTS despite lower levels of DC.

New-onset Constipation After Stroke: Caspian Nursing Process Projects

Introduction: The impacts of new-onset constipation outcomes in stroke clients have remained unclear. It seems helpful to update the structure planning with nursing-led intervention. Objective: The current study aimed to present a protocol and methods of Caspian Nursing Process Projects in new-onset constipation by nursing-led intervention considering the experts’ point of view. Materials and Methods: The current multi-stage evolutionary study describes the protocol and methods of Caspian Nursing Process Projects, which were conducted on stroke constipation, such as new-onset constipation. The study was conducted in several phases, including searching for scientific sources, formal-content validity, RAND and Delphi methods, and changes made at the Delphi stage and the experts’ panel. We selected 21 studies published between January 2004 and December 2019 in the Cochran database, Medline, Science Direct, PubMed, Elsevier, and Scopus. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and AGREE II (The Appraisal of Guidelines for Research & Evaluation) were used to evaluate the articles and guidelines. Results: After considering the inclusion and exclusion criteria, 14 articles and guidelines were entered. Most of the authorities were 16 men (72.7%), 11 cases had MD degrees (50%), and 4 (18.2%) were neurologists. Regarding the priority, the highest agreement was found on patient and companion education (98%) and the lowest on disability in daily activity (75.6%). In terms of benefits, patient education again achieved the highest agreement with 97.2%, and use of the Bartel index with 73.6% obtained the lowest agreement. Regarding the applicability, registration, and reporting, the water and electrolyte impairment and educational booklet obtained the highest agreement with 93.6%. Conclusion: All recommendations had reached over 70% agreement in all four areas of the initial draft, and some care should be taken only by stroke nurses or critical care nursing. The study results can be used for developing national guidelines or criteria.

Job Burnout and Its Related Factors Among Surgical Technologists

Introduction: Job burnout is a long-term response to job-related emotional and interpersonal stressors. These stressors are associated with individual, interpersonal, and organizational factors. Objective: This study aimed to determine the degree of burnout and its related factors among surgical technologists. Materials and Methods: This analytical cross-sectional study was conducted in hospitals affiliated with the Iran University of Medical Sciences. A total of 125 surgical technologists were recruited by stratified sampling method. The study data were collected using a demographic questionnaire and Maslach Burnout Inventory (MBI) and then analyzed by the independent t-test, 1-way analysis of variance, and multiple linear regression with a simultaneous model. Results: More than half of the participants (52%) were in the age group of fewer than 30 years. The Mean±SD scores of job burnout in terms of intensity and frequency were 47. 88±17.5 and 47. 95±17.42, respectively. The mean job burnout scores of the majority of surgical technologists in dimensions of emotional exhaustion (intensity), depersonalization (intensity and frequency), and reduced personal accomplishment (intensity and frequency) were at a low level, but it was at a moderate level in the dimension of emotional exhaustion (frequency) among more than half of them. Through a multiple regression, the identified predictors of job burnout (frequency) were education level (β=9.377, 95%CI; 1.618-17.136, P<0.05) and work experience (β=-21.091, 95%CI; -38.201- -3.980, P<0.05). Meanwhile, education level (β=8.320, 95%CI; 0.568- 16.073, P<0.05), work experience (β=-30.976, 95%CI; -54.715 - -7.236, P<0.05), and hours of night shifts per month (β=-10.660, 95%CI; -18.205- -3.115, P=0.01) predicted job burnout (intensity). Conclusion: The job burnout of more than half of surgical technologists in the dimension of emotional exhaustion (frequency) was at a moderate level. Novice workers and operating room BScs suffered more from job burnout than those with an Associate degree and experienced workers. In this regard, healthcare and planner providers must pay attention to operating room BScs, especially novice workers.

Effect of Reminiscence Training on Professional Communication Skills in Pediatric Nursing Staff

Introduction: The main way to improve the quality of care, especially for children, is to improve nursing communication skills. Objective: The purpose of this study was to determine the effect of reminiscence training on professional relationship communication skills in pediatric nursing staff. Materials and Methods: This study was a quasi-experimental design that consisted of all babies and infants’ nursing staff working in an educational hospital of Bushehr City, Iran, in 2019. A total of 84 nurses (41 cases were obtained for the experimental group and 43 cases for the control group) took part in the study. The samples were randomly assigned to the experimental and control groups. In this study, the questionnaires of nurses’ professional communication skills and nurses’ communication skills with hospitalized infant mothers were used. The validity and reliability of the questionnaires were confirmed. First, the pre-test was taken from the experimental and control groups. The experimental group received 8 hours reminiscence training session. Post-test was taken from both groups immediately and one month after the intervention. To analyze data, descriptive indices, the Chi-square test, independent t-test, and repeated measures ANOVA were used. Results: Comparison of demographic data in two groups showed no significant difference between them in terms of scores of both instruments before the intervention. The independent t-test showed that the mean scores of communication with mothers and communication with colleagues one month after the intervention were significantly different (P=0.001) between the experimental and control groups. The results of repeated measures ANOVA showed that the interaction effect between group and time was statistically significant, and the trend of mean scores changes in nursing staff professional relationships with colleagues (P=0.03) and mothers (P=0.001) during the study period (before, immediately after, one month after intervention) were different between the experimental and control groups. Conclusion: Training based on reminiscence effectively improves nurses’ professional communication. So we suggest that this training be included in nurses’ educational programs.

The Role of Type D Personality in Acute Coronary Syndrome

Introduction: Acute Coronary Syndrome (ACS) is one of the most common causes of death in patients with Cardiovascular Diseases (CVD). In addition to the known physical factors influencing the incidence of CVD, some psychologists have pointed to the role of psychological factors such as personality type. Objective: This study aimed to determine the role of type D personality in ACS patients in Iran in 2019. Materials and Methods: In a case-control study, 112 participants were included. A total of 56 patients with ACS were compared with 56 matched people without ACS. They were selected by the convenience sampling method. Type D scale 14 (DS14) was used to assess the type D personality. The Chi-squared test, independent t-test, and multivariate logistic regression were used to analyze the obtained data. Results: The Mean±SD age in the case group was 57.23±8.562 years, and in the Mean±SD age in the control group was 57.25±8.529 years. Also, most participants in both groups were men (71.4%). The result showed that type D personality was more prevalent in patients with ACS (26% vs 7.1%; P=0.006). Based on multivariate regression analysis and after controlling for demographic and clinical risk factors, type D personality was independently associated with ACS (OR=5.323, 95% CI; 0.987-28/712, P=0.052). Also, after investigating subscales, only social inhibition had a significant association with ACS (P=0.008). Conclusion: Type D personality is an independent risk factor of the ACS. Thus, type D personality may make people vulnerable to the ACS. Therefore, besides medical interventions, clinicians must consider behavioral interventions to reduce the incidence of ACS.

Professional Ethics Relationship with Patient’s Rights Charter Observance among Nurses and Midwives

Introduction: Respect for patients’ rights and observance of professional ethics standards improves medical services that will have an essential role in promoting patients’ health. Objective: This study aimed to determine the relationship between awareness of patient’s rights charter and professional ethics with patient’s rights charter observance. Materials and Methods: This analytical correlational study was performed on 285 staff members (196 nurses and 85 midwives) working in 2 hospitals affiliated to Alborz University of Medical Sciences, Iran, and 2 social security hospitals. They were selected using a stratified random sampling method. The study data were collected using the sociodemographic characteristics questionnaire, awareness and observance of the patient’s rights, and professional ethics charter questionnaires. Descriptive statistics and inferential statistics, including the independent t-test, Pearson correlation, Chi-square tests, and multivariate linear regression, were used for data analysis. Results: The Mean±SD ages of nurses and midwives were 36.2±8.3 and 37.5±7.9 years, respectively. The results also showed an association of professional ethics and awareness of patient’s rights charter with patient’s rights charter observance in both nurses (P=0.0001) and midwives (P=0.0001). Based on multivariate linear regression analysis, there were relationships between gender (B=-0.3; 95%CI; -2.0, 2.0; P=0.000), work experience (B=-0.6; 95%CI; -4.0, 3.0; P=0.000), marital and employment status (B=-3.2; 95%CI; -6.0, -0.0; P=0.045), in nurses and between job position (B=9.5; 95%CI; 5.4, 13.5; P=0.000), interest to work (B=-7.9; 95%CI; -11.5, -4.3; P=0.000), and income status (B=6.3; 95%CI; 3.3, 9.2; P=0.000), in midwives with Observance of the Charter of Patient Rights. Conclusion: It is possible to improve compliance with the charter of patient’s rights and its dimensions by strengthening the knowledge of nurses and midwives in this area and their professional ethics, which results in patient satisfaction in this area.

Complementary and Integrative Medicines Used by Cancer Patients to Cope With Chemotherapy-Related Taste Alterations

Introduction: Cancer is a global health problem. Taste change is one of the most common symptoms in cancer patients undergoing chemotherapy. Cancer patients often use Complementary and Integrative Medicine (CIM) to manage chemotherapy complications. Objective: This study aimed to evaluate CIM used by cancer patients to cope with chemotherapy-related taste alterations. Materials and Methods: This cross-sectional study was carried out on 318 cancer patients receiving chemotherapy in an oncology hospital in Malatya City, Turkey. The samples were recruited by convenience sampling method. The study data were collected with a data form developed by the research team. Written permissions were obtained from all participants and the Ethics Committee. Frequencies, mean scores, and standard deviation were used to present descriptive findings. The independent t-test, Chi-square test, and multivariate logistic regression analysis were used to analyze the obtained data. Results: The Mean±SD age of the patients was 65.18±8.36 years, and the mean duration of their diseases was 35.34±16.27 months. About 54.1% of the patients were female, and 42.8% had some information about CIM. Their primary source of information was other patients (49.6%), and 34.9% used CIM to cope with chemotherapy-related taste alterations. The most common method used was phytotherapy (50.5%), and the most commonly used herb was miracle fruit (21.4%). It was also determined that the frequency of CIM use was affected by age, illness duration, gender, living in a city, family history of cancer, having breast cancer, having information on CIM, having metastasis, and lacking complications (R2= 0.426, P=0.025). Conclusion: Cancer patients frequently use CIM to cope with chemotherapy-related taste alterations, and phytotherapy was the most commonly-used CIM.

Explaining Courage in Ethical Decision-making by Nursing Managers: A Qualitative Content Analysis

Introduction: Ethical decision-making by nursing managers is influenced by various essential factors, such as courage, without which it is impossible to act on them. Objective: This study aimed to explore the experiences of nursing managers about courage in ethical decision-making. Materials and Methods: The current study was conducted in Iran by a qualitative content analysis approach in 2018. Nineteen nurse managers were selected purposefully from hospitals in Tehran and Shahrekord cities. Data were collected using semi-structured, in-depth, face-to-face interviews, and after transcription, they were analyzed according to the Graneheim and Lundman method. Results: Based on data analysis, we extracted 2 categories (obligation, decisiveness) and 8 subcategories (clearness in expressing decisions, the ability of the manager to make decisions in critical and complex situations, authority/decision-making as a religious responsibility, follow the decision process, being responsible, making compensatory decisions, making preventive decisions). Conclusion: The findings showed that managers who are committed to ethical decision-making have enough assertiveness to make the decisions. Educating, empowering, and sensitizing managers and enhancing their insight into ethical issues through problem-solving and role-playing techniques can play an essential role in promoting their commitment and responsibility.

The Effects of Improving Emotional Intelligence on Death Anxiety in Older Adults

Introduction: Death anxiety is one of the main elements in mental health in older adults. Objective: This study aimed to determine the effects of improving emotional intelligence on death anxiety in older adults in Kashan City, Iran. Materials and Methods: This quasi-experimental study was carried out on 60 older adults referred to health clinics in Kashan City, Iran, in 2019. The participants were randomly allocated to the control and experimental groups. Before the intervention, a demographics data questionnaire and death anxiety scale was filled out by the two groups. The experimental group received emotional intelligence education in eight sessions (twice a week). The control group received no intervention. The study measures included a demographic checklist and the Templer Death Anxiety Scale (TDAS). Immediately and one month after the intervention, both groups filled out the death anxiety scale again. The collected data were analyzed using descriptive and analytical tests such as t test, the Chi-square, and repeated-measures Analysis of Variance (ANOVA). Results: The results showed that 22 participants (73.3%) and 17 (56.7%) were in the 61-65 age range in the experimental and control groups, respectively. Based on the Chi-square test, there was no significant difference between the two groups regarding demographical data, including age, gender, marital status, education, and job. The results of repeated-measures ANOVA in the experimental group showed that the mean scores of death anxiety decreased over the 3 time points (P<0.05). Also, the post hoc test showed a significant difference in death anxiety scores at different time points in the experimental group (P<0.05). The t test results showed no statistically significant difference in the mean score of death anxiety before the intervention between the two groups, but at the end of the sessions (P=0.006) and one month after the intervention (P=0.001), this difference was significant. Conclusion: The results indicated that improving emotional intelligence in older adults decreased their death anxiety. It is recommended that nurses use this method to decrease death anxiety in older adults.