Journal of Research Development in Nursing and Midwifery

Bridging the gap in palliative care education: Applying the ELNEC model to advance palliative care in Iran

Arvin Mirshahi

Palliative care (PC) has become essential for improving quality of life globally, yet Iran faces significant barriers, including limited policies, workforce shortages, and cultural misconceptions. Despite recent progress—such as establishing a national strategy and increasing medication access—service delivery remains limited, especially outside major cities. To address these gaps, the Student Scientific Research Center at Tehran University of Medical Sciences has initiated an international collaboration with the End-of-Life Nursing Education Consortium (ELNEC), in partnership with the American Association of Colleges of Nursing and the Center for Palliative and Supportive Care at the University of Alabama at Birmingham (UAB), to expand interprofessional palliative care education in Iran.

Psychometric evaluation of the Persian version of the Invisible Violence Against Women Questionnaire

Reza Ghanei Gheshlagh

Background: Some men use a nuanced set of attitudes, behaviors, and beliefs referred to as “invisible violence” to exert control over women. Although these behaviors are culturally accepted, they remain risk factors for intimate partner violence. Early detection of invisible violence can prevent domestic violence and its negative consequences. Therefore, this study aimed to evaluate the psychometric properties of the Persian version of the Questionnaire for the Invisible Violence Against Women (Q-IVAW).
Methods: This cross-sectional study was conducted on 520 married women who were referred to health centers in Western Iran (Asadabad) in 2023. Sampling was performed using a convenience sampling method. After forward-backward translation, face, content, and construct validity (through exploratory and confirmatory factor analysis) were conducted. Internal consistency was assessed using Cronbach's alpha and McDonald's omega coefficients and stability was assessed using a test-retest. The data were analyzed using SPSS version 16 and Amos version 26 software.
Results: In the exploratory factor analysis, four factors, including ‘utilitarian-benevolent sexist behaviors’, ‘crisis sexist behaviors’, ‘coercive sexist behaviors’, and ‘ambivalent sexist behaviors’, were extracted using the maximum likelihood method and Promax rotation. Cronbach's alpha for the four factors was 0.803, 0.724, 0.733, and 0.704, respectively. These factors account for 47.17% of the total variance. In confirmatory factor analysis, the final model demonstrated a good fit (CMIN/DF = 2.140, GFI = 0.952, AGFI = 0.932, NFI = 0.924, IFI = 0.958, CFI = 0.958, RMSEA = 0.047).
Conclusion: The Persian version of the Q-IVAW has acceptable psychometric properties and can be used to measure invisible violence in Iranian women.

Relationship between personality traits and self-control in emergency nurses in western Iran

Tayebeh Mahvar

Background: Personality traits significantly influence professional and occupational behaviors, allowing for the prediction of specific actions in various work-related contexts. Additionally, these traits play a crucial role in the development of self-control. This study aimed to evaluate personality traits and their association with self-control among nurses working in the emergency departments (EDs) of hospitals.
Methods: This cross-sectional study was conducted in Kermanshah, Western Iran, in 2022. The study sample comprised 154 nurses working in the EDs, selected using convenience sampling. Data were collected using the NEO Five-Factor Inventory and the Nikmanesh Self-Control Questionnaire. The data were analyzed using SPSS version 25, employing descriptive statistics, independent t-tests, ANOVA for group comparisons, and Pearson’s correlation, with a significance level set at 0.05.
Results: The mean age of the participants was 33.5±6.2 years (range: 23 to 54). The findings showed that there was a significant correlation between the components of personality traits and restraint in nurses (P<0.001). Personality traits can explain restraint in nurses working in EDs. All subscales of restraint were also significantly correlated with negative personality traits, except impulsivity and risk-taking.
Conclusion: The findings of this study suggest that personality traits significantly influence the self-control of nurses. Notably, stronger personality traits in all dimensions, except neuroticism, are inversely related to the self-control scores of nurses. Consequently, measures should be taken to improve the performance and job quality of nurses.

Secondary traumatic stress in emergency department nurses: A multi-methods study protocol

Hamidreza Khankeh

Background: Secondary traumatic stress (STS) is a psychological phenomenon that refers to the negative and traumatic emotional experiences that individuals endure as a result of exposure to the pain and suffering of others, particularly in caring professions such as emergency nursing. STS not only affects the mental health of nurses but can also have a significant impact on the healthcare system. We will conduct this study to explore the phenomenon of STS in depth and compile a policy brief.
Methods: This study employs a multi-methods approach, integrating a grounded theory study, a systematic scoping review, and the Delphi method, culminating in the development of a policy brief. Grounded theory, recommended by Corbin and Strauss (2014), will be used to explore the process of STS among emergency nurses through individual interviews and observations. Participants will be selected using purposive and theoretical sampling until data saturation is achieved. Data collection will focus on emergency nurses' experiences and emotional responses, with analysis proceeding through five stages: open coding, concept development, contextual analysis, process analysis, and category integration. The second phase is a systematic scoping review exploring challenges in managing STS among emergency nurses. This review will synthesize national and international experiences, based on Arksey and O’Malley’s five-step framework and the PRISMA model to systematically collect and integrate findings. The results from the grounded theory, including identified concepts, facilitators, and barriers, will be integrated with the scoping review findings using the classical Delphi method. A panel of expert nurses and scholars will engage in iterative Delphi sessions to refine perspectives on STS in emergency nursing. Finally, a policy brief will be developed, synthesizing key findings and providing evidence-based recommendations for policymakers.
Conclusion: This study protocol offers a comprehensive guide for conducting a multi-methods study, outlining the research process step-by-step to aid researchers using similar methodologies. It addresses common language-related challenges, suggests solutions, and helps deeply explore the phenomenon of STS and compile a policy brief. The protocol emphasizes maintaining high research integrity through specific criteria and provides a detailed discussion of ethical considerations and research methodology. The authors advocate for publishing multi-methods protocols before implementation to improve research integrity, foster ethical and integrated practices, and support novice researchers.

Intensive care unit nurses’ perceived Barriers to Optimal Pain management: A cross-sectional study in Tanzania

Fatemeh Bahramnezhad

Background: Inadequate pain management among critically ill nonverbal patients in ICUs is a significant public health issue that can lead to prolonged mechanical ventilation and poor quality of life. Critical care nurses play a vital role in mediating pain management, and identifying barriers they face is essential for developing effective pain relief policies. This study aimed to assess nurses' perceived barriers to pain management in ICUs.
Methods: The study employed a cross-sectional design, adhering to STROBE reporting guidelines, and was conducted from January to May 2022 across four national referral hospitals in Tanzania, including university-affiliated and public hospitals. It utilized the Eastern Cooperative Oncology Group (ECOG) barrier tool to assess critical care nurses' perceived barriers to pain management in the ICU, with data analyzed using the Kruskal-Wallis test. A total of 202 nurses were recruited through census sampling. Data collection involved demographic questionnaires alongside the ECOG barrier tool to evaluate the challenges faced by nurses in managing pain effectively.
Results: The findings revealed that there were perceived nurse barriers related to medical staff and patients with the overall mean 4.57± 1.25 and 3.90±1.17 respectively. ICU nurses did not perceive barriers related to the healthcare system with an overall mean 2.33±0.78.
Conclusion: Critical care nurses perceive barriers related to medical staff and patients as significant obstacles to effective pain management in ICUs. Intensive training on diagnosis and assessment, along with the use of tools like the Behavioral Pain Scale (BPS) and Critical Care Pain Observation Tool (CPOT), is essential for improving outcomes. Additionally, integrating patients' cultural backgrounds into pain assessments is crucial for effective management.

Prolonged grief disorder and associated factors among Iranian general population

Mahboobeh Khajeh

Background: Prolonged Grief Disorder (PGD) is a recently recognized mental health condition characterized by persistent and intense grief following the loss of a loved one. While global proportion estimates vary, limited data exist regarding PGD within the Iranian general population. This study aimed to determine the proportion of PGD in Iran and examine associated sociodemographic factors.
Methods: A cross-sectional survey was conducted among 469 general community dwelling in Shahroud, North east of Iran, using convenience sampling technique. Participants were eligible for inclusion if they were over 18 years old, possessed basic literacy skills, and had experienced the loss of a close loved one (such as a spouse, parent, or child) at least 12 months prior to enrollment. Participants completed online forms of the validated Persian version of the Prolonged Grief Disorder Scale (PG-13-R). Sociodemographic data (age, gender, education, marital, and job status) were collected, and multivariate logistic regression was used to identify factors associated with PGD.
Results: The proportion of PGD was 29.6% (95% CI: 28.5–30.5%), with a mean symptom score of 29.54 ± 10.68. A significant difference between PGD-positive and PGD-negative individuals in terms of education (p=0.005) and occupational status (p=0.01). Multivariate analysis indicated that age and education were significant predictors of PGD. Individuals aged 41–60 (OR: 12.7, CI: 1.5 - 107.05, p= 0.019) and over 60 (OR: 14.7, CI: 1.7 - 123.9, p= 0.013) were significantly more likely to meet PGD criteria compared to those under 20. Participants with secondary education were more likely to experience PGD than those with only primary education (OR: 4.1, CI: 2.06 - 8.5, p<0.001).
Conclusion: Prolonged grief disorder affects a substantial portion of the Iranian population, particularly among older adults and those with lower educational attainment. These findings highlight the need for targeted mental health interventions and the development of culturally sensitive diagnostic and therapeutic approaches. Future research should explore the moderating roles of religiosity, loneliness, and social support in grief outcomes to inform comprehensive, culturally grounded care strategies.

The effect of education and telephone follow-up after discharge (telenursing) on care pressure and resilience in caregivers of bipolar patients: A quasi-experimental study

Ali Khatib

Background: Family caregivers face a caregiving burden due to providing care to patients with mental illness. It is essential to employ appropriate strategies to reduce the caregiving burden and increase resilience. Telenursing, as an accessible and cost-effective strategy, enables continued support and education after discharge. This study was conducted with aim to evaluate the effect of education and telephone follow-up (telenursing) on care burden and resilience in caregivers of patients with bipolar disorder.
Methods: This quasi-experimental study was conducted from September 2024 to March 2025 at Razi Psychiatric Hospital, Tehran, Iran. A total of 60 caregivers of bipolar disorder patients were selected through convenience sampling. Participants were then randomly assigned to the intervention (n=30) and control (n=30) groups using a simple randomization method. The intervention group received eight group-based telenursing sessions (two sessions per week, 40–50 minutes each). The control group received only routine discharge education. Data were collected using the Caregiver Burden Scale and the Connor-Davidson Resilience Scale before and after the intervention. The data were analyzed using SPSS software (version 25) and independent and paired t-tests. P<0.05 was considered significant.
Results: After the intervention, the mean caregiving burden in the intervention group significantly decreased (28.03±16.72) compared to the control group (58.93 ± 12.18) (p<0.0001). Also, the mean resilience in the intervention group significantly increased (36.63 ± 1.86) compared to the control group (26.10±8.26) (p<0.0001). These results indicate the strong evidence for effectiveness of education and telenursing in reducing caregiving burden (p<0.0001) and increasing resilience of caregivers of bipolar patients (p<0.0001).
Conclusion: The results indicate that telenursing has a positive effect on reducing caregiving pressure and increasing the resilience in caregivers of patients with bipolar disorder. This type of support is useful for providing comprehensive care and maintaining the health of family caregivers.

Parental perspectives on the maltreatment of children with autism spectrum disorder and associated factors: A cross-sectional study in Indonesia

Lilis Lestari

Background: Parental maltreatment of children with autism spectrum disorder (ASD) remains a serious global issue and continues to be reported in developing countries. Parental perspectives on maltreatment can directly influence how parents take care of their children with ASD. Research specifically examining this issue in developing countries is limited. This study aimed to explore parental perspectives on maltreatment of children with ASD and their associated factors in Indonesia.
Methods: A cross-sectional study was conducted among 345 parents who were caring for children with ASD. Participants were selected by consecutive sampling in schools and facilities for children with special needs in two major cities in West Kalimantan Province, Indonesia, from January to March 2023. A self-administered questionnaire was developed for the Indonesian context. Data analysis involved descriptive, comparative, and multivariate regression analyses.
Results: This study included 251 participants, with a response rate of 72.8%. The majority were mothers (84.9%), with a mean age of 38.1 ± 7.1. The majority were aged >35 years (60.6%). Only 32.7% of the participants had the appropriate perspective that children with ASD should not be maltreated. Factors associated with appropriate perspectives were being a parent whose first child did not have ASD (OR=2.240, CI=1.227–4.090, p=0.009), having knowledge of typical development (OR=1.254, CI=1.048–1.499, p=0.013) and of ASD (OR=1.743, CI=1.316–2.309, p=<0.001), and a high need for pre-diagnosis support (OR=1.225, CI=1.042–1.439, p=0.014). Conversely, participants aged >35 years were more likely to have inappropriate perspectives (OR=0.532, CI=0.290–0.976, p=0.042).
Conclusion: Parental perspectives on maltreatment and their associated factors may contribute to the increased risk of maltreatment in children with ASD. Pre-diagnosis support, opportunities for socialization, and training aimed at increasing knowledge of non-violent parenting are needed to address inappropriate parental perspectives that tolerate the maltreatment of children with ASD in developing countries, especially Indonesia.

Comparing the effects of nettle extract with combined oral contraceptives on improving clinical and paraclinical symptoms of polycystic Ovary Syndrome: A triple-blind randomized controlled clinical trial

Khadije Hajizadeh

Background: Polycystic Ovary Syndrome (PCOS) is one of the most significant reproductive and endocrine disorders in women. This study aims to assess the impact of nettle extract on both clinical and paraclinical symptoms in women with PCOS.
Methods: This Triple-Blind Randomized Controlled Clinical Trial involved 60 women (n = 30 per group) aged 18 to 45, all diagnosed with PCOS based on definitive diagnostic criteria in Tabriz, Iran. Participants were randomly assigned in a 1:1 ratio using block sizes of 4 and 6 into two groups: an intervention group (receiving 500 mg of oral nettle extract containing flavonoids, tannins, and sterols daily for three months) and a control group (receiving combined oral contraceptives [COCs] for three months). Independent t-test and ANCOVA test were used in SPSS version 24 for data analysis. A p-value of <0.05 was considered statistically significant.
Results: The study showed that after the intervention, there were no statistically significant differences between the nettle extract group and the control group regarding mean levels of dehydroepiandrosterone sulfate (P=0.197), total testosterone (P=0.24), follicle-stimulating hormone (FSH) (P=0.549), luteinizing hormone (LH) (P=0.398), hirsutism score (P=0.149), or duration of menstrual bleeding (P=0.982), based on ANCOVA adjusted for baseline values, education level, and number of pregnancies. However, the two groups exhibited statistically significant differences in fasting blood glucose levels (P=0.020), intervals between menstrual bleeding (days) (P=0.031), and menstrual bleeding intensity (P = 0.008).
Conclusion: The findings indicate that nettle extract is as effective as low-dose oral contraceptive pills in reducing levels of dehydroepiandrosterone, total testosterone, follicle-stimulating hormone (FSH), and luteinizing hormone (LH), as well as in decreasing hirsutism scores and the duration of menstrual bleeding. Midwives can use nettle extract, which is a cheap, easy, and non-invasive method to improve PCO symptoms.

The relationship between motivations of volunteers and psychological well-being in Iranian elderly individuals

Akram Sanagoo

Background: Participatory actions and voluntary behaviors play a significant role in the health of elderly individuals. Evidence suggests that engagement in voluntary work positively impacts health, psychological well-being, and even longevity, with these benefits being particularly pronounced among older adults. The aim of this study was to examine the relationship between motivation for volunteer activities and psychological well-being in elderly individuals.
Methods: An analytical cross-sectional study was conducted involving 496 elderly individuals, selected through a multi-stage non-random sampling method, at comprehensive health service centers in Golestan Province, Northern Iran, in 2023. Data were collected through Clary's Voluntary Activities Questionnaire and Ryff's Psychological Well-Being Questionnaire. The data were analyzed using Pearson correlation tests, independent t-tests, chi-square tests, and ANOVA by SPSS v.26, all at a significance level of 0.05.
Results: The mean scores of voluntary motivation and psychological well-being among the elderly were 180.01±11.79 and 64.72±5.30, respectively. The results of the Pearson correlation test indicated a positive and significant relationship between the total score of voluntary functions and the total score of psychological well-being (r=0.1, p = 0.03).
Conclusion: Motivation for volunteer activities may be a significant factor in enhancing the psychological well-being of elderly individuals. Therefore, it is essential for policymakers in elderly health to create conditions that encourage participation in voluntary activities to promote psychological well-being.