Journal of Research Development in Nursing and Midwifery

Editorial Note: Addressing diabetes in rural communities through integrated social care and innovation

Samereh Abdoli

This editorial note highlights the persistent barriers to effective diabetes management in rural communities globally. It emphasizes the significant impact of social determinants of health (SDoH) such as food insecurity, transportation, and social isolation on diabetes outcomes, noting that emotional and social needs remain largely unaddressed by current healthcare systems. The Social Care Logic Model is presented as a comprehensive framework to bridge this gap, offering a multi-pathway approach encompassing social risk screening, emotional support, community service connections, and tailored clinical care. The editorial advocates for integrating Artificial Intelligence (AI) with Community Health Workers (CHWs) to deliver scalable, culturally tailored interventions that improve access to services, reduce social risk, enhance emotional well-being, and support chronic disease self-management in these vulnerable populations. It concludes by urging a continued focus on innovative, compassionate models that integrate clinical and social care to better serve those most impacted by healthcare disparities.

Feasibility study of using the magnet hospital model in improving quality of nursing care in Iran: An action research pilot study

Maryam Rassouli

Background: Iran’s health system continues to face challenges in nursing care quality, highlighting the need to improve nursing-sensitive indicators. This pilot study evaluated the feasibility of implementing the Magnet Hospital Recognition Program to enhance nursing care quality in six Iranian university-affiliated hospitals.
Methods: An action research design was carried out from 2022 to 2024 in six hospitals selected by predefined inclusion criteria. The study comprised three stages. In stage one, investigators used a validated gap-analysis questionnaire to assess existing nursing service processes across five Magnet dimensions and developed targeted improvement plans. Stage two involved implementing interventions, including specialized training courses, development of a nursing management portal and managerial dashboard, compilation of care indicators, facilitation of advanced qualification licensing for nurses, and establishment of a collaborative research committee with the nursing faculty. In the third stage, program monitoring was conducted through quarterly field visits and progress reports. All data were collected via the gap-analysis tool.
Results: At baseline (Stage one), all centers scored zero in most Magnet dimensions, prompting the design of specific improvement programs. During stage two, organizational overview initiatives empowered managers and updated the nursing management portal. Empirical outcomes advanced through training in the nursing process, pain and wound management, patient satisfaction measurement, and structured patient education and follow-up. Transformational leadership efforts delivered a managerial information dashboard and systematic indicator tracking. Structural empowerment was achieved via professional qualification programs, and innovation was fostered through a joint research committee and human-resource planning. Stage three monitoring revealed that most pilot hospitals had progressed to level 1 (Planning and development) and a minority to level 2 (Full implementation), demonstrating measurable advancement toward Magnet standards.
Conclusion: The Deputy of Nursing’s “Outstanding Hospital” initiative successfully piloted Magnet-based improvements, notably enhancing patient satisfaction and standard adoption. Continued focus on evidence-based practice, professional growth, and the integration of telenursing is recommended for broader implementation.

Impact of palliative care on the quality of life and patient satisfaction in cancer patients: A before-and-after quasi-experimental study

Hamideh Ebrahimi

Background: Palliative care is a holistic approach aimed at enhancing the quality of life for patients with cancer. Given the rising number of cancer patients in Iran, its significance has become increasingly apparent. This study investigates the effect of palliative care on the quality of life and satisfaction of patients with cancer.
Methods: This before-and-after quasi-experimental study was conducted in 2024 on 320 patients with breast, tongue, stomach, thyroid, osteosarcoma, and colon cancer at a teaching hospital in Tehran, Iran. Participants were selected through convenience sampling based on eligibility criteria, including being over 18 years of age, having literacy, being able to speak Persian, and being psychologically stable. The quality of life and life satisfaction of patients were assessed before and after participation in a structured palliative care program. The intervention consisted of six two-hour palliative care sessions, delivered over two months. Data were collected using the Satisfaction with Life Scale (SWLS) and the EORTC QLQ-C30 Quality of Life Questionnaire. Data analysis was conducted using SPSS software, version 26, and a paired t-test was employed for statistical evaluation.
Results: The results indicated that the participants had a mean age of 50.67 years, with a standard deviation of 13.23 years. After receiving palliative care, the overall quality of life score, along with its dimensions (except for emotional functioning, sore throat, and diarrhea), showed a significant improvement (P < 0.001, Cohen’s d = 2.36). Moreover, the intervention led to a significant improvement in patients' life satisfaction, with a p-value of less than 0.001 and a Cohen’s d of 1.01.
Conclusion: The study findings demonstrated that palliative care services, typically provided to individuals nearing the end of life, enhanced the quality of life for cancer patients. Policymakers should prioritize support for patients, and healthcare managers must collaborate to improve and provide palliative care services with qualified personnel, especially nurses.

Design and evaluation of a multi-theory model-based intervention to promote childbearing intentions among Iranian single-child women: A mixed-methods protocol

Seyed Saeed Mazloomy Mahmoodabad

Background: The total fertility rate (TFR) has dropped to below the replacement levels in numerous countries, which necessitates new educational approaches and behavioral models to encourage a more positive societal view of childbearing. The present research aims to design, implement, and evaluate an intervention based on the multi-theory model (MTM) aiming at boosting childbearing intentions among Iranian single-child women of reproductive age.
Methods: This mixed-methods study, designed in three phases, will first explore childbearing intentions qualitatively through in-depth interviews, with the resulting data analyzed using a directed content analysis based on the MTM. Second, the themes identified from this phase will then be used to develop and psychometrically validate a new measurement tool. Third, a field trial will be conducted to implement and evaluate an MTM-based educational intervention. Data will be collected with the validated tool both pre- and post-intervention, with follow-ups at three, six, and nine months to assess pregnancy outcomes. The effectiveness of the program and participant feedback will be analyzed via descriptive statistics, paired t-tests for within-group comparisons, and repeated measures analysis of variance (ANOVA) for between-group differences over time. All statistical analyses will be performed using SPSS version 22.
Conclusion: This study represents the first known application of the MTM to investigate childbearing intentions among single-child women. Developing and assessing a culturally-adapted intervention has the potential to boost individuals’ childbearing intentions and generate evidence for guiding reproductive health policies in settings experiencing a decline in fertility.

Fertility intentions for a second child and related factors among Chinese nurses: A cross-sectional study

Guiyu Qu

Background: The reproductive willingness of women of childbearing age and its related factors is key to coping with the change in population structure. This study aimed to explore fertility intention and associated factors for having a second child among Chinese nurses.
Methods: A cross-sectional multi-center study was conducted in three hospitals in Shandong, China, from November 2023 to January 2024. Participants were recruited through convenience sampling among female nurses. The survey was conducted face to face, enabling participants to ask questions and clarify difficulties with the questionnaire.
Data were analyzed via IBM SPSS 19.0. Multinomial logistic regression analysis was used to clarify the determinants of respondents’ fertility intention (yes, no, or not sure), with a p-value less than 0.05 considered statistically significant.
Results: Overall, 39.2% of participants reported that they would not have a second child under the current birth policy, which accounted for the highest proportion. Multinomial logistic regression analysis showed that those with higher work-family conflict, higher income, and late pregnancy were more likely to report a negative response toward fertility intention for a second child.
Conclusion: Family economic condition, age of the first child, and overloaded work were found to be significant influencing factors of Chinese nurses’ fertility intention to have a second child. Existing policies in China should continue to be implemented, including policy support and ideological guidance, to ensure that nurses have fewer worries when deciding to give birth to their second child. Limited by the cross-sectional study design, more qualitative studies are needed to explore barriers among populations who do not intend to have a second child.

Relationship between critical thinking and moral distress in nurses: A cross-sectional study

Mohammad Latif Rastian

Background: Nurses, as one of the key pillars of the healthcare system, constantly face complex ethical challenges that can impact the quality of care provided and their mental well-being. Enhancing critical thinking skills in this group may help them analyze ethical issues more effectively and make better decisions, ultimately reducing moral distress. Therefore, this study aimed to determine the relationship between critical thinking and moral distress in nurses.
Methods: This cross-sectional study involved the selection of 342 nurses from educational hospitals affiliated with Yasuj University of Medical Sciences in Iran in 2024, utilizing a systematic probability sampling method. Participants were required to have a minimum of one year of clinical experience and to be currently employed in hospital departments, ensuring a relevant background for the study. Data collection was conducted using the California Critical Thinking Skills Test – Form B and the modified 18-item Hamric Moral Distress Scale. The findings were analyzed employing both descriptive and inferential statistical tests, including the Kolmogorov–Smirnov test for normality, Pearson correlation, and multiple linear regression, which were used to examine relationships between variables utilizing SPSS version 27.
Results: The mean age of participants was 43.33 ± 10.7 years; 221 individuals (64.40%) were female, and 127 persons (37.10%) had 1 to 5 years of work experience. Nurses had an average critical thinking score of 21.25 ± 8.64 and a moral distress score of 116.08 ± 50.82. A significant negative correlation was found between critical thinking and moral distress scores (r = -0.66, p = 0.001). A multiple regression model significantly predicted moral distress, explaining 63% of its variance (R² = 0.628, F = 29.787, p = 0.001). Six predictors were significant. Overall critical thinking was the strongest negative predictor (β = -0.396, p = 0.001, 90% CI [-2.65, -1.69]). The analysis, inference, and induction components were also significant negative predictors. In contrast, the deduction component (β = 0.197, p = 0.029, 90% CI [0.24, 4.39]) and place of residence (β = 0.072, p = 0.037, 90% CI [1.01, 32.60]) were positive predictors of moral distress.
Conclusion: The findings suggest that as critical thinking skills improve, moral distress tends to decrease among nurses. Therefore, it is recommended to implement educational programs aimed at enhancing critical thinking skills in nursing practice, which could potentially alleviate feelings of moral distress.

The evaluation of emotional violence and sleep quality in Turkish pregnant women: A cross-sectional study

Nurdan Kaya Yilmaz

Background: Emotional violence during pregnancy may negatively affect maternal and fetal health and impair sleep quality. The study aimed to evaluate pregnant women’s exposure to emotional violence and their sleep quality.
Methods: A cross-sectional study was conducted with 262 pregnant women at Samsun Education and Research Hospital in the city of Samsun, Turkey, between February and May 2024. The sample was obtained using simple random sampling. Data were collected using the Sociodemographic and Obstetric Checklist, the Pittsburgh Sleep Quality Index (PSQI), and the Exposure to Emotional Violence Scale (EVS). Data were analyzed using independent samples t-test, one-way analysis of variance (ANOVA) with Tukey’s post hoc comparisons, and all data were analyzed using SPSS v.25. Statistical significance was set at p <0.05.
Results: Spousal violence during pregnancy was reported by 16.0% (CI 95%: 11.5 – 20.5) of participants. The mean (standard deviation) total PSQI score was 5.77 (3.49), and 54.2% (CI 95%, 48.2–60.2) of the pregnant women had poor sleep quality. The mean (SD) total EVS score was 38.80 (13.25), indicating a low level of emotional violence exposure. Pregnant women with poor sleep quality had significantly higher EVS total scores (p=0.020), as well as higher scores in the subdomains of obstruction (p=0.044), humiliation (p=0.046), harm (p=0.021), and verbal abuse (p=0.022).
Conclusion: It was demonstrated that half of the pregnant women had poor sleep quality and were exposed to low levels of emotional violence. Pregnant women with poor sleep quality were found to be more exposed to emotional violence.

The effect of digital coloring on the level of state anxiety and pulse rate in elderly patients before diabetic foot ulcer surgery: A quasi-experimental study

Sepideh Mohammadi

Background: Given the anxiety experienced by patients awaiting diabetic foot ulcer surgery, evidence supporting the efficacy of preoperative art therapy can be clinically valuable. However, evidence on the effectiveness of digital coloring, a modern and accessible form of art therapy, remains limited. This study aimed to investigate the effects of digital coloring on state-trait anxiety levels and pulse rate in elderly patients scheduled for diabetic foot ulcer surgery.
Methods: This quasi-experimental study employed a pre-test–post-test design with intervention and control groups. The study was conducted from January 2023 to July 2024 at a referral teaching hospital in Amol, Iran. The participants were selectively assigned to either an intervention group (n=30) or a control group (n=30) via purposive sampling. Both groups received standard preoperative care, but one hour before the scheduled surgery, the intervention group received a one-session digital coloring. Data were collected using a demographic questionnaire and the State-Trait Anxiety Inventory (STAI Form Y-1). The variables were assessed at baseline and immediately after the coloring session in both study groups. An analysis of covariance (ANCOVA) was conducted to compare post-intervention state anxiety between the intervention and control groups, while controlling for pre-intervention anxiety levels. Data analysis in SPSS v25 employed χ², Fisher’s exact, paired, and independent t-tests, with significance set at p <0.05.
Results: Both study groups were homogeneous in terms of gender, age, and education level. Baseline anxiety (p=0.43) and pulse rate (p=0.12) were similar between groups. Post-intervention results revealed a clinically meaningful reduction in the intervention group (43.20±3.70) versus controls (50.33±6.18), with a significant between-group difference (p<0.001, d=1.42). The between-group difference in pulse rate was also significant (p=0.002), with a large effect size (Cohen’s d=0.87).
Conclusion: Our findings suggest that the digital coloring intervention may be associated with reductions in state anxiety and pulse rate among elderly patients awaiting diabetic foot ulcer surgery. Given that this intervention is simple, inexpensive, and easily accessible, we recommend its use to alleviate state anxiety in clinical settings that typically provoke anxiety, such as during diagnostic procedures.

The effects of maternally administered neonate massage on feeding tolerance and physiological indicators in neonates admitted to the neonatal intensive care unit: A Randomized Controlled Trial

Maryam Radmehr

Background: Feeding intolerance, defined as the inability to maintain enteral feeding, is frequently observed in neonates with immature gastrointestinal tracts in neonatal intensive care units (NICUs). This study aimed to examine the effects of maternally administered infant massage on feeding tolerance and physiological indicators in NICU-admitted neonates.
Methods: This single-blind, parallel-group randomized controlled trial was conducted among neonates admitted to the NICU of a university-affiliated tertiary neonatal and pediatric center in Isfahan, Iran. Using simple random allocation via card shuffling, 62 neonates meeting the inclusion criteria were divided into two groups: intervention and control. The intervention group received maternally administered massage for five days, three times daily for 20 minutes after feeding with breast or formula milk. The control group received routine care. Assessed outcomes were gastric residual volume, abdominal circumference, frequency of vomiting and stools, and physiological indicators checklist, which measured respiratory rate, heart rate, and oxygen saturation (SaO₂) levels two hours after each feeding every day for five days. Data were analyzed using the Mann–Whitney U test, Wilcoxon signed-rank test, and ANCOVA in SPSS v.26, with a significance level of p < 0.05.
Results: Neonates in the intervention group showed a greater reduction in gastric residual volume % (r² = 0.82, 95% CI [0.75, 0.88]), abdominal circumference (r = 0.82, 95% CI [0.68, 0.97]), and vomiting frequency (r = 0.83, 95% CI [0.69, 0.97]) compared to the control group. Additionally, stool frequency increased significantly in the intervention group (r = 0.85, 95% CI [0.73, 0.99]). In this group, SaO₂ levels increased (r = 0.82, 95% CI [0.68, 0.97]), while heart rate (r = 0.83, 95% CI [0.69, 0.97]) and respiratory rate (r = 0.85, 95% CI [0.73, 0.99]) decreased significantly, indicating improved physiological stability.
Conclusion: Maternally administered infant massage appeared effective in improving feeding tolerance and physiological indicators in this study. Healthcare teams may also consider training mothers to provide neonate massage as a complementary intervention to support feeding tolerance in newborns admitted to the NICU.

Prevalence of domestic violence among Iranian couples in Gorgan, Northern Iran, in 2022

Kosar Amini

Background: Domestic violence is a pervasive issue characterized by a pattern of coercive and controlling behaviors within an intimate relationship. While traditional gendered models often portray males as perpetrators and females as victims, this perspective oversimplifies the complex reality of intimate partner violence (IPV). Research indicates that domestic violence can affect individuals of any gender. Therefore, this study aims to examine domestic violence as it is experienced by both males and females.
Methods: This cross-sectional study investigated 240 cohabiting couples in Gorgan, northern Iran, in 2022. The researchers used a simple random sampling method, facilitated by R software (version 4.4.2) and the national electronic health information system, to identify eligible participants. Participants included females aged 20–49 and their husbands, all of whom had been married for at least two years. Data were collected via the online, self-administered Persian version of the Conflict Tactics Scale 2 (CTS2), which measures the following subscales of conflict: Psychological aggression, physical assault, sexual coercion, and injury. Data analysis included descriptive statistics (mean and standard deviation) and qualitative statistics (frequency and percentage). The Kruskal-Wallis test was employed to compare mean scores between groups, with statistical significance set at P < 0.05.
Results: This study's findings revealed that 52.8% of couples (95% confidence interval [CI]: 40.72–58.45) experienced domestic violence. The research further specified the prevalence of various forms of violence as follows: Bilateral violence: 25% (95% CI: 19.48–30.52), male-to-female partner violence (MFPV): 19.58% (95% CI: 14.53–26.64), and female-to-male violence (FMPV): 7.5% (95% CI: 4.14–10.86). The most frequently reported types of abuse were psychological aggression (male: 5.0 ± 3.48; female: 5.07 ± 3.67) and sexual coercion (male: 2.71 ± 1.8; female: 2.93 ± 2.42).
Conclusion: The results of this study suggest that IPV can be perpetrated by any individual within a relationship, regardless of gender. Consequently, educational initiatives and screening programs should be developed to include both members of a couple, instead of being focused on a single individual. These findings can be utilized by healthcare professionals to develop more comprehensive prevention strategies and to enhance the effectiveness of existing screening protocols for IPV.