Background: Developing interventions that improve deep sleep and quit awake is important to improve the quality of care that is provided to preterm infants. Purpose: The aim of this study was to compare the effects of kangaroo care and in-arms-holding on the sleep and wake states of preterm infants. Methods: A randomized controlled trial design was employed in 2011–2012. Seventy-two stable preterm infants with gestational ages of 32–37 weeks and their mothers were recruited from the neonatal intensive care unit of Valiasr Hospital in Tehran, Iran. Seventy participants completed the trial. In the preintervention phase, nurses placed all of the infants, clad only in diapers, in supine position in their incubator for 20 minutes. Next, the infants in the kangaroo care group were placed onto their mothers’ bare chest, whereas those infants in the in-arms-holding group were cradled in their mothers’ arms, with the head and back supported by the mother’s left arm. The intervention period lasted for 70 minutes. In the postintervention phase, the infants were returned to their incubators and placed in supine position for 20 minutes. The observer recorded the status of the infants during the three phases of study. Results: There were no significant differences between the two groups in terms of state distribution in the preintervention phase. However, the kangaroo care group had longer periods in deep sleep (p < .001) and in the quiet awake/alert state (p = .004) during the intervention phase and less time in the light sleep or drowsy state (p < .001) and in the actively awake state (p = .02) than the in-arms-holding group. No significant group differences were found in terms of crying. Conclusions: Kangaroo care appears to increase the length of time that preterm infants spend in deep sleep and quiet awake states as compared with simply being held in their mothers’ arms. Replication of this research will strengthen the results.

Stigma affects all aspects of mental disorders, and is the most important risk factor for promoting mental health. The aim of this study was to explore strategies effective in reducing the stigma toward people with mental disorders in Iran. This qualitative study was conducted from 2013 to 2016. All participants were recruited by purposive sampling method. The majority of them were stakeholders of mental health in Iran. Data were collected through eight individual interviews, two focus groups, and six written narratives. The data were collected, coded and analyzed simultaneously. Content analysis was employed to analyze the qualitative interview data. The major themes that emerged were: “Emphasis on education and changing attitudes”, “Changing the culture”, “Promoting supportive services”, “Role of various organizations and institutions”, “Integrated reform of structures and policies to improve the performance of custodians”, and “Evidence-based actions”. This study did not investigate the extent of stigma or its origins, rather it examines strategies appropriate for implementation in Iran. Additional studies are needed to evaluate the effectiveness of strategies for reducing the stigma attached to patients with mental disorders.

Background. The proper implementation of cardiopulmonary resuscitation (CPR) is crucial in saving patients. Purpose. This study was aimed at evaluating the difference in educating nursing students on CPR when using the traditional simulation training with a mannequin versus a more novel serious game training on the smartphone platform. Methods. This randomized control trial was conducted in 2018-2019. Through purposive sampling, 56 nursing students were selected and randomly assigned to three groups: a simulation-based CPR training, CPR training using a serious game on the smartphone platform, and a control group that received no CPR training. Each student was evaluated pre- and posttraining on CPR knowledge and skill. Results. Both the simulation and serious game training groups increased CPR abilities two weeks after training. The control group did not show improvement in skill or knowledge of CPR. The simulation and serious game intervention groups demonstrated better scores on the knowledge questionnaire and on the CPR skill demonstration in comparison to the control group. However, the simulation group and the serious game group showed no significant difference in knowledge ( vs. ; ) or CPR skill demonstration ( vs. ; ). The overall scores for CPR knowledge did not meet minimum expectations (70% score) in either the simulation (47.75%) or serious game (38.85%) group. However, both groups demonstrated adequate CPR skill on demonstration (simulation 87.64% and serious game 83.06%). Conclusions. Both the simulation and serious game training groups were found to increase CPR skill. CPR training would likely benefit from a multimodal approach to education.

Comparison of Intermittent and Bolus Enteral Feeding Methods on Enteral Feeding Intolerance of Patients with Sepsis: A Triple-blind Controlled Trial in Intensive Care Units

Background: Iran’s nursing education has undergone significant modifications in the last decades, especially following the Islamic revolution and the Iran-Iraq war. This review outlined changing trends in Iran’s nursing education and evaluate its status compared to other developing and developed countries. Methods: Six international and two national electronic data sources were searched up to May 2021, using relevant keywords and terms. The studies were included if they addressed history, development, or evolutionary aspects of Iran’s nursing education or evaluated its status by comparing it with developing or developed countries, using Bereday's model. To obtain more relevant information, the organizational documents of the Iranian Ministry of Health and Medical Education and the Iranian Ministry of Culture and Higher Education were searched. Of 753 evidence found in the initial search, 73 were considered eligible for this review. A systematic and unbiased data synthesis was performed and a narrative and tabulated summary was presented. Results: The evolution in Iran’s nursing education has resulted in the establishment of Bachelor, Master, and Ph.D. programs. Iran’s nursing education system plays an important role in fulfilling the healthcare system’s mission, and it does not hold a dissatisfactory position in comparison with other developed and developing countries. However, this system is expected to be more versatile for the upcoming changes and advancements. Conclusion: Iran’s nursing education has a moderate rating despite recent changes. Hence, this system has to be modified in some aspects by adopting experiences of other countries, with an appropriate and successful education system, to prepare future highly competent nurses.