The effect of cognitive behavioral therapy on the severity of fatigue in women with multiple sclerosis: a Randomized Controlled Trial study

Background and aims: Multiple sclerosis, as a chronic and progressive disease of central nervous system, affects different aspects of patient’s life. Considering importance of fatigue in these patients and on the other hand, increasing acceptability of complementary therapies in health care system, this study was aimed to determine the effect of group cognitive behavioral therapy on the severity of fatigue in women with multiple sclerosis that was conducted during 2014. Methods: This study was a two-group, three-stage (before, right after and a month after the intervention) clinical trial that was conducted on 66 women with multiple sclerosis who had the inclusion criteria and referred to medical centers of Isfahan. After convenient sampling, participants were equally divided into two groups of control and intervention by random allocation. The intervention group received eight 90-minute group sessions (a session per week) for cognitive behavioral therapy. Control group along with receiving the usual drug therapies, participated in 3 group sessions and expressed their feelings and experiences. Data was gathered using a questionnaire and fatigue severity scale (FSS) and was analyzed by SPSS software using independent t-test, Mann-whitney, Chi square and one-way ANOVA tests. Results: There was no significant difference between the mean score of severity of fatigue in both groups before the intervention (P=0.532), but this score was significantly lower in the intervention group than the control group right after the intervention and a month after the intervention (P= 0.03). Also, the results of post-hoc LSD showed that the mean score of severity of fatigue in the intervention group right after the intervention and a month after the intervention was significantly lower than before the intervention (P<0.001). Conclusions: Considering the effect of cognitive behavioral therapy on the severity of fatigue in patients with multiple sclerosis, the use of this therapeutic method, as a clinically beneficial, effective, cost effective and reasonable method, is recommended

Nurses versus physicians' knowledge, attitude, and performance on care for the family members of dying patients

Purpose: Nurses and physicians must be competent enough to provide care for the clients. As a lack of knowledge and a poor attitude result in a low performance of delivering care, this study aimed to explore the nurses versus physicians’ knowledge, attitude, and performance on care for the family members of dying patients (FMDPs). Methods: This descriptive study was conducted at the educational hospitals in Isfahan, Iran. The samples were 110 nurses and 110 physicians. The data were collected through a convenience sampling method and using a valid and reliable questionnaire. Results: The average knowledge, attitude, and performance on care for the FMDPs were not significantly different between nurses and physicians (p>0.05). The majority of nurses (55.4%) and physician (63.6%) were at a moderate and a fair level of knowledge of care for the FMDPs. Most of the nurses (81%) and physicians (87.3%) had a positive attitude towards caring the FMDPs. Most of the nurses (70%) and physicians (86.3%) had a moderate and fair performance. Conclusion: Having enough knowledge and skills, and a positive attitude are necessary for caring the FMDPs. Nurses’ and physicians' competencies must be improved through continuing educational programs and holding international and national conferences with a focus on the palliative care

Effectiveness of Cognitive Behavioral Therapy on the Quality of Sleep in Women with Multiple Sclerosis: A Randomized Controlled Trial Study

Background: Multiple sclerosis is accompanied by secondary clinical signs such as insomnia. Considering the side effects of drugs and also increasing acceptability of psychotherapy methods in health systems, we aimed to determine the effect of group cognitive behavioral therapy on the quality of sleep in women with multiple sclerosis in 2014. Methods: This study is a randomized controlled clinical conducted on 72 women with multiple sclerosis who referred to medical centers of Isfahan. After convenience sampling, participants were randomly allocated into two equal groups of control (n=36) and intervention (n=36). In the intervention group, cognitive behavioral therapy was performed in 8 sessions. The control group, along with receiving the common drugs, participated in 3 group sessions and talked about their feelings and experiences. Data were gathered using Pittsburgh Sleep Quality Index (PSQI) and analyzed through independent t-test, Chi-square, Mann Whitney, ANOVA with repeated measure, using SPSS 18. Results: There was a significant difference between the mean score of sleep quality of the control and intervention groups immediately and one month after the intervention (P<0.001). ANOVA with repeated measure test showed that the mean score of sleep quality of patients in the intervention group had a significant difference at three stages of before, immediately and one month after the intervention. Conclusions: According to the results of this study, cognitive behavioral therapy, as an effective and cost-effective therapy, could improve sleep quality in patients with multiple sclerosis

Vulnerable Women’s Self-Care Needs in Knowledge, Attitude and Practice Concerning Sexually Transmitted Diseases

Background: Vulnerable women are prone to sexually transmitted diseases (STD) due to their special conditions and poor knowledge about these diseases in the society. Therefore, the present study aimed to determine the vulnerable women’s self-care needs in knowledge, attitude and practice concerning STD. Methods: This is a cross-sectional-descriptive study conducted in 2014. The data collection was carried out using a self-administered structured questionnaire. 120 vulnerable women referring to centers affiliated to health and well-being center in Isfahan participated in this study. They were selected through proportional rationing sampling and filled out a researcher developed questionnaire containing information on personal characteristics, self-care knowledge, attitude, and practice needs toward the STD. The data were analyzed using statistical methods including Spearman & Pearson correlation co-efficient, independent t-test and ANOVA. All analyses were carried out using SPSS, 20. Results: Based on the results, most of the subjects mentioned that their priorities of self-care needs in domains of knowledge, attitude and practice were “familiarization with the types and contamination ways of sexually transmitted diseases” (57.9%); “diagnosis of STD only makes us anxious” (24.8), and “the method of washing the genital area before and after intercourse” 41.3%), respectively. There was a significant association among marital status, education, history of addiction, and self-care needs in domains of knowledge, attitude and practice (P<0.05). Conclusion: Results showed that vulnerable women not only knew their need about STD, but also paid attention to their attitude and practice needs toward STD. Therefore, educational programs should be designed and administrated by the experts, based on vulnerable women’s self-care needs concerning their knowledge, attitude and practice to prevent and control STD in vulnerable individuals

Empowering Nurses in Providing Palliative Care to Cancer Patients: Action Research Study

Background: Chronic diseases such as cancer would lead to various health needs in patients and their families. To meet needs, developing new educational nursing courses is necessary. Therefore this study was conducted to empower nurses through designing and conducting short-term educational courses for training palliative care nurses. Materials and Methods: This study was a community-based action research which was conducted at Isfahan hospitals that provide services for cancer patients during 2015 at four stages (planning, acting, reflection, and evaluation). Participants (33 samples) included nurses, head nurses, managers of nursing services, nursing professors and professors of oncology department. Data were gathered through individual and group interviews and analyzed using content analysis. Results: Data analysis resulted in 3 categories of "professional development of nursing in palliative care" which included subcategories of: knowledge-based performance and positive change in attitude, "obstacles to provide palliative care" with subcategories of: insufficient professional responsibility, insufficient ability in managing some of patients' symptoms and inappropriate interaction between nurses and physicians and "strategies for improving provision of palliative care" with subcategories of: improving the interactions between physicians and nurses, continuous trainings for palliative care and the necessity of developing palliative care in the country. Conclusions: To facilitate the process of providing palliative care to cancer patients, necessary actions and measures must be conducted including improvement of interaction between the members of health team, organizing continuing educational courses on palliative care and development of providing palliative care all over the country by managers of health centers

The effect of group cognitive behavioral therapy on stress, anxiety, and depression of women with multiple sclerosis

Background: One of the factors that could influence the quality of life in patients with multiple sclerosis, which is usually overlooked, is its psychological aspects. Considering the increasing acceptance of complementary medicine in the health system, this study was designed and conducted to determine the effect of group cognitive therapy on the stress, anxiety, and depression of women suffering from multiple sclerosis. Materials and Methods: This clinical trial was conducted among 70 women suffering from multiple sclerosis who were referred to the health centers of Isfahan. Participants were randomly allocated into two groups of intervention and control, each containing 35 patients. The intervention group received cognitive behavioral therapy as 8 90-minute group sessions (a session per week), and the control group participated in 4 group sessions to express their feelings and experiences. Data were gathered using the Depression Anxiety Stress Scale (DASS-24). Results: There was a significant difference between the mean score of stress (P = 0.03), anxiety (P = 0.02), and depression (P = 0.03) of the intervention and the control group immediately after and 1 month after the intervention. Least squares difference test showed that the mean score of stress (P = 0.02), anxiety (P = 0.02), and depression (P = 0.03) immediately and 1 month after the intervention was significantly lower in the intervention group. Conclusions: According to the results of the present study, cognitive behavioral therapy could decrease stress, anxiety, and depression in patients suffering from multiple sclerosis