Journal of Research Development in Nursing and Midwifery

Lights and shadows of caring for older adults: The invisible companions in hospitals

Leila Jouybari

Editorial

Reframing cancer care equity: The expanding role of oncology nursing in low- and medium-HDI settings

Hadis Ashrafizadeh

Substantial inequities in cancer care persist across countries and population groups with lower levels of human development. Although very high- and high-Human Development Index (HDI) settings often report higher cancer incidence and comparatively lower mortality, low- and medium-HDI countries experience lower recorded incidence but disproportionately higher mortality-to-incidence ratios. This pattern reflects delayed diagnosis, restricted access to treatment, workforce shortages, and fragile health systems. This narrative policy paper examines how oncology nurses can contribute to reducing these inequities across the cancer care continuum in low- and medium-HDI settings. Drawing on evidence from nursing practice, health systems research, and cancer control initiatives, we emphasize the roles of oncology nurses in prevention, early detection, treatment, survivorship, and palliative care. Key contributions include health education, community-based screening, patient navigation, symptom management, psychosocial support, and culturally responsive end-of-life care. The paper also discusses innovative and scalable service-delivery models, including task-sharing approaches, nurse-led early detection initiatives, case management, telemedicine, and international capacity-building partnerships. Despite their strategic importance, oncology nurses remain constrained by limited access to specialized education, inadequate policy recognition, workforce shortages, burnout, and insufficient locally generated evidence. Addressing these barriers requires sustained investment in oncology nursing education, leadership development, research capacity, and supportive health policies. Strengthening oncology nursing is therefore a practical and potentially high-impact strategy for expanding access to care, improving service continuity, and advancing cancer care equity in resource-constrained settings.

Family influence and gender role perceptions in career choice among Turkish midwifery students: A cross-sectional study

Nurdan Kaya Yilmaz

Background: Career choice is a critical decision that influences an individual's future and social role. In this process, family factors may be associated with career choice by shaping perceptions of traditional gender roles, particularly in sociocultural contexts where traditional values coexist with modern social structures, including Türkiye. This study aimed to evaluate family influence and gender roles in the career choices of midwifery students.
Methods: A cross-sectional study was conducted between November 2023 and February 2024 with 337 midwifery students at a state university in Samsun, Türkiye, using a census (Total population) sampling approach. Research data were collected using the "Student Information Form", "Gender Roles in Career Choice Scale (GRCCS)", and "Family Influence on Career Choice Scale (FICCS)." Data were analyzed using independent-samples t-tests, one-way ANOVA with Tukey's post hoc comparisons, Pearson correlation, and multiple linear regression in SPSS v.25. Statistical significance was set at p < 0.05.
Results: The mean total GRCCS score of the students was 44.53±6.69 (Obtained score range: 21-85), while the mean total FICCS score was 67.82±8.15 (Obtained score range: 43-105). A weak but statistically significant positive correlation was found between the students' GRCCS and FICCS total scores (r = 0.265, p < 0.001), and between GRCCS scores and the FICCS sub-dimensions of Information Support (r = 0.125, p = 0.021), Financial Support (r = 0.234, p < 0.001), Family Expectations (r = 0.143, p = 0.009), and Values and Beliefs (r = 0.164, p = 0.002). In the regression analyses, career counselling (B = 2.77, 95% CI: 0.70 to 4.84), family relationship quality (B = 1.83, 95% CI: 0.70 to 2.96), and year of study (B = -1.31, 95% CI: -2.26 to -0.36) were independently associated with FICCS scores, while desiring midwifery as a profession (B = 1.62, 95% CI: 0.18 to 3.05) and income level (B = -2.29, 95% CI: -3.60 to -0.98) were associated with GRCCS scores.
Conclusion: The findings suggest that family influence and gender-role perceptions may be related to career-choice attitudes among midwifery students. Therefore, career guidance practices should consider family expectations and gender-based role perceptions. Educational programs that promote independent decision-making and gender awareness may support students in making informed career decisions.

Effect of nursing care based on Roy’s Adaptation Model on pain severity in intensive care unit patients in Pakistan

Farnaz Ahsan

Background: Pain is a prevalent and distressing symptom among intensive care unit (ICU) patients, and inadequate management may lead to serious complications and adverse outcomes. Roy’s Adaptation Model provides a structured nursing framework for improving patient adaptation and health outcomes. This study aimed to evaluate the effect of the Roy Adaptation Model on pain levels in ICU patients.
Methods: This quasi-experimental study was conducted in 2026 among 100 patients admitted to the ICU in Pakistan. Two comparable ICU wards were randomly assigned to the intervention or control group before participant recruitment. Eligible patients were then consecutively enrolled and assigned to the study groups according to the ICU ward to which they were routinely admitted. Outcome assessors were blinded to group allocation. Patients in the intervention group received care based on the Roy Adaptation Model for 7 days, whereas those in the control group received routine care. Data were collected using the Behavioral Pain Scale (BPS). Data were analyzed using SPSS software version 26. Descriptive statistics (Mean, standard deviation, frequency, and percentage) and inferential statistics (Independent t-test and ANOVA) were applied. A p-value of less than 0.05 was considered statistically significant.
Results: Pain scores decreased over the seven-day follow-up period in both groups; however, the reduction was significantly greater in the intervention group than in the control group. For daytime pain, repeated-measures ANOVA showed significant effects of group (F = 16.84, P < 0.001, ηp² = 0.147), time (F = 6.54, P < 0.001, ηp² = 0.063), and the time × group interaction (F = 4.72, P < 0.001, ηp² = 0.046). Similar findings were observed for nighttime pain, with significant effects of group (F = 18.32, P < 0.001, ηp² = 0.157), time (F = 6.87, P < 0.001, ηp² = 0.066), and the time × group interaction (F = 4.15, P < 0.001, ηp² = 0.040). Independent samples t-tests showed no significant between-group differences during the first two days and nights (P > 0.05); however, pain scores were significantly lower in the intervention group from day 3 to day 7 and from night 3 to night 7 (P < 0.05).
Conclusion: The findings suggest that Roy’s Adaptation Model may contribute to pain reduction among ICU patients, supporting the potential value of theory-based nursing care in critical care settings. Incorporating this model into routine ICU practice may enhance pain management and facilitate patient adaptation.

Use of information and Communication Technologies to improve health literacy among pregnant women: A scoping review

Emanuela Gomes Falcão

Background: Health literacy is a key component of informed decision-making during pregnancy and is influenced by access to and interpretation of health information. This study aimed to map and analyze the available evidence on the use of Information and Communication Technologies (ICTs) during pregnancy and their implications for obstetric nursing.
Methods: A scoping review was conducted according to JBI guidance and reported in accordance with PRISMA-ScR. The initial searches were conducted in December 2023 and updated in May 2026, covering records indexed from database inception through May 2026 in MEDLINE, EMBASE, LILACS, Scopus, and ScienceDirect. Controlled and uncontrolled terms based on MeSH, DeCS, and Emtree were used. Primary and secondary studies employing quantitative, qualitative, or mixed-methods approaches were eligible, with no restrictions on language or publication period. The findings were synthesized descriptively and thematically.
Results: Twenty-five studies were included. The evidence indicates that ICTs, including mobile applications, websites, and digital platforms, facilitate access to health information, promote self-care, and improve adherence to prenatal care. However, their effectiveness depends on three factors: digital literacy, information reliability, and integration into professional care. Barriers include digital inequality, low health literacy, information overload, cultural and linguistic limitations, and a lack of content regulation. Despite these challenges, benefits such as increased knowledge of warning signs, greater self-efficacy, and support for decision-making were observed.
Conclusion: ICTs play an important role in supporting maternal care and strengthening health literacy during pregnancy. Their effective use depends on the interaction among digital literacy, information reliability, and professional mediation.

Relationship between self-rated health and current depression among patients with diabetes: Insights from the 2020 Korea health panel study

Djoko Priyono

Background: Self-rated health (SRH) is a validated subjective measure that reflects not only the burden of chronic disease but also socioeconomic and psychological determinants associated with mortality. However, the direct relationship between SRH and current depressive symptoms among Korean adults with diabetes remains insufficiently characterized. This study aimed to determine the association between SRH and current depressive symptoms among Korean adults with diabetes.
Methods: A cross-sectional study was conducted using secondary data from the 2020 Korea Health Panel Survey (KHPS). The analytical sample comprised 1510 adults with confirmed diabetes mellitus. The primary outcome, current depressive symptoms, was assessed using a single yes/no item. The main independent variable, self-rated health, was measured using a single-item question and categorized as either poor or good health. Both measures were obtained from the KHPS and analyzed as dichotomous variables. Additional covariates included sociodemographic and clinical or behavioral factors. Statistical analyses were performed using IBM SPSS Statistics version 26.0. Binary logistic regression was used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with current depressive symptoms.
Results: Among the 1,510 participants, 551 (36.5%) reported poor self-rated health, and 174 (11.5%) exhibited current depressive symptoms. A significant association was observed between these primary variables; poor SRH was a robust factor independently associated with current depression (Adjusted odds ratio [aOR]=2.16; 95%CI:1.35-3.46; p=0.001). In the fully adjusted regression model, the strongest covariate associated with depressive symptoms was anxiety (aOR=33.67; 95% CI: 19.50-58.15; p < 0.001), followed by suicidal ideation (aOR=3.78; 95% CI: 2.10-6.82; p < 0.001) and high perceived stress (aOR=2.61; 95%CI:1.63-4.15; p < 0.001). Conversely, employment emerged as a significant protective factor against depression (aOR=0.41; 95%CI:0.25-0.68; p<0.001). The adjusted model demonstrated excellent discriminatory capacity (AUC = 0.890; 95% CI:0.862-0.918) and explained 50.7% of the variance in depressive symptoms (Nagelkerke R²=0.507).
Conclusion: Poor SRH is a significant independent factor associated with current depression among Korean adults with diabetes. Subjective health perception should be recognized as a key marker of psychological risk. Routine SRH assessment should be integrated into diabetes care to facilitate the early identification of depression and enable timely psychosocial intervention.

Iranian cancer patients' social media stories: Implications for nursing strategies

Ehsan Shahghasemi

Background: Social media platforms provide important spaces in which cancer patients narrate their illness experiences and reveal needs that often remain unexpressed in clinical settings. However, Persian-language cancer discourse has received limited scholarly attention. This study sought to identify the emotional orientations and dominant themes in Iranian cancer patients' posts on X and to determine their implications for nursing practice.
Methods: This cross-sectional infodemiology study examined posts published between September 2017 and June 2025. Among 50 screened accounts belonging to self-identified cancer patients, 24 satisfied the inclusion criteria. A Persian-language keyword lexicon yielded 2,489 posts, of which 1,617 remained following manual relevance screening. Sentiment was classified into five categories with a Persian BERT-based model (ParsBERT-DeepSentiPers), and themes were identified by Latent Dirichlet Allocation (LDA) topic modeling in Python 3.10 (Gensim, Transformers); a 12-topic model achieved the highest coherence (0.4729). Sentiment distributions were subsequently examined within each theme.
Results: Happy was the most frequently identified sentiment (31.2%), followed by Neutral (25.5%), Furious (17.3%), Angry (16.7%), and Delighted (9.4%); the overall proportion of positive sentiment (40.6%) exceeded that of negative sentiment (34.0%). Among the twelve identified themes, Treatment Process was the most prevalent (66.8%), followed by Personal Journey and Empowerment (23.7%) and Side Effects and Physical Suffering (23.2%), the only major theme in which negative posts outnumbered positive posts. Negative sentiment was concentrated in accounts of stigma, financial hardship, and experiences with the healthcare system. Metaphorical misuse of cancer language and fabricated illness claims were identified.
Conclusion: Iranian cancer patients' online narratives identify priorities for nursing practice, including symptom-management education, psychosocial screening, financial navigation, stigma reduction, and caregiver inclusion, while positioning nurses to guide patients toward credible online communities amid health misinformation.

Effect of white noise on physiological parameters and pain levels during airway suctioning in preterm infants admitted to a neonatal intensive care unit: A Randomized Clinical Trial

Monirsadat Nematollahi

Background: Preterm neonates are frequently exposed to painful procedures in neonatal intensive care units (NICUs), including endotracheal suctioning. Non-pharmacological interventions such as white noise may help reduce pain and improve physiological stability. This study aimed to investigate the effect of white noise on pain intensity and physiological parameters in preterm neonates during airway suctioning.
Methods: This parallel-group randomized controlled clinical trial was conducted on 50 preterm neonates admitted to the NICU of Afzalipour Hospital, Kerman, Iran. Eligible neonates were randomly assigned to intervention and control groups using a random number table. Allocation concealment was ensured using sequentially numbered, opaque, sealed envelopes prepared by an independent researcher. Neonates in the intervention group were exposed to white noise at 45 dB from 5 minutes before until 10 minutes after suctioning, whereas those in the control group received routine care. Pain was assessed using the Neonatal Infant Pain Scale (NIPS). Physiological parameters, including heart rate, oxygen saturation, respiratory rate, and body temperature, were recorded before, during, and after suctioning. Body temperature was measured using the skin temperature probe integrated into the neonatal vital signs monitor. Data were analyzed using SPSS v23. Repeated-measures analysis of variance with Greenhouse-Geisser correction was used to evaluate changes over time between groups. Independent t-test, Chi-square test, and Fisher’s exact test were applied where appropriate. A P-value <0.05 was considered statistically significant.
Results: The intervention group showed significantly lower pain scores (P=0.001), heart rate (P<0.001), and respiratory rate (P=0.010) during suctioning compared with the control group. Oxygen saturation levels were significantly higher in the intervention group during the procedure (P<0.001). No significant differences were observed in body temperature between groups (P=1.000).
Conclusion: White noise reduced pain scores and improved heart rate, respiratory rate, and oxygen saturation during airway suctioning in preterm neonates. These findings support the use of white noise as a complementary non-pharmacological intervention in NICU care.

Effect of the Family-Centered Empowerment Model on self-care requisites in patients with schizophrenia: A randomized controlled trial

Mohammad Reza Sheikhi

Background: The families of patients with mental disorders can provide an appropriate foundation for care. This study aimed to determine the effect of the Family-Centered Empowerment Model on self-care requisites in patients with schizophrenia.
Methods: This randomized controlled trial, conducted in 2025, enrolled 72 patients with schizophrenia who were discharged from Razi Hospital, Tabriz, Iran, together with their primary caregivers. Eligible patients were randomly allocated to the intervention (n = 36) or control (n = 36) group using block randomization. Data were collected at baseline and after the intervention using the Self-Care Requisites Scale in Schizophrenia (SCRS-H). Caregivers in the intervention group participated in eight weekly group-based educational sessions based on the Family-Centered Empowerment Model, whereas the control group received routine care. Data were analyzed using independent t-tests and analysis of covariance (ANCOVA), with adjustment for baseline scores and educational level, using SPSS version 25.
Results: The two groups were comparable at baseline with respect to demographic and clinical characteristics. Following the intervention, the intervention group demonstrated significantly better self-care requisites (Reduced SCRS-H score) than the control group (90.72 ± 12.19 vs. 100.22 ± 15.03, P = 0.004). After adjustment for baseline scores and educational level, ANCOVA confirmed a significant effect of the intervention (P < 0.001). The intervention had a moderate-to-large effect on self-care requisites (Cohen's d = 0.69, 95% CI: 0.21-1.17).
Conclusion: Participation in the Family-Centered Empowerment Model was associated with significant improvements in self-care requisites among patients with schizophrenia. This intervention may represent a useful adjunct to routine psychiatric rehabilitation by strengthening patients' capacity for self-care. Further multicenter studies with larger samples and extended follow-up are warranted to confirm these findings and assess their long-term clinical impact.

Midwives’ knowledge and practice of respectful maternity care and related factors in Golestan province, Iran: A cross-sectional study

Sedigheh Moghasemi

Background: Respectful maternity care (RMC) involves providing healthcare that upholds women's dignity, privacy, and confidentiality. It also entails protecting women from harm, supporting informed decision-making, and providing continuous support throughout labor and delivery. This study aimed to evaluate the knowledge and practices of midwives working in hospitals in Golestan Province regarding respectful maternity care.
Methods: In a cross-sectional study conducted in 2023, a total of 137 midwives working in the maternity wards of hospitals in Golestan Province, Iran, were selected through census sampling. Data were collected using the Respectful Maternity Care questionnaire, which covers emotional support, safe care, and the prevention of mistreatment. The data were analyzed using SPSS 18 and the Mann-Whitney U test, Kruskal-Wallis test, generalized linear models (GLMs), and Wilcoxon signed-rank test, with the significance level set at P < 0.05.
Results: The median (Interquartile range) knowledge and practice scores for respectful maternity care were 95.62 (13.04) and 90.21 (11.41), respectively. Knowledge scores were significantly higher than practice scores for the overall score (P < 0.001) and in the domains of providing emotional support (P < 0.001) and preventing mistreatment (P < 0.001). In the generalized linear regression analysis, the RMC knowledge score was significantly associated with education level (B = -67.60, 95% CI: -132.82 to -2.39, P = 0.04), whereas the RMC practice score was significantly associated with the overall knowledge score (B = 246.73, 95% CI: 152.94-340.52, P < 0.001).
Conclusion: Midwives demonstrated high levels of knowledge and practice regarding respectful maternity care. However, discrepancies between knowledge and practice in some domains highlight the need for interventions that facilitate the translation of knowledge into routine clinical practice.