Background: Pain is a common and unavoidable phenomenon in childbirth, and in terms of severity, childbirth pain is among the most severe pains in human. Objectives: The current study aimed at investigating the effect of localized heat and cold therapy on pain intensity, duration of phases of labor, and birth outcomes among primiparous females. Satisfaction was also compared in the two intervention groups. Methods: The current randomized, controlled trial was conducted on 120 primiparous females in three groups (heat/ cold therapy, and control) from September 2015 to January 2016. Intensity of pain, duration of phases of labor, and birth outcomes were measured before and after intervention in the three groups. Satisfaction with localized heat and cold therapy was compared in the two intervention groups. No intervention was conducted in the control group. Data were analyzed using the Fisher exact, Chi-square, the Kruskal-Wallis, and ANOVA tests with SPSS version 19. Results: After intervention, statistically significant difference was found in the average pain severity respectively among the heat therapy, cold therapy, and control groups in dilations of 5 -6 cm (3.25 ± 0.91, 3.57 ± 1.14, 4.00 ± 1.37) 7 -8 cm (4.08 ± 0.91, 4.88 ± 1.05, 4.97 ± 1.17), and 9 -10 cm (6.00 ± 1.35, 6.40 ± 1.09, 7.80 ± 1.18) in the first and second phase of the labor (6.22 ± 1.13, 7.37 ± 1.08, 7.94 ± 1.08). There was a statistically significant differences in the average duration of first phase of labor, respectively among heat therapy, cold therapy, and control groups (293.70 ± 68.97, 368.57 ± 79.82, 400.86 ± 77.43) and second phases of labor respectively among heat therapy, cold therapy, and control groups (42.85 ± 13.60, 51.71 ± 12.24, 46.85 ± 13.67), but there was no statistically significant difference among the three groups in terms of the average duration of labor in the third phase. No significant difference was observed between heat and cold therapy groups in terms of satisfaction. No significant difference was observed among the three groups in birth outcomes, including the mean first and fifth Apgar scores, time of cuddling newborn, and the first breastfeeding of newborn. Conclusions: Localized heat and cold therapy are non-pharmacological, non-invasive, satisfactory for the primiparous females, and effective methods to control and relieve pain during labor without adverse effects on maternal and fetal outcomes.

Background:The lack of clinical competence in nurses leads to problems in providing nursing services. Studies indicate that nurses lacking the required skills can endanger the public health in medical centers. Critical thinking is a factor that can affect nurses' clinical competence. Objectives: The current study aimed at investigating the relationship between critical thinking and clinical competence in nurses. Methods: The current descriptive-analytical and cross sectional study was conducted on 120 nurses selected by random sampling method. Data collection tools included the California Critical Thinking Disposition Inventory (CCTDI), as well as clinical competence and demographic information questionnaires. Data were analyzed with SPSS using Pearson correlation coefficient, linear regression, and t-test. Results: Pearson correlation test showed a positive correlation between the total scores of critical thinking and clinical competence. Based on the results of the linear regression analysis, the tendency toward critical thinking could predict 28.4% of the clinical competence. The nurses mean CCTDI scores were at the positive level and their mean clinical competence scores were at the average level. Conclusions: According to the obtained results, nursing authorities can organize practical workshops on the development of critical thinking of clinical nurses as one of the most important and operational strategies to improve nursing clinical competence and, ultimately, move towards optimal care.

Background and Objectives:Labor pain is one of the most severe pains. Given the importance of reducing labor pain and prioritizing natural delivery, this study was performed with the objective of investigating the effect of local heat therapy on pain, delivery outcomes, and rate of satisfaction in primiparous women.Methods: This clinical trial study was conducted on 80 primiparous women in Karaj city. The samples were selected using easy sampling and assigned to two groups, then, pain severity, delivery outcomes, and rate of satisfaction, were recorded in the two groups,. Data were analyzed using independent and dependent t-tests at the significance level of p<0.05. Results:In this study, there was a significant difference between the two groups in variables of severity of pain, mean duration of first and second stages of the labor, frequency distribution of satisfaction of the studied subjects in terms of the type of intervention, satisfaction from the delivery process, first experience of breastfeeding, and mothers' satisfaction from embracing their newborn babies (p<0.05); however, there was no significant difference between the two groups in terms of the mean duration of the third stage, the mean Apgar score, the duration of embracing the infant, and the first infant's breastfeeding. Conclusion:Based on the results of this study, it seems that control of pain and making satisfaction using noninvasive methods of local heat therapy without affecting adverse maternal and fetal outcomes, promote progression and encourage mothers for normal delivery.

Background:In 2010, the world's maternal mortality compared to 2000, forty-seven percent drop. Nevertheless the rate of maternal mortality in developing countries is still 15 times more than developed countries. Midwifery and maternity health care interventions can reduce infant and maternal mortality. The aim of this study is to investigate the midwifery and maternal health management services in a developed country in Asia to extract the japans' midwifery services management factors. Materials and Methods: This is a descriptive study. Country studied, is developed and successful country in the field of midwifery services, Japan. Management aspects of midwifery services in this study include: human resources, government policiesregulations and support, financial resources and midwifery service package and using research cards have been collected from reliable-available sources. Results: Several factors in the Japan midwifery and maternal health services management were determined including midwifery education new training techniques, staff proper distribution, Regulations and support policies developed by the government, uniform and universal health insurance, Participation of the Regions in services provision, home visits and delivery, equal health education and registration manual, maternal education, wives participation and encourage natural childbirth. Conclusion: paying more attention to training, support and regional services provision in the midwifery services management, can have a positive impact on improving the midwifery and maternal health services quality in Iran.