Iranian Journal Of Nursing and Midwifery Research
Volume:18 Issue: 2, Mar-Apr 2013

After radiofrequency catheter ablation of arrhythmias, patients have to bed rest for 4-6 h to prevent bleeding and hematoma. However, such a rest may cause back pain in the patients. The aim of this study was to determine the effects of continuous change in body position during and after the radiofrequency ablation on the back pain. In a quasi‑experimental design 75 patients referring to university‑affiliated hospitals were randomly assigned to a control group, receiving no change in body position, group A subjected to changes in body position during and after ablation, and group B subjected to changes in body position during ablation. The intensity of pain, blood pressure, heart rate, and extent of bleeding and hematoma were measured. The groups were not significantly different in terms of demographic characteristics, blood pressure, heart rate, overall bleeding, or hematoma at the entry into the coronary care unit. While not significantly different from each other, the intensity of back pain between group A and B were significantly lower than that of group C. Compared to group C, group A and B had a significantly lower pain score up to 6 and 4 h after the procedure, respectively. Group B had a significantly higher pain score at 2, 4, and 6 h post ablation than group A. The findings show that changing the body position during and after the ablation procedure would reduce or prevent the back pain without increasing the chance of bleeding and hematoma.

The clinical evaluation, as one of the most important elements in medical education, must measure students’ competencies and abilities. The implementation of any assessment tool is basically dependent on the acceptance of students. This study tried to assess midwifery students’ satisfaction with Direct Observation of Procedural Skills (DOPS) and current clinical evaluation methods. This quasi‑experimental study was conducted in the university hospitals affiliated to Mashhad University of Medical Sciences. The subjects comprised 67 undergraduate midwifery students selected by convenience sampling and allocated to control and intervention groups according to the training transposition. Current method was performed in the control group, and DOPS was conducted in the intervention group. The applied tools included DOPS rating scales, logbook, and satisfaction questionnaires with clinical evaluation methods. Validity and reliability of these tools were approved. At the end of training, students’ satisfaction with the evaluation methods was assessed by the mentioned tools. The data were analyzed by descriptive and analytical statistics. Satisfaction mean scores of midwifery students with DOPS and current methods were 76.7 ± 12.9 and 62.6 ± 14.7 (out of 100), respectively. DOPS students’ satisfaction mean score was significantly higher than the score obtained in current method (P < 0.000). The most satisfactory domains in the current method were “consistence with learning objectives” (71.2 ± 14.9) and “objectiveness” in DOPS (87.9 ± 15.0). In contrast, the least satisfactory domains in the current method were “interested in applying the method” (57.8 ± 26.5) and “number of assessments for each skill” (58.8 ± 25.9) in DOPS method. This study showed that DOPS method is associated with greater students’ satisfaction. Since the students’ satisfaction with the current method was also acceptable, we recommend combining this new clinical evaluation method with the current method, which covers its weaknesses, to promote the students’ satisfaction with clinical evaluation methods in a perfect manner.

Stress is a nonspecific reaction to everything the body needs. Although occupational stress exists in every occupation, it is seen with more frequency and intensity amongst those occupations related to human health. In this study, we aimed to investigate the level of occupational stress in operating room staffs working in the hospitals affiliated to Isfahan University of Medical Sciences and its association with some factors. This is a descriptive co‑relational study conducted in summer 2010. The population studied comprised 100 OP staffs working in hospitals affiliated to Isfahan University of Medical Sciences. The data were collected by a questionnaire including two sections of personal information and Toft-Anderson Standard occupational stress inventory. The first section contained 13 questions and the second included 34 questions on stressful factors, measured through Likert’s scale in which the scores of 0-33 indicated mild stress, 34-66 indicated moderate stress, and 67-100 indicated acute stress. The data were analyzed through SPSS. The statistical tests of Pearson correlation, variance analysis, and independent t‑test were employed to analyze the data (P < 0.05 was considered significant). Based on the findings, mean score of staffs’ stress (out of 100) was 32.3 (12.9) and was in the range of 1-65. The highest frequencies were for mild stress (57.4%) and moderate stress (42.6). In addition, mean score of stress was not the same in different domains. There was a significant inverse association between the score of stress and monthly working hours (r = -0.21, P = 0.049). Mean score of stress was 28.1 (12.3) among those with average income and 33.8 (12.8) for the low‑income subjects, showing a significant difference (P = 0.048).Discussion and The present study showed that most of the subjects suffer from mild stress. Since the highest level of stress was for work overload, it is suggested to reduce the staffs’ work overload by employing capable and knowledgeable work force and enhancing their scientific and practical abilities.

Breast cancer is the most common malignancy among Iranian women and is a significant stressor in women’s life that may affect their coping strategies and quality of life. This study aimed to investigate coping strategies, quality of life and pain of women with breast cancer. This was a cross‑sectional study which held in Seyed‑AL shohada hospital and two private offices in Isfahan, Iran. Target population was women with confirmed diagnosis of breast cancer in a recent year and between 18 and 60 years old. Data were collected via3 questionnaires (Brief cope, EORTC QLQ‑C30 and Brief pain Inventory). The reliability and validity of these questionnaires were confirmed in different studies. Sixty‑two patients completed the questionnaires. Analysis included descriptive statistics and Pearson correlation coefficient and t‑test where necessary. All analysis were conducted using the SPSS version 16.0 and P‑value of less than 0.05 considered as statistically significant. Sixty‑two women with breast cancer completed questionnaires. The mean age of respondents was 45/81±6/78 years; most married (93/5%), high school‑educated (41/97%), house wife (82/3%) and stage II (46/8%). The most common coping strategies were religion, acceptance, self‑distraction, planning, active coping, positive reframing and denial. Mean score for the worst pain during the past 24 hours was 6/24 ± 2/55 and for the least pain was 3/19 ± 2/17. The global health scale was 60.34 ± 21.10. Emotion‑focused coping strategies were positively and significantly related to symptom aspect of quality of life (r = 0/43 P ≤ 0/01) and affective interference of pain (r = 0/36 P = 0/004) and also was inversely correlated to functional health status (r = ‑0/38 P = 0/002). There was no significant correlation between problem‑focused coping strategies and dimensions of quality of life and also different aspects of pain. The findings of this study indicated that the care of breast cancer should address physical, psychological and social wellbeing and the findings point to the importance of taking individual coping strategies into account when evaluating the impact of breast cancer on psychosocial wellbeing. Description of coping strategies might be useful for identifying patients in need to particular counseling and support.

One of the first‑line assessment tools for fetal surveillance is nonstress test (NST), although it is limited by a high rate of false‑nonreactive results. This study was performed to investigate if external stimulation from vibroacoustic and halogen light could help in provoking fetal responsiveness and altering NST results. This is a clinical trial. Sampling was done from April to July 2010. One hundred pregnant women with nonreactive NST for 20 min were allocated in two groups: Vibroacoustic stimulated NST (VNST, n = 50) who received vibration from a standard fetal vibratory stimulator and halogen light stimulated NST (LNST, n = 50) who received a halogen light source for 3 and 10 sec, respectively. Results were compared together and then compared to biophysical profile (BPP) scores as a backup test. We used Mann-Whitney U test, Chi‑square test, and Fisher’s exact test to compare the variables in the two groups through SPSS version 14. P < 0.05 was considered as statistically significant. Following stimulations, 68% nonreactive subjects in halogen light stimulation group and 62% in vibroacoustic stimulation group changed to reactive patterns. Time to onset of the first acceleration (VNST: 2.17 min; LNST: 2.27 min) and the test duration (VNST: 4.91 min; LNST: 5.26 min) were the same in the two groups. In VNST 89.5% and in LNST 87.5% of nonreactivity followed by score 8 in BPP. There was no significant relation between stimulus NSTs and BPPs. Vibroacoustic and light stimulation offer benefits by decreasing the incidence of nonreactive results and reducing the test time. Both halogen light stimulation and vibroacoustic stimulation are safe and efficient in fetal well‑being assessment services.

Endotracheal suctioning (ETS) is one of the most common supportive measures in intensive care units (ICU). ETS may be associated with complications including hypoxia and tachycardia. Closed system suctioning (CSS) decreases the rate of cardiorespiratory complication mainly due to continuation of ventilatory support and oxygenation during procedure. CSS has questionable efficacy, therefore higher values of negative pressure has been recommended to enhance the efficacy of CSS. This study was designed to evaluate the effects on gas exchange of 200 mmHg suctioning pressure compared with 100 mmHg in CSS Fifty mechanically ventilated (MV) ICU patients were selected for the study. Two consecutive ten seconds CSS using suction pressures of 100 and 200 mmHg, in random order applied in each subject with the two hours wash out period. Effects of two levels of suction pressure on gas exchange were measured by recording the SPo2 values at 4 times. Repeated measure analysis of variance didn’t show any significant difference between two levels of pressure (P = 0.315), but within each groups (100 and 200 mmHg) SPO2 changes was significant (P = 0.000). There was a mild but significant and transient increase in heart rate following both suction pressures, but no significant difference between two groups. The results show that CSS with suction pressure 200 mmHg has no detrimental effect on cardiorespiratory function of MV ICU patients. Since the safety of 200 mmHg suctioning pressure was approved, using 200 mmHg suction pressures is recommended for ETS of MV patients.

Job satisfaction among nurses has consequences on the quality of nursing care and accompanying organizational commitments. Nursing procedure measurement (NPM) is one of the essential parts of the performance‑oriented system. This research was performed in order to determining the job satisfaction rate in selected wards of Baqiyatallah (a. s.) Hospital prior and following the NPM. An interventional research technique designed with an evaluation study approach in which job satisfaction was measured before and after NPM within 2 months in selected wards with census sampling procedure. The questionnaire contained two major parts; demographic data and questions regarding job satisfaction, salary, and fringe benefits. Data analyzed with SPSS version 13. Statistical evaluation did not reveal significant difference between demographic data and satisfaction and/or dissatisfaction of nurses (before and after nursing procedures measurement). Following NPM, the rate of salary and benefits dissatisfaction decreased up to 5% and the rate of satisfaction increased about 1.5%, however the statistical tests did not reveal a significant difference. Subsequent to NPM, the rate of job value increased (P = 0.019), whereas the rate of job comfort decreased (P = 0.033) significantly. Measuring procedures do not affect the job satisfaction of ward staff or their salary and benefits. Therefore, it is suggested that the satisfaction measurement compute following nurses’ salary and therefore benefits adjusted based on NPM. This is our suggested approach.

Primary dysmenorrhea refers to the occurrence of painful menstrual cramps of uterus and is considered as a gynecological complaint. The common treatment for this problem is medical therapy such as mefenamic acid [non‑steroidal anti‑inflammatory drugs (NSAIDs)] and oral contraceptive pills, both of which work by reducing myometrial activity. Fennel contains an antispasmodic and anethol agents and may be helpful for management of primary dysmenorrhea. The aim of this study was to evaluate the effects of oral fennel drop for treating primary dysmenorrhea. In this randomized clinical trial study, fennel drop 2% was compared with mefenamic acid for reducing pain of primary dysmenorrhea. Sixty college students suffering from primary dysmenorrhea were randomly assigned to two groups and followed up for two cycles. Statistical analysis was performed using SPSS version 16. P < 0.05 was considered to be statistically significant. Parametric and non‑parametric tests were adopted. Comparison of pain intensity in the two groups showed that there was no significant difference in pain relief between the two groups. Comparison of bleeding severity in the study group before and after intervention was demonstrated from the first day to the fifth day (PV on first day, second day, third day, fourth day, and fifth day 0.948, 0.330, 0.508, 0.583, 0.890, respectively). It seems that fennel can be effective in reducing the severity of dysmenorrhea, but it has an unpleasant taste in view of most of the volunteers.

The related literatures revealed that there is a lack of effective patient/family education in the health care centers. Several studies indicate that patients, while getting discharged from hospitals, receive insufficient information about their illness and self‑care. The purpose of the study was to explore the factors influencing patient education from the perspectives of nurses in Iran. Settings and Design: We conducted a qualitative study using a content analysis approach. We used a purposive sampling technique to recruit and interview 18 nurses with at least 2 years of working experience in the cardiac care unit (CCU) and post‑CCU ward of two educational hospitals in Tehran related to Tehran University. Data were collected through face‑to‑face audio‑taped interviews and field observations.Statistical Analysis Used: The interviews were transcribed verbatim and analyzed concurrently with data collection. The major theme extracted in this study was the inappropriate organizational culture which includes eight categories listed as follows: Not putting value on education, non‑professional activities, physician‑oriented atmosphere, conflict and lack of coherence in education, inappropriate communication skills, ignoring patient’s right in education, lack of motivation, rewarding system in the organization, and poor supervision and control. The results of this study show that according to the participants’ perspective, organizational culture is in a poor level. So, to improve the performance of nurses, it is necessary to increase their motivation through optimization of organizational culture.

Studies showed that poor quality of sleep is a common problem among the elderly. Because of drug complications and side effects such as drug dependency and resistance and decrease of sleep depth in long‑term intake of sleep medication, cognitive‑behavior therapy including sleep restriction therapy which does not cause these problems is more considered. This is a quasi‑experimental study on 38 elderly who were members of jahandidegan canter in Shiraz. The subjects were selected according to the inclusion criteria and were divided into experimental and control groups. The Pittsburgh Sleep Quality Index (PSQI) was used for evaluation of sleep quality. A 4 week sleep restriction therapy was implemented for experimental group and finally both groups were compared. The data were analyzed by Kolmogorov‑Smirnov test, independent and dependent t‑tests in significance level of 0.05. Mean sleep quality decreased from 14.21 to 11.26 after the intervention in the experimental group while it was 13 before intervention and decreased to 12.78 after the intervention in the control group. Independent t‑test showed a significant difference after the intervention (P = 0.038). Mean of sleep medication intake and daytime dysfunction after intervention were 0.947, 1.94 in experimental group and 0.894, 1.63 in control group respectively, which showed no significant difference (P = 0.903, P = 0.272). This study indicated that sleep restriction therapy can improve quality of sleep, but the amount of sleep medication intake and daytime dysfunction did not show a significant difference after intervention.

Caring is the essence of nursing. Since care is influenced by cultural, economic, and social factors, various diverse barriers exist in the realization of care. The aim of the study was to clarify barriers to caring in emergency patients based on experiences of nurses and patients and their relatives. A qualitative design of content analysis was used to identify the barriers to caring in emergency patients. In‑depth interviews were conducted with 18 Iranian nurses working in a university hospital emergency ward and with seven patients. Participants were selected purposefully. Data were analyzed according to qualitative content analysis. After the classification analyses and integration of codes, seven categories were acquired. Finally, following three themes were extracted: Identified barriers to nursing care in emergency wards – the nature of critical ward, performance weakness of nurses, and deficiency in clinical management. According to the results of this study fundamental and management education for nurses, empowerment of nurses, principle and scientific triage, effective supervision, nurses’ support, wage increase, and motivation in nurses are important to achieve the research purpose.

Heart failure is one of the chronic heart diseases and a debilitating condition of increased prevalence in the elderly. One of the important and non‑pharmacological strategies for improving clinical outcomes in these patients is promotion of the self‑care. Background and social environment in which a patient is trying to control his disease is an important factor in the self‑care. The aim of this study was to evaluate the effects of family support intervention on the self‑care behaviors in patients with heart failure. This study was a randomized clinical trial conducted in university hospitals in Isfahan, Iran, in 2012. A total of 62 patients with heart failure were randomly assigned to experimental (n = 32) and control (n = 32) groups. Supportive intervention including three educational sessions with the delivery of educational booklet and follow‑up by telephone was performed for caregivers of patients in the experimental group. Data were collected using the questionnaire of self‑care behaviors, which was completed before and 1 month after the intervention in both the groups, and the questionnaires were analyzed using descriptive statistics and independent and paired t‑tests. The results indicate that after the intervention, self‑care behavior scores in the experimental group and control group were 47.2 and 28.4, respectively, and independent t‑test revealed that the difference was statistically significant. Family‑focused supportive interventions can be used as an effective method for improving the self‑care behaviors in patients with heart failure.

Background and With regards to the importance of women’s beliefs in improving pregnancy outcomes, this study was performed to determine the perceived internal control on future pregnancy outcomes and its related factors in women who participated in pre‑marital counseling. In a cross‑sectional study, women’s perceived internal control was investigated. The study population comprised the women in reproductive age of whom 400 were selected by random sampling. Data collection instrument was a questionnaire consisting of demographic, pre‑conceptional care, and internal control questions. Two categories of favorite and not favorite levels of internal control were defined based on the total score. The validity of the questionnaire was determined via content validity method by use of experts’ opinion and its reliability was evaluated through the calculation of Cronbach’s alpha coefficient which was 0.76. Data were analyzed through frequency tables, correlation coefficient, and Chi‑square test at the confidence level of 0.95. Two hundred sixty‑five (65%) women had a good perceived internal control and it was significantly associated with the age, educational level, and hearing about pre‑conceptional care. The internal control score also showed a positive and significant correlation with both age and the subject knowledge about folic acid (r = 0.19 and r = 0.15, respectively). The majority of women had a favorite perceived internal control. Since age and educational level were the affecting factors on the perceived internal control of women, promoting the level of internal control in young women and those with low education in pre‑marital counseling classes seems necessary.

Spirituality is recognized as a personally important matter to the elderly, and there are evidences of its impact on their health. The aim of this study was to explore the concept of spirituality from the perspectives of Iranian healthy elderly individuals. A conventional qualitative content analysis of carried out with 21 healthy elderly people from both male and female genders were chosen using a purposive sampling method in Tehran in 2010‑2011. Data collection was done through semi structured interviews. A qualitative content analysis was used to analyze the participants’ experiences and perceptions on spirituality, using a central question ‘what characterizes the spirituality in the Iranian healthy elderly people?’ The following categories emerged from the data analysis: (1) Spiritual health, with four sub categories including saying prayer as a calming factor; beneficence as a way to God; loss of psychological and spiritual support; faith as a way to happiness; (2) spiritual beliefs, with three sub categories including seeking help from God in difficulties; God‘s power over life and death; doing good deeds is the God’s will; and (3) religious practice with three sub categories including saying prayer; reading Quran; and going to mosque, religious ceremonies and pilgrimage. In this study was found that spirituality was a fundamental element in elderly individuals’ lives that help them to adapt with daily living conditions.

Nursing education is mostly conducted through electronic educational programs. We aimed at assessing the Iranian postgraduate nursing students’ skills and attitudes regarding the electronic education. Ninety‑seven postgraduate nursing students were surveyed using questionnaires assessing their individual‑social and educational characteristics, electronic education skills, and attitudes toward the electronic education. Scores of the students’ skills in using computer and the Internet were significantly associated with gender and the number of hours working with computer and the Internet at home and work. Prerequisites for performing electronic education programs are present at moderate levels in Iran.