Iranian Journal Of Nursing and Midwifery Research
Volume:18 Issue: 4, Jul-Aug 2013

By increasing the survival of immature newborns, intravenous access methods, used to provide intravenous therapy, became more important. More attention has been recently paid on peripherally inserted central venous catheters in newborns, although it is yet unknown in Iran. In this study, we tried to discover the barriers to spread the usage of peripherally inserted central venous catheters (PICC) in the neonatal intensive care units of hospitals affiliated to Isfahan University of Medical Sciences. In this descriptive explorative qualitative research, conducted from December 2011 to April 2012 with purposeful sampling and snowball method, participants were selected from nurses and residents of neonatology and neonatal specialists working in Alzahra, Shahid Beheshty, and Amin hospitals, until data saturation occurred. Data were analyzed with thematic analysis proposed by Broun and Clarke in 2006. Data analysis yielded 175 initial codes, 12 sub-themes, and 3 main themes. The main themes included barriers related to procedure and maintenance, barriers related to persons providing care, and barriers related to management and planning. One of the major problems in premature newborns during hospitalization is long-term and safe intravascular access; therefore, more use of PICC is needed. A complete planning is also needed to eliminate barriers and to provide required catheters. Educating the personnel is also necessary.

The primary goal of antenatal testing is to identify fetuses at risk of intrauterine neurologic injury or death so that these adverse outcomes can be prevented. We want to assess nonstress test (NST) results and some parameters before and after vibro-acoustic stimulation and acupressure. We did a randomized controlled clinical trial in Shahid-Beheshti Hospital in Isfahan in 2011. A total of 64 pregnant women (32-36 weeks) in prenatal care unit were selected for vibro-acoustic stimulation (n = 32) and acupressure (n = 32) during the second NST. The statistical processing was performed by descriptive, paired t-test, analysis of variance (ANOVA), chi-square, and McNemar test through SPSS version 20. The mean baseline fetal heart rate (FHR) in vibro-acoustic and acupressure groups before and after stimulations did not differ significantly. The mean time of first acceleration in vibro-acoustic group was decreased after stimulations significantly, but in the acupressure group it did not differ statistically. The numbers of accelerations in both groups did not differ significantly before and after stimulation. The mean time of second acceleration in the vibro-acoustic group was 6.7 min before stimulation and 3.9 min after stimulation. This decrease was significant. The mean time of second acceleration after stimulation was lower than before significantly in the acupressure group. The frequency of reactive NST was same in both groups, before and after stimulation. Vibro-acoustic stimulation and acupressure of acupoint BL67 did not change FHR parameters but they could decrease the time of reactive result of NST.

Metaparadigm of nursing is one of the nursing discipline challenges of the present century, which should take into consideration the diversity of different cultures and viewpoints. The purpose of this study is to evolve the concept of “nursing” (one of the concepts in nursingmetaparadigm) on the basis of the Islamic scholars’ view. In this philosophical inquiry, we sought to clarify the concept of nursing according to the ideas derived from the Islamic scholars’ view. To achieve the research objectives, Islamic texts were studied and analyzed based on the criteria of concept anatomy (definition, attributes/characteristics, and boundaries). Based on Morse’s criteria, with regard to Islamic thought, the concept of nursing in scientific literature is an immature concept. In Islamic viewpoint, human is a unique and integrated reality that implies a holistic paradigm in nursing theories. Since in Islamic thought human is described precisely and delicately, nursing concept can be delineated more clearly and can be helpful in enhancing and producing nursing clinical knowledge, nursing care, and nursing philosophy, specially clarifying holistic nursing. According to the criteria of concept anatomy, nursing is caring for and fulfilling the needs of patients, and it believes that nursing has a holistic paradigm and includes all of the dimensions and aspects of human beings.

Nausea and vomiting are the most common and unpleasant side effects of chemotherapy, and they may prevent successful treatment completion. Antiemetics not only cannot control nausea and vomiting completely but also have numerous side effects. So it is necessary to find other methods for a better control. This study aimed to assess the effect of massage therapy on chemotherapy-induced nausea and vomiting in pediatric cancer. In this randomized controlled clinical trial study, 70 patients (4-18 years of age) under chemotherapy were divided into two (massage therapy and control) groups randomly. In the massage group at 0.5 h and 24 h before and 24 h after chemotherapy, the patients were massaged (Swedish massage) for 20 min, respectively. All indices of nausea and vomiting (incidence, severity, time, and length) were assessed by Visual Analogue Scale (VAS) and BARF scales and other questionnaires and documented. The results of Mann–Whitney and chi-squire tests indicated that in the massage group, the incidence of nausea was 25.7%, the severity, length, and times of nausea were 20%, 54 min, and 0.35 times, respectively, and the severity and times of vomiting were 0.24 scores and 0.31 times lower than those of the control group (P < 0.05), respectively. But vomiting incidence in the two groups showed no significant difference (P = 0.192). Massage therapy reduced chemotherapy-induced nausea and vomiting. So, nurses can use it and educate it to the patients’ families. Nurses, besides using it clinically, can provide instructions to families for involving them in the treatment process and they feel they are more efficate in care of their suffering children.

x Self-esteem is essential for clinical judgments. Nursing students in clinical environments should make a bridge between theoretical education and clinical function. This study was aimed to survey the effect of guided questioning in peer groups on nursing students’ self-esteem and clinical learning. In this quasi-experimental study, all nursing students in semester 4 (60) were selected. The autumn semester students (n = 28) were chosen as the control group, and the spring semester students (n = 32) as the experimental group. The experimental group underwent the course of cardiac medical surgical training by the Guided Reciprocal Peer Questioning. The control group was trained by lecture. After confirmation of the validity and reliability of tools including Rosenberg Self-esteem Scale and the researcher-made questionnaire, data were collected and analyzed by SPSS version 17.0. There was no significant difference concerning demographic and educational characteristics between the two groups. Mean score differences of self-esteem and learning were not significant before teaching, while they were significantly promoted after teaching in the experimental (P < 0.001) and control (P < 0.05) groups. Promotion in the experimental group was more considerable than in the control group. As revealed by the results, inquiry method, due to its more positive impact on self-esteem and students’ learning, can be applied alone or in combination with the other methods. Conducting this study for other students and for theoretical courses is suggested.

Learning of clinical skills in the intensive care unit (ICU) is important for nursing students. “Direct observation of procedural skills (DOPS)” is a modified objective method in the field of medical sciences, and we conducted this study with the aim of investigating the effect of evaluation using DOPS method on learning practical skills among nursing students in the ICU. This semi-experimental study was conducted on 39 nursing students of the 7th semester (20 in the intervention group and 19 in the control group). First, the control group students spent their apprenticeship by the routine assessment method. The intervention group underwent formative evaluation using DOPS method in addition to the routine one. At the beginning and end of the period, skill levels of both groups in performing two optional procedures (arterial blood sampling and endotracheal suctioning) were evaluated using checklists, and each student’s skill score was calculated in a range of 0-20. Period initiation and termination scores were considered as pre- and post-test values, respectively. The results showed no significant difference in pre-test scores between the two groups (P > 0.05), whereas the mean difference of post-test scores was significant for both procedures between the two groups (P < 0.001). Difference between the mean values of pre- and post-test scores of the two procedures for both intervention and control groups was significant (P < 0.001). Our findings indicate that DOPS formative assessment, more than the routine approach, increases arterial blood sampling and endotracheal suctioning skills in the ICU. Therefore, it is recommended that this method be used in other wards as well as for other skills.

Nursing burnout is the main characteristic of job stress that is a delayed reaction to chronic stressful situations in the workplace which could affect nurses who do not have sufficient emotional energy to cope and communicate with different types of patients. There is also sometimes this belief that they do not have the required capabilities for their jobs. The aim of this study was the evaluation of burnout among nurses working in medical and educational centers in Shahrekord. This descriptive study was performed on 340 nurses working in medical and educational centers in Shahrekord in 2009. Samples were selected using proportionate random sampling. Demographic information and the Maslach Burnout Inventory (MBI) were filled in for all nurses. Burnout was considerable among nurses. The results showed that 34.6, 28.8, and 95.7% of the nurses had emotional exhaustion (EE), high depersonalization (DP), and high reduced personal accomplishment (PA), respectively. The mean scores (± standard deviation) for EE, DP, and PA were 22.77 (12.44), 6.99 (6.23), and 32.20 (9.26), respectively. Our results showed that burnout was noticeable among nurses working in medical and educational centers in Shahrekord. Disproportionate relationship between the number of nurses, workload, and income was the most important factor affecting nursing burnout. Due to the importance of nursing in the health-care system, policy makers should adopt suitable strategies for increasing the satisfaction of nurses.

Labor pain is one of the severest pains that cause many women request cesarean section for fear of pain. Thus, controlling labor pain is a major concern of maternity care. Nowadays, interest in non-pharmacological pain relief methods has been increased because of their lower side effects. The effects of discrete heat and cold on decreasing labor pain have been reported but there was no evaluation of the effects of simultaneous heat and cold. The aim of this study was to investigate the effect of intermittent heat and cold on pain severity and childbirth outcomes. This study was a randomized controlled trial. Sixty-four nulliparous women with term, One fetus, andlow-risk pregnancy were divided into the intervention (32 participants) and the control group (32 participants) by random allocation. Excluding criteria were: administration of pain relief drugs, skin disease in the field of intervention, fetal distress, bleeding, fever, and disagreement with participation during the first phase and on perineum during the second phase of labor. Pain intensity was assessed with Visual Analogue Scale. Descriptive statistic, chi square, and t-test were used for data analysis. There were no significant differences in demographic and midwifery characteristics and the baseline pain between two groups. The pain was significantly lower in intervention group during the first and second phases of labor. Duration of the first and third phases of labor was shorter in the case group. There were no significant differences in type of delivery, perineal laceration, oxytocin uptake, fetal heart rate, and APGAR between two groups. Local warming with intermittent cold pack can reduce labor pain without adverse effects on maternal and fetal outcomes. It is an inexpensive and simple method. Intermittent local heat and cold therapy is a no pharmalogical, safe andeffective method to relief labor pain.

Diabetes is a major health problem, which has a wide prevalence in the world. There is no sign of its stopping, but it is increasing. Diabetes in children is three to four times more common than other childhood diseases. Diagnosis of diabetes for children causes emotional responses in parents and family members. Interventions for children with diabetes involve the family, child, and professionals including physicians, nurses, and nutritionist. Self-care is difficult without direct parents’ participation. According to studies, burden of diabetes for mothers is more than for fathers. This study aimed to explore mothers’ experience of children with diabetes. This is a qualitative content analysis. Study population was recruited through purposeful sampling. Elevenmothers who have a child with diabetes and referring to the “Glands and Metabolism Research Center” and “Al-Zahra Hospital” were selected. Participants were aged 28 to 42 years. Data gathering was done through deep interviews with participants in 2007 that was tape-recorded. Mean average of interviews was 45 minutes. Data analysis was done using conventional qualitative content analysis. Participants’ experience was classified in the two main concepts including reaction at the time of diagnosis and disease consequences for mothers. Mothers of children with diabetes expressed some reactions at the time of diagnosis, which was mainly due to lack of information, and lack of attention to their needs at the time of diagnosis, especially it was due to the sudden diagnosis and lack of enough opportunities for mothers to accept the disease. The disease causes some consequences for mothers that affect their lives. Therefore, it is necessary to consider the needs of families of children with diabetes and to provide support and sufficient information about their child’s illness for them.

According to the biopsychosocial model, menstrual symptoms are caused not only by a combination of biological factors such as hormonal disorders and lifestyle, but also by psychological and social factors such as working environment. This study aimed to determine the relation between occupational stress and dysmenorrhea in Iranian midwives. This prospective correlational study was performed on 150 midwives at public and private hospitals and health care centers of Mashhad, Iran. The subjects were selected through two-stage cluster sampling during 2010-2011. At the beginning of the study, participants completed questionnaires containing demographic information, work circumstances, the 21-item Depression, Anxiety, and Stress Scale, and the Job Content Questionnaire. They then completed the short form of daily Menstrual Distress Questionnaire during three consecutive menstrual cycles. Independent Student’s t-test, one-way analysis of variance, Kruskal–Wallis, Mann–Whitney, and chi-square tests, correlation coefficients, and linear regression analysis were used to analyze the data collected data in SPSS11.5. Dysmenorrhea was observed in 63.3% of the participants. Among these individuals, 15.7%, 45.2%, and 38.9% had mild, moderate, and severe symptoms, respectively. Moreover, 59.3% of the studied midwives had severe occupational stress. There was a significant positive correlation between occupational stress and severity of dysmenorrhea (P = 0.002, r = 0.82). Occupational stress is associated with increased risk of severe dysmenorrhea. This finding can be used to guide preventive measures to eliminate or decrease occupational stress and dysmenorrhea among Iranian midwives. However, identification of sources of occupational stress and related workloads is necessary.

Because of unemployment and inadequate education and health services, high rate of maternal and infant mortalities, a rapidly growing population is a serious problem in Turkey. Social values and attitudes of women might be effective in using modern family planning methods. Our aim in this study was to evaluate the factors concerning the attitudes of married women toward family planning. Four hundred and twenty-seven women were randomly selected among 29,874 women and included in this cross-sectional study. The study was conducted between June 2008 and September 2008, and included married women between 15 and 49 years of age, living in the provincial centre of Aydin, a city in western Turkey. The study data were obtained using a questionnaire and the Family Planning Attitude Scale. Of the women participating in the study, 60.4% used modern methods and 26.0% used conventional methods. These variables included, in a descending order of contribution to the model’s power, having a college degree, being a primary schoolgraduate, the longest period of rural life, use of conventional methods, discussing with one’s spouse issues about family planning, and age and high perception of income level. Reorganization of family planning services by giving priority to women living in rural areas with low income and education level and conventional contraception method use could contribute to positive attitudes toward family planning. Including their spouses to this reorganization may enhance the impact.

Surgery is a stressful condition for both patient and family members. This anxiety may interfere with the adequate family functioning and in providing positive support for the patient. Thus, specialized assessment and interventions to reduce anxiety level of family members are essential. The aim of this study was to assess the effect of watching movie on anxiety level of family members during their relatives’ surgery. This was a before-after trial study conducted in Alzahra Medical Center, Isfahan, Iran. Between February 2010 and November 2010, 164 eligible family members in the surgical waiting room who met the inclusion criteria entered in the study. Before and after watching movie, the anxiety level was evaluated using the State-Trait Anxiety Inventory (STAI).Chi-squares, ANOVA and paired- t test were used for analysis using the Statistical Package for Social Sciences (SPSS, Version 14) for Microsoft Windows. The study population were 164 people, of whom 87 (53%) were female and 77 (47%) were male. The mean age of participants was 36.6 (SD: 8.4) years ranging from 18 to 67 years. After watching movie, the mean STAI score reached from 46.06 (SD: 9.26) to 39.15 (SD: 11.81) and this difference was statistically significant (p = 0.003). The results of this study indicated that watching movie could reduce family members’ anxiety during surgery. The findings suggested that movie might be a simple and cost-effective tool to help family members to manage anxiety during surgery of their relatives.

Interprofessional teamwork is considered as the key to improve the quality of patient management in critical settings such as trauma emergency departments, but it is not fully conceptualized in these areas to guide practice. The aim of this article is to explore interprofessional teamwork and its improvement strategies in trauma emergency departments. Participants of this qualitative study consisted of 11 nurses and 6 supervisors recruited from the emergency departments of a newly established trauma center using purposive sampling. Data were generated using two focus group and six in-depth individual interviews, and analyzed using qualitative content analysis. Interprofessional teamwork attributes and improvement strategies were emerged in three main themes related to team, context, and goal. These were categorized as the effective presence of team members, role definition in team framework, managerial and physical context, effective patient management, and overcoming competing goals Interprofessional teamwork in trauma emergency departments is explained as interdependence of team, context, and goal; so, it may be improved by strengthening these themes. The findings also provide a basis to evaluate, teach, and do research on teamwork.

In recent years, there is a growing appreciation of the stresses involved in nursing training. It is important for nursing educators to know the prevalence of psychological distress and psychological well-being among nursing students. The present study aimed to assess perceived stress in the undergraduate students studying in a nursing college located in North India. The present cross-sectional study was carried out at College of Nursing, Maharishi Markandeshwar University, Haryana, in the month of August 2011 using pretested self-administered questionnaire. Perceived stress score was measured using perceived stress scale (PSS). The mean perceived stress score of all 282 students was 28.67 (SD = 5.32), with a median of 26 (IQR = 22–34). Female students had more perceived stress score (31.33) than male students (26.01). The maximum mean perceived stress score (29.66) was observed in 2nd year students, and the least mean perceived stress score (26.28) was found in 3rd year students. The present study indicates high levels of psychological disturbance among nursing undergraduate students in the middle phase of the course. Hence, there is an urgent need to take measures by the authorities to reduce stress among the nursing students.