Iranian Journal Of Nursing and Midwifery Research
Volume:19 Issue: 1, Jan-Feb 2014

Professionalism is an important feature of the professional jobs. Dynamic nature and the various interpretations of thisterm lead to multiple defi nitions of this concept. The aim of this paper is to identify the core attributes of the nursing professionalism. We followed Rodgers’ evolutionary method of concept analysis. Texts published in scientifi c databasesabout nursing professionalism between 1980 and 2011 were assessed. After applying the selection criteria, the fi nal sampleconsisting of 4 books and 213 articles was selected, examined, and analyzed in depth. Two experts checked the process ofanalysis and monitored and reviewed them. The analysis showed that nursing professionalism is determined by three attributes of cognitive, attitudinal, andpsychomotor. In addition, the most important antecedents concepts were demographic, experiential, educational, environmental,and attitudinal factors. Nursing professionalism is an inevitable, complex, varied, and dynamic process. In this study, the importance, scope,and concept of professionalism in nursing, the concept of a beginning for further research and development, and expanding thenursing knowledge are explained and clarifi ed.

Dystocia is one of the important causes of maternal morbidity and mortality in low-income countries. This study wasaimed to determine the diagnostic accuracy of maternal anthropometric measurements as predictors for dystocia in nulliparous women. This prospective cohort study was conducted on 447 nulliparous women who referred to Omolbaninhospital. Several maternal anthropometric measurements such as height, transverse and vertical diameters of Michaelis sacralrhomboid area, foot length, head circumference, vertebral and lower limb length, symphysio-fundal height, and abdominal girthwere taken in cervical dilatation ≤ 5 cm. Labor progression was controlled by a researcher blind to these measurements. Afterdelivery, the accuracy of individual and combined measurements in prediction of dystocia was analyzed. Dystocia was defi nedas cesarean section and vacuum or forceps delivery for abnormal progress of labor (cervical dilatation less than 1 cm/h in theactive phase for 2 h, and during the second stage, beyond 2 h or fetal head descend less than 1 cm/h). Among the different anthropometric measurements, transverse diameter of the Michaelis sacral rhomboid area ≤9.6 cm,maternal height ≤ 155 cm, height to symphysio-fundal height ratio ≤4.7, lower limb length ≤78 cm, and head circumference to heightratio ≥ 35.05 with accuracy of 81.2%, 68.2%, 65.5%, 63.3%, and 61.5%, respectively, were better predictors. The best predictorwas obtained by combination of maternal height ≤155 cm or the transverse diameter of the Michaelis sacral rhomboid area ≤9.6cm and Johnson’s formula estimated fetal weight ≥3255 g, with an accuracy of 90.5%, sensitivity of 70%, and specifi city of 93.7%. Combination of other anthropometric measurements and estimated fetal weight with maternal height in comparisonto maternal height alone leads to a better predictor for dystocia.

Addiction, especially addiction quitting, has been the main problem of health systems of many countries in recent years. High percentage of addiction recurrence (more than 80%) indicates that the nature and therapeutic method of addiction have not been recognized and it demands more efforts in this field. Thus, the present study was conducted with an aim to examine the effect of Bandura’s social cognitive theory implementation on addiction quitting of clients referred to Imam Reza Hospital addiction quitting clinic.This two-group experimental study was conducted on 60 clients (30 clients in test group and 30 in control group) referred to Imam Reza Hospital addiction quitting clinic. The study tools were demographic and addiction-quitting self-efficacy questionnaires. After gathering demographic data and conducting pretest, the intervention was carried out based on Bandura’s social cognitive theory for the test group and post-test was taken 1 month after the intervention. Data were analyzed by SPSS using related tests.According to the results, test group was more successful than the control group in addiction quitting. There was a significant difference between the two groups in terms of recurrence; it was less in the test group. A significant difference was also found between self-efficacy scores before and after the intervention in the test group.Using Bandura’s social cognitive theory was effective on addiction quitting. So, it is recommended to apply it for clients referring to addiction quitting clinics.

Pain originating from intramuscular (IM) injection should not be underestimated, because it can damage the nurse–patient relationship. This research aimed at answering two main questions, whether acupressure is effective on pain severity dueto IM injection or not and whether pain severity in two groups is different or not. This research was performed in government-affi liated hospitals of Ilam. The patients were 15-55 yearsold. Subjects were individually asked to participate in the research, and an informed consent was obtained from them. Beforeinjection, the patients were asked to lie in prone position and the acupressure point UB32 was found. It was pressed for 1 mincircularly. Then, the acupressure point was pressed directly (pressure equal to 4.5 kg/cm2) by thumb three times sequentially.After acupressure, 3 ml penicillin 6.3.3 was injected to buttock muscle. In the control group was injected only penicillin 6.3.3 bythe conventional method. Collected data were analyzed by SPSS 16 version. Means of pain intensity in the acupressure group according to body mass index values (BMIs) were 1.50 ± 0.75 inthin, 1.64 ± 0.72 in normal, 1.38 ± 0.60 in overweight, 1.40 ± 0.54 in obese, and 1 ± 0.0 in severely obese subjects, with a totalscore of 1.53 ± 0.68. Analysis of variance (ANOVA) showed no signifi cant difference between mean pain intensities based onBMI. There was no signifi cant difference in the two groups concerning BMI and age (age: 30.24 ± 10.98 vs. 29.26 ± 10.07;BMI: 23.74 ± 4.45 vs. 23.88 ± 5.74), but the difference between them in terms of pain intensity mean was statistically signifi cant. It is concluded that acupressure in UB32 is effective on reducing the pain severity. Pain severity mean in theacupressure group was lesser than in the other group, and t-test showed a signifi cant difference between the two groups.

Gender role attitudes toward sexual matters may define suitable and appropriate roles for men and women during a sexual relationship. This study aimed to explore and assess gender-based sexual roles in Iranian families. This was an exploratory mixed methods study in which perceptions and experiences of 21 adult Iranian participants about gender-based sexual roles have been explored in three provinces of Iran in 2010-2011, to generate items for developing a culture-oriented instrument to assess gender role attitudes. The developed and validated instrument, then, was applied to 390 individuals of general population of Tehran,Iran in 2012. In content analysis of the qualitative phase data, four categories emerged as the main gender-based sexual roles: Decision making, relationships, care, and supervision and control. After passing the stages of item reduction, seven items remained for the instrument. In the quantitative phase, results showed thatmost of the participants (78.9%) believed in shared sexual roles forboth genders. Consideration of a sexual role as “entirely masculine” or “preferably masculine” was the second prevalent attitude in 71.43% of gender-based sexual roles, whereas “entirely” or “preferably feminine role” was the second next most dominant attitude (14.28%). The results of the present study have revealed some new gender-based sexual roles within Iranian families; which may be applicable to show the capacity for achieving some domains of reproductive rights in Iran.

The purpose of this qualitative exploratory study was to explore the views of nursing trainers and students about nursing students’ clinical evaluation problems and drawbacks in Shiraz Nursing and Midwifery School. A qualitative exploratory approach was used in this study at Shiraz Nursing and Midwifery School in 2012. A purposeful sample of 8 nursing instructors and 40 nursing students was interviewed and the data on their opinions about the problems of the clinical evaluation were collected through semi-structured deep interviews. Initially, four open-ended questions, which were related to the clinical evaluation status, problems, were used to stimulate discussions in the interview sessions. Content analysis was employed in order to analyze the transcribed data. The recorded interviews were initially transcribed, read, and reread on a number of occasions to get an overall feeling of what the participants were saying. Each line or incident was described, and then a code, which reflected the essence of the participants’ comments, was given.The codes were compared for similarity and differences, merged together, and categorized. Finally, five themes emerged:In appropriate clinical evaluation method, problems of clinical valuation Process, problems related to clinical instructors, unsuitable programming of clinical education, and organizational shortcomings.Besides focusing on upgrading the current clinical evaluation forms, nursing trainers should improve their knowledge about a complete and comprehensive clinical evaluation. They should also apply other appropriate and objective clinical evaluation methods and tools, and perform a formative and summative clinical evaluation. Also, workload adjustment of the nursing trainers needs revision. Therefore, despite using traditional and sometimes limited evaluation methods for assessing nursing students, a comprehensive and appropriate evaluation of nursing students’ clinical competencies seems necessary.

Mood disorders related behaviors are imposed on family members and infl uence the family’s mental atmosphereand level of quality of life. Therefore, the researchers decided to study the effect of group psycho-educational program on thequality of life in families of patients with mood disorders. This is a two-group interventional study conducted on 32 members of families of the patients with mooddisorders selected through random sampling. A group psycho-educational program was conducted in ten 90-min sessions (twicea week) for the study group. (World Health Organization’s Quality of Life-BREF WHOQOL-BREF) questionnaire was adopted inthe study and was fi lled before, immediately after, and 1 month after the intervention. Independent t-test showed a signifi cant difference in the scores of quality of life in the domains of mental health, socialcommunications, and environmental health, immediately after and 1 month after intervention in the study group compared to thecontrol group. Repeated measure analysis of variance showed a signifi cant increase in the mean scores of quality of life in thestudy group. The results showed that the impact of group psycho-educational program is observed in the prevention of reductionin quality of life and its promotion in the families of patients with mood disorders.

Living with patients of chronic diseases such as heart failure (HF) is a difficult situation for the caregivers. This study explored the Iranian family caregivers’ burden of caregiving for patients with HF. Eighteen family caregivers of the HF patients from two governmental medical training centers in Isfahan, Iran were recruited using purposive sampling. Data were collected through face-to-face semi-structured interviews. Each interview was transcribed verbatim and was thematically analyzed concurrently.Four major themes emerged from the analysis of the transcripts: Lack of care-related knowledge, physicalexhaustion, psychosocial exhaustion, and lack of support. Family caregivers believed that they have little knowledge about the patients’ disease, drugs, and how to perform caregiving roles. They experienced negative physical and psychosocial consequences of full-time and highly extended caregiving roles, such as musculoskeletal disorder, fatigue, and sleep disturbance, and a high level of anxiety, stress, and social isolation. Caregivers believed that they receive little familial and organizational support on the emotional and financial dimensions of caregiving.The findings of this study can be used by healthcare providers, especially nurses, to provide more effective social, informational, and professional support for family caregivers.

Hypothermia is one of the problems occurring during surgery, which can happen due to thermoregulation mechanism isorders and intake of low temperature IV fluids, and may cause increase in blood pressure, heart rate, intracranial pressure,oxygen consumption, pain, and discomfort to the patient. The rate of esarean section in our country is three times more than the global standard. As one of the responsibilities of the nurse is patient’s advocacy, s/he should support them. This study aimed to investigate the effect of pre-warmed intravenous fluids on prevention of hypothermia during general anesthesia in cesarean section. Sixty-two women undergoing elective cesarean section by general anesthesia were randomly allocated in two groups of intervention and control. Women in the intervention group received pre-warmed serum (37°C) while those in the control group received serum at room temperature (25.5°C). The core body temperature and some hemodynamic parameters of the participants were assessed during the operation. Infusion of pre-warmed serum (37°C) would prevent intraoperative hypothermia and improve the nursing care for women who undergo cesarean section by general anesthesia.

Enhancing nursing students’ critical thinking is a challenge faced by nurse educators. This study aimed at determiningthe effect of clinical concept mapping on discipline-based critical thinking of nursing students. In this quasi-experimental post-test only design, a convenient sample of 4th year nursing students (N = 32)participated. They were randomly divided into two groups. The experimental group participated in a 1-day workshop on clinicalconcept mapping. They were also assigned to use at least two clinical concepts mapping during their clinical practice. Post-testwas done using a specially designed package consisting of vignettes for measurement of 17 dimensions of critical thinking innursing under two categories of cognitive critical thinking skills and habits of mind. They were required to write about how theywould use a designated critical thinking skills or habits of mind to accomplish the nursing actions. The students’ responses wereevaluated based on identifi cation of critical thinking, justifi cation, and quality of the student’s response. The mean score of bothgroups was compared by Mann-Whitney test using SPSS version 16.5. The results of the study revealed a signifi cant difference between the two groups’ critical thinking regarding identifi cation,justifi cation, and quality of responses, and overall critical thinking scores, cognitive thinking skills, and habits of mind. The twogroups also differed signifi cantly from each other in 11 out of 17 dimensions of critical thinking. Clinical concept mapping is a valuable strategy for improvement of critical thinking of nursing students. However,further studies are recommended to generalize this result to nursing students in their earlier stage of education.

Chest tube removal is a painful procedure. The goal of this study was to evaluate the effect of cold application incombination with Indomethacin suppository on chest tube removal pain in patients undergoing open heart surgery. This single-blind, double-group clinical trial was performed on 66 patients aged 18-68 years with thechest tube in pleural space. The Indomethacin suppository (100 mg) was administered 1 h before the chest tub removal in bothgroups. In the intervention group, we applied a 4°C cold pack in the chest tube side for 20 min. In the placebo group, the appliedpack was at room temperature. Pain intensity was measured by Visual Analog Score 20 min before, immediately after, and 15 minafter the chest tube removal. Immediately after the CTR, the mean pain score was 2.67 ± 0.79 and 3.9 ± 0.76 in the intervention and placebo groups,respectively. The pain scores measured before and 15 min after the CTR were not statistically different between the two groups. Application of cold in combination with Indomethacin suppository during the CTR was a suitable, low-risk, and easymethod for pain control in open heart patients.

Postpartum time is a transient time for the mother and her family, in which mothers need psycho-physical andsocial adaptation. This study aimed to defi ne the association between postpartum physical activity 3-12 months after deliveryand postpartum well-being. This is a historical cohort study in which based on the primary information obtained from the physicalactivity questionnaire, 91 mothers were divided into two groups of postpartum light activity and moderate/heavy activity. Then,postpartum well-being in both the groups was measured by using the physical activity questionnaire.The subjects were selected from seven health care centers through purposive convenient sampling, and the obtained data wereanalyzed by descriptive and analytical statistical tests. The results showed that 74.7% (n = 68) of the subjects had light physical activity and 25.3% (n = 23) had moderateand heavy physical activity. There was no signifi cant difference in these two groups concerning physical activity. Mean score ofmothers’ well-being in the group of light physical activity was less than that in moderate and heavy activity. The fi ndings showed that postpartum physical activity increases postpartum well-being and having a program inthis regard can promote some of the health dimensions.

Leukemia is the most common and fatal cancer among young adults. Among all malignancies, it has the greatesteffects on emotional and mental aspects of the patients. While 25-33% of patients with non-hematological malignancies sufferfrom anxiety disorder, some studies have reported the rate among patients with leukemia as high as 50%. Anxiety can negativelyaffect other important characteristics and parameters in patients with cancer. Furthermore, cancer increases the patients’ spiritualneeds. Therefore, spirituality has a signifi cant role in adapting to leukemia and coping with its consequent mental disorders such asanxiety. This study was hence performed to determine the effects of a spiritual care program on anxiety of patients with leukemia. This randomized clinical trial was conducted in Sayyed-Al-Shohada Hospital affi liated to Isfahan Universityof Medical Sciences (Isfahan, Iran) in 2012. Sixty four adult patients with leukemia were randomly divided into the experiment andcontrol groups. The spiritual care program including supportive presence and support for religious rituals was implemented for 3 days.Anxiety subscale from the 42-item depression, anxiety and stress scale was completed before and after the intervention for bothgroups. Data was analyzed using descriptive and inferential statistical methods (Chi-square, paired and independent t-tests) in SPSS18. There was no signifi cant difference between the two groups before the intervention. However, after the intervention,mean score of anxiety were signifi cantly lower in the experiment group than in the control group (P < 0.01). There was also asignifi cant difference in the scores of the experiment group before and after the intervention (P < 0.01). Such a difference wasabsent in the control group. Our spiritual care program could successfully decrease anxiety levels in patients with leukemia. Therefore, in casesof refractory diseases such as cancer, nurses have to apply a holistic care approach with emphasis on spiritual care.

The purpose of this study was to perform the Creating Opportunities for Parent Empowerment (COPE) program for Iranian mothers and evaluate its effectiveness on stress, anxiety, and participation of mothers who have premature infants hospitalized in neonatal intensive care units (NICUs). A randomized clinical trial was conducted with 90 mothers of premature infants hospitalized in the educational neonatal NICUs of state hospitals affiliated to Isfahan University of Medical Sciences. For measuring the variables,State-Trait Anxiety Inventory, the Parental Stressor Scale: Neonatal Intensive Care, and The Index of Parental Participation/Hospitalized Infant were used. Intervention group received two phases of COPE program. This program consisted of information and behavioral activities about the characteristics of premature infants. Sessions’ interval was from 2 to 4 days. Stress and anxiety were measured three times (before each phase and 2-4 days after the second phase). Mothers’ participation was evaluated 2-4 days after the second phase. The t-test, χ2, Mann-Whitney U test, and repeated measurement test were used for data analysis.Mothers in the intervention group reported significantly less anxiety and less stress in the NICU after performing each phase of the COPE program (P< 0.001), whereas at this time, the level of stress in the comparison group increased. Also, COPE mothers participated in their infants’ care rather than the mothers in the comparison group (P< 0.001).COPE program was effective for Iranian mothers. This study shows that irrespective of any culture, giving early and comprehensible educational-behavioral information may have positive effect on maternal psychological condition and maternal–infant interaction.

The reporting of adverse drug reactions (ADRs) by nurses in hospitals is very important. This study was aimed at investigating the impact of an educational intervention to improve ADR reporting and whethertrained nurses had better knowledge، attitude، and practice toward ADR reporting. A total of 300 nurses in a tertiary care teaching hospital in Tehran، Iran were evaluated with a knowledge،attitude، and practice (KAP) questionnaire regarding ADR reporting in March 2010. After this، an educational program about ADRwas provided to nurses. Then the nurses were re-evaluated by the same questionnaire. Comparisons were made of the attitudeand knowledge within nurses، before and after education. Data were analyzed using SPSS software. P < 0. 05 was consideredas signifi cant level. Independent-sample t-test was used to measure the intervention effect. The response rate was 61. 3% (N = 184). Knowledge of nurses before the intervention was signifi cantly less than theknowledge after the intervention (P = 0. 001). Also، there was a signifi cant effect on attitude (P = 0. 002). During the follow-upperiod of 4 months after the intervention، 26 spontaneous reports were received. Continuous ADR educational program، training، and integration of ADRs’ reporting into the activities of the nurseswould likely improve ADR reporting.