Iranian Journal Of Nursing and Midwifery Research
Volume:19 Issue: 4, Jul-Aug 2014

Cancer is one of the major causes of death in children and adolescents. About 4% of deaths in children of age less than 5 years and 13% of deaths in children of age 5-15 years are due to cancer in Iranian population. The disease can cause many problems, which are usually detected by a psychologist, for the children and their mothers. Therefore, this study aimed to identify the psychological challenges of the children with cancer and their mothers’ experience. This is a qualitative research conducted through thematic analysis approach. Semi‑structured interviews were used to collect the data. Purposive sampling was conducted. The numbers of the children and their mothers participating in this study were 34 and 32, respectively. Data analysis showed that the problems faced by children with cancer and their mothers fell into five main categories. These categories included spiritual, psychological (such as aggression, anxiety, depression), communicational problems, inadequate knowledge (about the disease, its treatment, and treatment complications), and care‑related problems. The results showed that lack of awareness and spiritual problems were the most important problems of the patients and their mothers. If necessary knowledge about the disease and its treatment and complications is given to the children and their mothers at the time of diagnosis, and also, spiritual care interventions are administered during treatment, their psychological problems can be notably reduced.

In recent years, there has been a rise in the number of premature births. Mothers of these newborns experience a high degree of stress over time. Since a more comprehensive understanding of this phenomenon can help the healthcare teams in detecting the deficiencies and needs of such newborns’ mothers for a better and more effective intervention, the present study was carried out to describe the mothers’ experiences in the area of premature birth. The present study is a qualitative study with a content analysis approach. The data collection process included 15 semi‑structured and in‑depth interviews with the mothers elivering premature babies during 2012-2013 in the medical educational centers of north and northwest of Iran. A purposive sampling method was used. All the interviews were recorded, typed, and finally analyzed using a qualitative content analysis with a conventional method. Data analysis led to the extraction of continuous and multiple waves of emotional responses in mothers with premature birth. This has been revealed in mothers by the different categories of affective reactions, symptoms of anxiety, and mood disturbances including decline in performance, individual shortcomings, and mental irritation. Mothers’ unpreparedness and unexpected childbirth make them encounter the multiple and continuous waves of emotional responses, which will consequently lead to decline in performance, individual shortcomings, and mental irritation among them. Therefore, in order to prevent the negative and long‑term consequences of such reactions, it is recommended that more attention should be given to support these mothers as the main caregivers of such infants.

Preterm infants constitute a large proportion of the newborn population in the neonatal intensive care units (NICUs). Parents, as the main members of the care team, are not adequately supported as the focus is chiefly on infant care. The present study aimed to evaluate the effect of a family support intervention on the stress levels among the parents of preterm infants in NICU. In this quasi‑experimental study, convenience sampling method was used to select 50 parents of preterm infants. The subjects were allocated to two groups of intervention and control (n = 25 pairs in each). While the control group received routine care, the intervention group benefitted from a two‑stage family support program (including informational and observational phases in the first stage and emotional supportive intervention in the second). The Parental Stressor Scale‑NICU (PSS‑NICU) was completed by both fathers and mothers of the two groups (before and after intervention). Descriptive and inferential statistics were employed to analyze data in SPSS version 18. Before the intervention, the mean total scores of PSS‑NICU and also the mean scores of its three subscales were not significantly different between the two groups. However, after the intervention, significant differences were observed between the two groups. The scores of the intervention group showed significant reduction following the intervention, but such a difference was not detected in the control group. Apparently, early educational and emotional support for parents of preterm infants decreased their stress. Similar interventions may thus be effective in empowering parents for caring of their infant and playing their parental role.

Intensive care unit is a center to provide comprehensive care for critically ill patients whose condition can be improved by receiving specialized care. The importance of accurate and rapid monitoring of patients at this precise moment is in recording patient data and its comparison with previous data. Monitoring the patient by either devices or direct examination of the nurses requires accurate documentation. Hence, accuracy of the documentation is essential to enhance the quality of care, despite the high volume of data in intensive care unit. This study was conducted by review of domestic and international texts through Delphi method. There were 20 participants in Delphi stage. Data were collected by the questionnaires sent in two stages. Experts’ panel was used to complete and finalize the obtained structures. Data analysis was conducted by descriptive statistics in the form of frequency percentage. In a review of 15 domestic and international flow sheets as well as 30 reference texts and 80 articles, 99 primary flow sheet structures were detected, of which 58 had a consensus of >70%. With the goal of avoiding repetition and making the recordable data brief, and with respect to the nurses’ initial assessment in better planning and administration of care, a flow sheet was designed as a nursing admission sheet to be completed at the moment of admission. Its content and template had consensus among the panel of experts, and the instruction for complement of the sheets was finally developed. After obtaining content validity and including the given indications, daily monitoring sheet and admission sheet were developed.

While critical care nurses are vulnerable to burnout because of the complex nature of patients’ health problems, working in critical care areas has become even more complicated by shift working schedules. This study aimed to determine the relationship between fixed and rotating shifts and burnout in a sample of critical care nurses working in critical care areas. In this retrospective cohort design, 170 critical care nurses from six selected hospitals were chosen using quota and random sampling and divided into two groups (exposed and non‑exposed). Maslach Burnout Inventory was used for data collection and independent t‑test and logistic regression was performed to analyze the data. The mean scores of emotional exhaustion (EE) and depersonalization (DP) were significantly high in the non‑exposed group, but the mean score of personal accomplishment (PA) had no significant difference in the two groups. Furthermore, the non‑exposed group had 10.1 times the odds to expose to EE and 2.2 times the odds to expose to DP in comparison with the exposed group. High levels of burnout in the non‑exposed group were 60%, 32.9%, and 27.1%, and in the exposed group were 12.9%, 18.8% and 43.5% in EE, DP and PA, respectively. The present study has revealed that critical care nurses with fixed shift schedules display more burnout compared to those working with rotating shift schedules.

Clearing the endotracheal tube through suctioning should be done to promote oxygenation. Depth of suctioning is one of the variables in this regard. In shallow suctioning method, the catheter passes to the tip of the endotracheal tube, and in deep suctioning method, it passes beyond the tip into the trachea or brunches. This study aimed to evaluate the effect of shallow and deep suctioning methods on cardiovascular indices in patients hospitalized in the intensive care units (ICUs). In this clinical trial, 74 patients were selected among those who had undergone mechanical ventilation in the ICU of Al‑Zahra Hospital, Isfahan, Iran using convenience sampling method. The subjects were randomly allocated to shallow and deep suctioning groups. Heart rate (HR) and blood pressure (BP) were measured immediately before and 1, 2, and 3 min after each suctioning. Number of times of suctioning was also noted in both the groups. Data were analyzed using repeated measures analysis of variance (ANOVA), Chi‑square and independent t‑tests. HR and BP were significantly increased after suctioning in both the groups (P < 0.05). But these changes were not significant between the two groups (P > 0.05). The suctioning count was significantly higher in the shallow suctioning group than in the deep suctioning group. Shallow and deep suctioning were similar in their effects on HR and BP, but shallow suctioning caused further manipulation of patient’s trachea than deep suctioning method. Therefore, in order to prevent complications, nurses are recommended to perform the endotracheal tube suctioning by the deep method.

Quality of life is a concept, which in recent years is considered as a measure for health in chronic diseases such as kidney diseases. Complications of chronic diseases can affect the quality of life in children and their families over time. Therefore, empowerment programs are necessary to improve their quality of life. This study aimed to investigate the impact of the family empowerment model on the quality of life in children with chronic kidney diseases. This quasi‑experimental study was conducted on 64 children with chronic kidney diseases and their families. The research tools included the questionnaire of demographic characteristics and the quality of life questionnaire 4th edition. After data collection in the first phase, the family empowerment model was implemented in the intervention group and the test was repeated after 1 month. For comparison of data between the two groups and within each group, independent t‑test and paired t‑test were used, respectively. Independent t‑test showed that the mean score of quality of life was not significantly different in the two groups before intervention. However, after intervention, the differences were significant. Paired t‑test showed a significant difference in the quality of life before and after intervention in the study group. The findings showed that family empowerment model was effective in increasing the quality of life of children with chronic kidney diseases. Thus, we suggest this model to be used in inpatient and outpatient children’s health care.

Secretions contaminated with oral, nasal, and gastric bacteria accumulate in the subglottic space, above the endotracheal tube cuff. If these secretions are aspirated into lower airways, the intubated patient will be susceptible to ventilator‑associated pneumonia (VAP). The aim of this study was to investigate the effect of inspiratory pause maneuver for intermittent subglottic secretions drainage (SSD) on the incidence of VAP in patients receiving mechanical ventilation. This randomized clinical trial was conducted in four intensive care units of educational hospital in Isfahan, Iran. A total of 76 adult patients intubated with a conventional endotracheal tube and connected to ventilators for more than 48 h were selected through convenient sampling and were randomly assigned to undergo intermittent SSD (n = 38) or not (n = 38). In this study, for SSD, we used inspiratory pause/hold key in the ventilators to hyperinflate the lungs. Pressure that produces with this maneuver could remove the secretions from the subglottic space. VAP was found in 10 (26.3%) patients receiving SSD and in 18 (47.4%) patients in the control group (P = 0.04). SSD using inspiratory pause during mechanical ventilation results in a significant reduction in VAP.

New teaching methods are essential in the promotion of competence in nursing students. Measuring blood pressure, which is one of the most essential skills, is the foundation of nursing care and clinical decision‑making, and students should be trained to master this skill. This study aimed to determine the impact of two teaching methods on students’ performance in blood pressure measurements. In this semi‑experimental study, 36 first‑term nursing students from Isfahan University of Medical Sciences, Iran, were divided into six groups of six people each. The type of training for each group was determined by random draw. Blood pressure measurement training was given to three groups on a simulator and to the other three groups on human samples. Pre‑ and post‑test evaluation of knowledge of the methods of measuring blood pressure was conducted using a researcher‑made checklist and by observation of the students’ actions. The knowledge and skill scores were compared using paired and independent t‑tests. The mean performance scores of students in simulator (19.14 ± 1.60) and human (19.64 ± 1.08) groups were not significantly different. In both methods, there was no significant difference between systolic and diastolic blood pressures measured by students and by teachers (standard). Mean knowledge scores of both groups increased significantly after training compared to before training. According to the results of the study, the two training methods (on human subjects and simulator) provide the students with the necessary ability to measure the systolic and diastolic blood pressures correctly. Therefore, to enrich the educational program of nursing students, using simulators is recommended as an effective teaching strategy to facilitate learning and for the development of students’ knowledge.

Many people suffer from burn injuries every year, and burns make the patients undergo surgeries and years of rehabilitation. Burns lead to more years of disability, compared to cancer or heart diseases. Epidemiologic studies are needed to reveal the span, impact, and related factors of burns to help take appropriate efforts to reduce its mortality and morbidity. This study was conducted in two phases. The first phase was a descriptive retrospective study conducted on 836 burn patients who were admitted to the main special burn hospital of Isfahan, Iran. Data were collected from archived patients’ files using a checklist approved by the faculties of epidemiology and nursing. In the second phase, a survey was done based on the professional task checklist of burn ward nurses to assess the fulfillment of each task by the nurses. Burns were found to occur more among those in the age groups of 20-30 (26.2%) and 0-10 years (22.9%). The most common causes of burns were flammables and gas explosions due to imprudence at home and workplaces, or self‑infliction. Mortality rate was 21.7% due to sepsis, shock, and inhalation injuries, respectively. Nurses gave 19.78 out of 50 points (39.56%) to their performance in the prevention of sepsis. Based on the findings of this study, it can be concluded that there is still an increasing need for safety education and using environmental safety measures, as well as developing high‑quality methods to transport burn patients and administer care to decrease the mortality and morbidity associated with burns.

Hypertension has become a major problem throughout the world, especially in developing countries like Iran. As it is a major risk factor for coronary heart disease, even small reductions in the prevalence can have potentially large public health benefits. Among the complementary methods, massage provides an effective means to lower the blood pressure. If nurses perceive the experiences of hypertensive patients receiving massage, they can use massage more effectively in their care plan. This is a descriptive phenomenological study. Deep interviews were conducted with nine prehypertensive women who received Swedish massage three times a week in a total of 10 sessions, with each session lasting 10-15 min. Then, the researcher conducted an interview using a ‘grand tour question (open ended question) and the participants were then encouraged to speak freely explaining their thoughts and feelings about the experience of massage therapy. Data analysis was done by Colaizzi’s method. Validity and reliability were obtained through measures such as real value, applicability, continuity, and authenticity. Women evaluated the massage therapy positively. The findings yielded six themes, including relaxation, sleeping better, reduction of anxiety and tension, reduction of fatigue, invigorating experience, improve connecting. This study demonstrates that a body‑centered intervention like massage can be valuable in a multidisciplinary approach to women with prehypertension. This method is easy to learn and relatively short (10-15 min) to administer as a suitable complement in nursing care for this group of patients.

Understanding how novice nurses perceive their career in the psychiatric ward can be helpful for nurse educators and managers to gain insight into psychiatric nursing care and adding applicable knowledge to the development of support strategies for this group. The aim of this study was to describe and illuminate experiences of new graduated nurses working at a psychiatric ward in an Iranian context. A descriptive phenomenology has been chosen. Participants with baccalaureate degrees in nursing were selected purposefully and they all had less than 6 months of work experience in psychiatric wards beforehand. The study was conducted at the Razi Hospital in Iran. Data were collected through unstructured individual in-depth interviews and analyzed according to the Colaizzi method by means of Husserlian phenomenology. Three main themes were found in this study, of which six sub-themes were constructed as follows: Being in the world of fear and complaint, which has been abstracted by having mixed feelings of confl ict and compliant on entry to the psychiatric ward, doubt about adequacy of being a psychiatric nurse and working in psychiatric ward and a frightening and non-supportive environment; A sense of imprisoned and confi ned, which has been constructed by different experience with different environmental milieu in psychiatric ward, as a lock sense; Becoming a psychiatric nurse, which has been constructed as a sense of usefulness, a sense of sympathy and compassion for patients and a sense of professional identity. This study identifi ed areas that require modifi cation by providing insight into lived experiences of beginners’ nurses as the value in psychiatric ward. New graduated nurses may face negative perceptions and feelings due to confrontation with a new environment, patients and colleagues as well as shortcomings in the preparation.

Since nursing and midwifery students avoid taking care of the diseased patients and taking care of the patients with AIDS can be influenced by their level of knowledge, the present study aimed to define the association between students’ knowledge and their tendency to take care of HIV patients. This is a descriptive analytical study conducted on 210 students of Nursing and Midwifery School, who were selected through random stratified and convenient sampling in 2012. Inclusion criteria were having Iranian nationality, being a Muslim, passing two credits of nursing internship, and not being an AIDS patient. The exclusion criterion was any one of the parents or relatives suffering from AIDS. The data were collected by questionnaires of personal and familial characteristics, the level of awareness, and tendency to take care of AIDS patients. Questionnaires of AIDS awareness scale and AIDS care tendency scale are valid and reliable. The data were analyzed by charts, Pearson statistical test, t‑test, one‑way analysis of variance (ANOVA), Kruskal-Wallis, and linear regression through SPSS version 16. The findings showed that 79.5% of the students had average awareness about AIDS and 61.4% had no tendency to take care of AIDS patients. Pearson correlation coefficient showed that there was a linear association between the score of awareness and tendency to take care of AIDS patients. The results of linear regression also showed that there was a significant association between the score of the tendency to take care of the patients and sex, education level, awareness, and educational course. Since students’ awareness level was not so high, special attention should be paid in this regard through more organized and precise programs. A separate university credit concerning the diseases and education through mass media should be also considered.

Workplace bullying is a significant issue confronting the nursing profession both in Iran and internationally. This study examined workplace bullying among a group of Iranian nurses. The prevalence rate of bullying behavior among nurses was determined. Data were collected from 162 nurses who worked in four hospitals located in West Azerbaijan province, Iran. Results showed that only 9% of nurses who participated in this study had frequently been exposed to bullying behavior, 22% had occasionally been bullied, and 69% had never been exposed to these behaviors during the last year. The most common type of workplace bullying experienced by nurses was verbal bullying. Forty percent of the nurses reported exposure to verbal bullying behavior frequently or occasionally. To be able to intervene with bullying behavior in the workplace, there is a need to pay greater attention to the problem by the entire range of managers, lawyers, industrial–organizational psychologists, counselors, social workers, and local authorities.

The broad spectrum of problems caused by multiple sclerosis (MS) imposes heavy responsibility to caregivers in caring of their patients. Therefore, they encounter many issues and challenges in this situation. The purpose of this study was to explore the experiences and challenges of MS family caregivers. A qualitative design, based on a thematic analysis approach, was used to reach the study aim. Data were collected and analyzed concurrently through in-depth unstructured interviews, fi eld notes, and observations that were held with 23 participants (14 family caregivers and 9 MS patients) at two referral centers in Ahvaz, Iran. Three major themes were extracted from the analysis of the transcripts: “emotional exhaustion of caregivers,” “uncertain atmosphere of caring,” and “insularity care.” The fi rst theme consisted of three subthemes: “stressful atmosphere of caring,” “confl ict and animism,” and “continuing distress affecting the caregiver.” The second theme consisted of three subthemes: “unstable and complicacy of disease,” “caring with trial and error,” and “frequent hospitalization of patients,” and the third theme consisted of two subthemes: “caring gap and disintegration” and “lack of suffi cient support.” This study will be useful to healthcare system for managing the challenges of MS patients’ family caregivers. Improving the conditions and performance of family caregivers is crucial in order to provide high-quality care to people with MS.

Sexual behaviors of adolescents and youth are categorized as one of the main health priorities of a society because of high prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), sexually transmitted infections (STIs), and unwanted pregnancies. Family is an important environment that is associated with a range of social and emotional behaviors of children. This study was aimed at explaining the actions and functions of families in youths’ engagement in sexual relations. Twenty‑six single males and females of 18-24 years who were living in Isfahan participated in this qualitative research study. The participants had begun to have some form of sexual activities. Twelve other participants including parents, teachers, school counselors, clinical psychologists, family counselors, and health care providers also took part in the study. Data collection method was based on semi‑structured interview and observing the sexual actions and interactions of youths at different levels. In order to analyze the data, the researcher used constant comparison analysis of investigation. The results showed that five main concepts are involved in the formation of sexual relations before marriage, including “parents’ child‑rearing practices”, “parents’ interactions”, “children’s economic support”, “religious beliefs,” and “sexual awareness”. Based on the prominent role of the family in shaping sexual relations before marriage, it is necessary to educate and support families and also revise the neglected aspects.

Being a nurse is more than just a series of business activities and skills. In fact, it is a part of the process of socialization, which is internalization and development of professional identity. Professional socialization is necessary for involving the students in professional practices. Thus, the purpose of this qualitative research was to increase the understanding of professional socialization in nursing and explore the related factors from the perspective of registered nurses and nursing students. In this qualitative design, data were collected on 43 nurses with a variety of experiences using semi-structured interviews and focus groups in the Shiraz University of Medical Sciences in 2012. Data were analyzed through inductive content analysis. The data analysis revealed two main categories: (1) sense of belonging with three sub-categories of theory-practice incongruence, educational experiences and tacit knowledge and (2) forming professional identity consisting of three sub-categories of relatedness, internal motivation and role model. This study demonstrates that in nursing, sense of belonging and professional identity contributes to professional socialization; it is suggested that these factors, which improve socialization in nurses, be taken into account by authorities.

The fear of aspiration of gastric contents and its life‑threatening disadvantages in patients have encouraged many medical practitioners to follow conservative policies for clear fluid/liquid and solid intake from midnight to the time of surgery. These policies have been pursued more severely in case of pregnant women, leading the physicians to follow “nil per os” policy. The aim of this study was to determine and compare the incidence of regurgitation in two groups of pregnant women during general anesthesia for cesarean section, with standard fasting policy and taking clear fluid an hour prior to the induction of anesthesia. This clinical trial was conducted for a period of 21 months in Nik‑Nafs Maternity Hospital of Rafsanjan. The pregnant women who were candidates for elective cesarean section were registered for the study. All women fasted from midnight, and then were randomly assigned to one of the two groups. Those in the case group received 150 ml of clear liquid containing 10% carbohydrate about an hour before the induction of anesthesia. The occurrence of regurgitation was assessed by inserting the turnsole paper into the pharynx. Finally, the data of 411 cases were analyzed by descriptive methods. There was one case of regurgitation (0.69%) in the control group and one case (0.36%) in the case group, and no case of aspiration. There was no evidence to suggest that taking clear fluids about 1 hr before cesarean section will increase the risk of regurgitation. It confirms the safety of following more flexible fasting policies preoperatively, in addition to oral fluid intake, in case of parturients.

We read with interest Bahrami et al.’s article which has been recently published in your journal.[1] However, we noted some points in their study which are worth discussing. First of all, it seems that the researchers conducted a peer...