نشریه مراقبت امروز
پیاپی 12-13 (پاییز و زمستان 1387)

Elderly people often suffer from sleep disturbances. The aim of this study was to investigate the relationship between self reported nocturnal sleep quality and napping pattern in elderly persons with insomnia and to compare the nocturnal sleep quality between napping and non napping groups. In this cross sectional study convenience Sampling was used to recruit 78 elderly people living in kahrizak nursing home in 2007. The pittsburgh Sleep Quality index (PSQI) questionnaire was used as a screening tool to select subjects with sleep disturbance. Data were analyzed using nonparametric Mann-Whitney U and Spearman Correlation Coefficient tests. Analysis of data showed that there was no relationship between sleep latency, sleep efficiency, sleep duration, use of sleeping medication, daily performance and global score of PSQI and napping pattern. Also between duration of naps and global score and subscales of PSQI questionnaire. Whereas significant correlation was found between subjective sleep quality (r=-0.255, p=0.023), sleep disturbances(r=-0.236, p=0.038) and napping pattern. The finding of this study showed that elders in napping group reported relatively better subjective sleep quality and lower sleep disturbance and day- time napping may have not effect on night-time insomnia in elderly people.

ESRD is a multi-causes disease with irreversible reduction of kidneys’ function, in which renal function in electrolyte regulation, excretion of toxins and important hematopoietic hormones will be impaired. Then a permanent dependency with dialysis or a kidney transplant will need for patient to be survived. The purpose of this study was to determine risk factors for chronic renal failure in hemodialysis patients in hospitals of the Hamedan province. In this descriptive study, a total of 455 patients with ESRD were studied to determine the etiology of ESRD. Data were collected by a demographic questionnaire (age, sex, marital status, educational level, and job) and risk factors of chronic renal failure disease. The information was collected by studying of medical records and interviews with patients if necessary. Descriptive statistics were used for data analyzing. Results showed 51.87% of patients were male and 48.13% were female. Risk factors of the disease were idiopathic 29.33%, diabetes 23.73%, hypertension 22.19%, glomerulonephritis 17.47%, urologic disorders 6.25% and other 1.13% respectively. In this study the most common risk factors for chronic renal failure were, idiopathic, diabetes and hypertension, so by careful examination, Control and treatment of patients with diabetes and hypertension we can reduce the rate of chronic renal failure.

Measuring blood pressure is one of the most important clinical skills of nursing. Most nurses think controlling blood pressure is a simple and banal matter. However, various studies show the weakness of nurses and physicians in controlling blood pressure. Therefore, the aim of this study was to measure the nurse's awareness level of the basic principles of blood pressure control. This study was a descriptive-analytical study performed on 145 nurses working in Valiasr Hospital in Borujen(=11.1±3.25) and Seyedalshohada hospital in Farsan(=11±3.65). Data was collected using the demographic information questionnaire and the primary information questionnaire regarding blood pressure control. Data were analyzed using descriptive statistics, chi square test and Independent T-test. The results confirmed that nurses have little primary information and awareness about basic blood pressure control (=12.5±3.72). Also, the awareness mean does not show a considerable difference between nurses in Valiasr Hospital, Borujen and Seyed alshohada hospital, Farsan (P> 0.05). Moreover, the mean of awareness of staff in general wards was higher than those of critical care wards (P< 0.01). Considering the vital role of blood pressure in monitoring the patient's health, the necessity of its correct control is inevitable. This is while the results of this study show the weakness of nurses in this regard. The nurse's role in monitoring vital signs, especially on the patient's acceptance, monitoring the treatment process and discharge cannot be disregarded. Therefore, it is necessary to provide clinical skill training such as monitoring vital signs for nurses.

Lecture is the most commonly-used teaching method, but it is not associated with active participation of learners. The aim of this study was to compare the effect of group discussion and lecture teaching methods on the performance of students in final cumulative exam of anatomy course and determining the attitude of the learners toward them. This semi-experimental study was done on the midwifery students of Lorestan University of Medical Sciences in 2009-2010. The course materials were divided into two comparable sections. These two sections were taught by lecture or group discussion. After completion of the course, the effect of the teaching method on the performance of the students was evaluated by comparing their grades in cumulative assessment of these two sections. Attitude of students toward these two methods was also assessed by a valid and reliable researcher-made questionnaire which contained some questions with five-level likert scale. The mean score of cumulative or final assessment of participants in the course materials taught by lecturing was 15.2±2.3 and of those taught by group discussion was 15.7±2.5 which were not statistically significant. The mean satisfaction rate of the participants toward lecture method was 58.9% and toward group discussion method was 58.5% which were also not statistically significant. There was not any significant difference between lecture and group discussion when considering their effect on the student's performance in final assessment and attitude of students toward them. However, this claim should be approved by future studies.

Medical education in the world is changing toward outpatient training. Psychiatry because of holistic care for patients and the importance of psychological problems in a large percentage of diseases, have a key role in training of general physicians. This study determines the impact of outpatient and clinical education on the academic performance of interns in the psychiatric department in Lorestan University of Medical Sciences. In this quazi experimental study participants were 78 interns of two consecutive years, in psychiatric ward of Lorestan University of Medical Sciences, which were assigned randomly into two control and intervention groups. The control group was trained as usual method but the intervention group in addition to the usual training took six sessions of outpatient and clinical training in the afternoon at the psychiatric clinic of Khorramabad. At the end of course a similar exam was given to all the participants by two psychiatrists. Data were compared using statistical tests. Data had normal distribution, the mean score was 13.369±2.052 for control group, and 17.1396±1.469 in case group which was significantly different with 95% confidence interval and was better in case group (p<0. 001). According to the results of this study, we can conclude that, Outpatient and clinical training of interns in the field of psychiatry has a significant effect on academic performance in psychiatric ward and increases general physicians’ ability in this area. Therefore we recommend that a larger share of psychiatry training allocated to outpatient and clinical education.

According to latest statistics published by the daily 100 people died of cancer in Iran. Paying attention to positive dimensions of one’s living, e. g. spiritual well -being is one of the ways which is preventive from decrease of hope that leads to decrease in one’s power of challenge in special situations such as illness. In this research we’ve decided to investigate the correlation between spiritual well-being and hope in cancer patients. This is a review study that has been accredited to uses the latest books, articles, and foreign and domestic sites. In this study, all articles about the effects of spiritual well-being and hope in patients with cancer in 1990 and 2010 in Persian and English had been reviewed. Databases searched included: Medline, Cancer Lit, Proquest، SID، Iranmedex، Magiran. The researchers stated there is the life expectancy in all stages of the disease. Even if the majority accept that there is no hope, still for many realistic patients there is a possibility of hope, perhaps a new drug is discovered or a research project reach a result at the last moment. Popularity of spirituality locating at the center of the crisis is more highlighted in late stages of the disease. Advancement of Science has shown that spiritual health may boost mental performance and judgments about the disease and help increasing life expectancy. Considering the impact of the spiritual aspect on the body, it was determined that doing spiritual care for patients is very economical in the long term and increase strength of life expectancy and improve the patient's mental status.

Results¬ of various surveys show that medical personnel perceptions may not align with those of patients about educational needs. This led to the failure to meet the educational needs of patients and their families. The aim of descriptive study was to determine of educational needs of patients with epilepsy. Sixty nine patients with epilepsy hospitalized in neurology and pediatric units were studied using a questionnaire which consisted of 31 questions and 4 parts (training needs priorities in the areas of disease, lifestyle, use of antiepileptic drugs and etc through interviews the data were analyzed with descriptive statistics, t-test and Univariate analysis of variance. 58.2% cases were male, the majority had elementary education and the mean of age of them were 30.8 year.61.2% of them has higher than 2 times seizure in month and 56.3 have a history of multiple drugs using. In case of educational needs priorities the highest mean was drugs and disease areas and results suggested they tend to receive more information about mentioned area, and minimal mean was pertaining to life style area. Education process should be taken with regard to patient education priorities to meet the educational needs¬ of patients and their families. Therefore, it is recommended to help train medical staff and confidence of necessary information should be given before patients would be discharged, education be done based on questioning of patients in possible areas.