Advances in Nursing & Midwifery
Volume:21 Issue: 72, 2011

Background and aimFeeling of health is subjective and unique and health criterion varies in different age, cultural and socioeconomic groups. Illness can have a great effect on individual’s feeling and definition of health and well being. The aim of this study was to explore the meaning of health concept in the view of diabetic patients.Materials and methodsThis study was qualitative, semi structured interviews were conducted with 20 diabetic patients who attended to the diabetes clinic of Sanandaj Tohid Hospital. Interviews were transcribed and analyzed using conventional content analysis, and codes and themes were derived from participant’s responses Findings Based on the findings of study five major themes about health emerged: intact body and happiness, life without any limits, peace of mind, spirituality and absence of complications. ConclusionHealth definition based on specific conditions of any culture and group that affect health behavioral. Based on emerged themes, health care providers must consider these themes and seek ways to achieve health in diabetic patients and use them in care plans.

Background and aimAcute heart diseases cause limitation in physical activity and problems in quality of life. The aim of this study was to determine the effect of cardiac rehabilitation on quality of life in myocardial infarction patients in Zanjan.Materials and methodsThe current study is a two group and a pre & post test experimental study. 60 patients were selected and randomly assigned in two groups, control group and experimental group. For data collection, demographic questionnaire and Nottingham Health Profile (NHP) were used. Content validity of questionnaire was measured by content validity and reliability by Test-re-Test (r=0.82). Intervention program included, individual training, nutrition and mental counseling and exercise program. From each of the two groups control and experimental pre-test and post-test examinations were taken. Data were analyzed by SPSS v16 and descriptive and analytical statistics (T test, repeated measurement ANOVA) were used. Findings The results show a significant difference in the quality of life scores of the control and experimental groups (P=0.001 Mean=1.55 S.E=0.41, P=0.000 Mean=2/71 S.E=0.59, respectively). Thus, cardiac rehabilitation program is effective on quality of life of MI patients in the experimental group. According to results, the average score of the eight week (experimental: P=0.000 Mean=0/64 S.D=1.42 control: P=0.001 Mean=2.27 S.D=2.20) was better than that of the third week (experimental: P=0.000 Mean=3.35 S.D=2.73 control: P=0.001 Mean= 3.82 S.D=2.13) for both groups. This is more drastic in the experimental group. Furthermore, results showed no significant difference between the quality of life scores of men and women. ConclusionThe cardiac rehabilitation program can affect and improve the quality of life. Providing rehabilitation centers, gives the patients the chance to use these programs and gives them a better chance of independence life.

Background and aimAdvancements in medical knowledge and treatment modalities have resulted in increasing the survival rate of high risk infants. This increased number of survivors call attention to future development of these children. After infection and trauma, developmental and behavioral problems are the most common children medical problems. The aim of this study was to determine correlation between anthropometric indices at birth and developmental delay in children 4-60 months that were visited in health services centers affiliated to University of Medical Sciences in 2010.Materials and methodsIn this descriptive-corrolational study, 401 children 60-4 months that were visited in health services centers affiliated to University of Medical Sciences in 2010 were selected by multistage method. Anthropometric indices of children at birth were collected from their health care records and development status of children was measured by "Ages and Stages Questionnaire". Validity of 0/84 and reliability 0/94 were obtained from pervious study. Data were analyzed by SPPS v 18.Findings The results showed that the average age of children in normal group was 17/33±13/18 month and in developmental delay group was 29/92±19/19 month. Most gender in normal group was female (%56) developmental delay group was male (%55/2). In addition, there were no correlation between height and head circumference at birth and developmental delay. However, birth weight of children with developmental delay were four times lower than birth weight of normal developmental children (p = 0.004, OR = 4). ConclusionFactors that lead to intrauterine growth reduction will create many problems in the neonatal period. On the other hand, staying these infants in NICU is longer and lead to presenting disorders in child developmental process.

Background and aimThe prevalence of congestive heart failure (CHF) continues to rise and nearly 5 million people in the United States have CHF, with more than one-half million new cases diagnosed each year. The readmission rate within 3-6 months after discharge in these patients is 10-50 percent. The aim of this study was to determine factors contributing to readmission of patients with congestive heart failure (class 2 and 3) who were admitted in internal ward of Hospitals of Shahid Beheshti University of Medical Sciences in Tehran 2009.Materials and methodsIn this correlation -descriptive study, 110 patients with congestive heart failure based on 2 and 3 New York Heart Association Classification (NYHA) were included. Subjects were selected by quota purposive sampling and were divided into two groups (readmission and no readmission). Data were collected by a questionnaire. Content validity of the questionnaire was assessed by 10 nursing experts, 5 persons with congestive heart failure and 2 cardiologists. Reliability was measured by ted-retest (0/86). Data were analyzed by SPSS 15.Findings Results showed that, % 61.8 of samples was readmitted to the hospital during the previous 6 months period. In addition, two individual factors (age and literacy level) and two disease related factors (NYHA class and having other disease) contributed to readmissions. Therefore, age and higher NYHA class and having co morbidities had direct and also literacy level indirect relationship with readmissions.ConclusionThe readmission rate of patients with congestive heart failure in this study was high. Therefore, attention to contributing factors is needed.

Background and aimA majority of children experience moderate to severe postoperative pain. To ensure adequate pain relief in pediatric patients, non pharmacological techniques are needed for use in conjunction with pain medication. The aim of this study was to determine the effect of therapeutic play on postoperative pain of hospitalized school age children in surgical ward of Sheikh’s Pediatric Hospital affiliated to Mashhad Medical University in 2009-2010.Materials and methodsIn this randomized clinical trial, 40 hospitalized children in surgical ward between the age of 8 and 12 years old were selected and randomly assigned to the experimental group who participated in a session of therapeutic play that lasted between 30 and 45 minutes whereas those in the control group received routine care. Data collection tools included demographic questionnaire and Objective Numeric Pain Scales. The intensity of pain was assessed before (Phase1), immediately after (Phase2), and 15 minutes after (Phase3) intervention or routine care. The validity of ’Objective Pain Scales’ and ‘Numeric Pain Scales’ were determined by concurrent validity (0/89) and between ‘Objective Pain Scales’ and ‘Face pain Scale’ (0/95). Reliability of ‘Objective Pain Scales’ was measured by inter -rater reliability (0/95). Data were analyzed by SPSS v16.Findings The results showed that children in the experimental group reported having significantly less pain.

Background and aimWith the increasing elder population, providing effective family care is turning to be the most important challenge in health and welfare of elder people. The aim of this study was to explore needs of family caregivers of the patients with Alzheimer disease by analyzing of family caregivers experiencesMaterials and methodsThis qualitative study was conducted by latent conventional content analysis. 35 family caregivers of elder patients with Alzheimer disease participated in the study. Participants were selected based on purposive sampling. Sources of information included documents of participant's diaries, about their problematic and complicated days of caring. Data were analyzed through reading and rereading documents, determining meaning units, extracting of codes and categorizing of them.Findings Most of participants (80%) were female, with mean age of 56/2 and literate (under diploma level). The findings generated 794 initial codes, which were grouped in 7 categories of: need to knowledge, receiving help from other family members in caring, modification of the home environment, self caring of caregivers, need "to be visible", compatible and complimentary health care system and caring equipments.ConclusionRegarding to Global expansion of Alzheimer disease, considering the family care giving issue of elders with Alzheimer disease is essential. Therefore, providing suitable information, establishing education for caregivers related to disease and patient care management, management of caregivers’ health, psych–social support and establishing of appropriate complimentary health care system for elderly patients should be considered. These strategies would facilitate the family care giving and support the caregivers on their journey.

Background and aimHemodialysis is one the most common renal replacement therapies in end stage renal disease. Despite progress in dialysis technology, intradialytic complications occur frequently. The aim of this study was to determine the rate of intradialytic complications and their risk factors in patients undergoing hemodialysis in hospitals affiliated to Medical University of Hamedan Iran in 2009.Materials and methods192 patients undergoing hemodialysis participated in this descriptive correlational study. These patients were included in the study using census method. Data were collected by1- a questionnaire which consisted of 3 sections (demographic information, person – related factors and therapy- related factors),2-a check list and clinical examination (blood pressure and weight measurement). Content validity of the questionnaire was assessed by 10 nursing experts, 5 staff of hemodialysis wards and 2 nephrologists. Reliability of check list was measured using inter-rater reliability (r=0.98). Data were collected by the second author. Data were analyzed by SPSS 15.Findings Findings showed that the most frequent complications include: hypotension (%15.1), muscle cramp(%11.5), nausea(%9.4), headache(%7.8), angina(%2.6), vomiting (%2.1) and itching(%1.6) respectively. Logistic regression analysis, showed a significant correlation between age and cramp (person – related causes) and a significant correlation between hypotension, cramp with vomiting and headache. Moreover, findings showed a significant correlation between nausea with eating during dialysis (patient- related causes); and between hypotension with dialysis solution (therapy- related causes).ConclusionBased on the results of this study, most of intradialytic complications can be prevented. Use of these findings can improve the process of dialysis.

Background and aimSuccessful implementation of TQM requires a committed leadership, customer – based approaches, process management, efficient communication, knowledge management, empowerment and involvement of staff and an organizational culture for continuous quality improvement. The aim of this study was to assess basic requirements for implementation TQM in Centers of Emergency Medical Services in Iran according EFQM model.Materials and methodsIn this descriptive study, all of operational and official stations of Medical Emergency services in Ilam, Bushehr, Mazandaran, Ardebil, West Azerbaijan and Yazd province, one half of operational stations in city of Tehran, Sistan–Baluchestan, Khorasan-razavi and Isfahan, were included. All senior managers and personnel of these centers and a random sample of 3246 customers who have received care during the last 6 months were selected. By using a 189 –item’s rating scale and 4 questionnaires; leadership style, job and patients satisfaction and state of organizational empowering, according to 5 enabler criteria, from EFQM model was assessed. Validity of instruments by measuring content validity and reliability by internal consistency and test-retest confirmed. Descriptive and inferential statistics used for analyzing data.Findings The overall mean score was 168.4±34.6 out of 500; therefore, the selected divisions were labeled as drifters organizations which were in early stage of quality improvement road. In comparison, the Tehran, Isfahan and Khorasan-razavi centers with more score labeled as improver’s organizations. At the entire, leadership criterion obtained minimum (26.6%) and people criterion obtained maximum (39%) mean scores.ConclusionResults showed that enabler criteria of the EMS centers in Iran need to reinforcement. It is essential enhancing the knowledge and attitude of managers and personnel about quality improvement principles. Additionally, establishing the management by process, creating customer focused approach and culture of continuous improvement, empowering employees and constituting quality circles are appropriate interventions that should be considered.