Iranian Journal Of Nursing and Midwifery Research
Volume:20 Issue: 5, Sep-Oct 2015

According to professionalization in nursing profession, the nursing researches expanded dramatically and rapidly in a very short period. Research results showed improvement in quality of provided care by using research findings. But there is still a gap between nursing research and practice, which led scientists to explore the barriers and facilitators of research utilization that could affect the application of research results. The aim of this review was to appraise and synthesize evidences of studies about the facilitators and barriers to research utilization in Iranian nurses. A systematic review of quantitative and qualitative studies about the barriers and facilitators of nursing research utilization in Iran was undertaken. The results showed that items such as “The nurse is isolated from knowledgeable colleagues with whom to discuss the research,” “There is insufficient time on the job to implement new ideas,” “The nurse does not have time to read research,” “The nurse does not feel she/he has enough authority to change patient care procedures,” “The facilities are inadequate for implementation,” “Physicians will not cooperate with implementation,” and “The relevant literature is not compiled in one place” were rated as the main barriers. The results of 10 studies about research utilization in Iran showed that the barriers and facilitators remained constant through time and across different locations. The rank orders of barriers and facilitators were the same approximately. The nurse managers and administrators could utilize the findings of this review to allocate human resources and other sources and promote nursing research utilization in clinical field.

Committing an error is part of the human nature. No health care provider, despite the mastery of their skills, is immune from committing it. Medical error in the labor and obstetrics wards as well as other health units is inevitable and reduces the quality of health care, leading to accident. Sometimes these events, like the death of mother, fetus, and newborn, would be beyond repair. The purpose of this study was to investigate the perspective of gynecological ward providers about medical errors. This was a descriptive–analytical study. Sample size was 94 participants selected using census sampling. The study population included all midwives of four hospitals (Al‑Zahra, Beheshti, Isa Ben Maryam, and Amin). Data were collected by a self‑administered questionnaire and analyzed using SPSS software. This study shows that three factors (human, structural, and managerial) have affected medical errors in the labor and obstetrics wards. From the midwifery perspective, human factors were the most important factors with an average score of 73.26% and the lowest score was related to structural factors with an average score of 65.36%. Intervention strategies to reduce errors, service training program tailored to the needs of the service provider, distribution of the tasks at different levels, and attempts to reform the system instead of punishing the wrongdoer were set in priority list. Based on the results of this study on the perspectives of participants, among the three factors of medical errors (human factors, structural factors, and management factors), human factors are the biggest threat in committing medical errors. Modification in the pattern of teaching by the midwifery professors and their presence in the hospitals, creating a no‑blame culture, and sharing of alerts in medical errors are among appropriate actions in the dimensions of human, structural, and managerial factors.

Fatigue is the most common side effect of chemotherapy in children with acute lymphoblastic leukemia (ALL).Acupressure is one of the most popular non‑pharmacologic methods used to reduce fatigue in other settings. The aim of the study was to evaluate the effect of acupressure on reducing fatigue among children with ALL compared with a placebo treatment. In a single‑blind, randomized, placebo‑controlled clinical trial of 120 hospitalized school‑aged children with ALL, 24 h after chemotherapy, they were randomly divided into experimental (n = 60) and placebo groups (n = 60). Intensity of fatigue was rated using the Visual Analog Scale. The intervention (finger acupressure) was applied on ST36 (true points) in the experimental group and on LI12 (sham points) in the placebo group. We evaluated the symptoms of fatigue intensity immediately and 1 h after intervention. Fatigue was also measured 24 h after intervention by Fatigue Scale‑Child (FS‑C). Data were analyzed by SPSS version 16.0 using descriptive statistics, independent t‑test, and Chi‑square and Fisher exact tests. Significant differences were observed between the two groups in the intensity of fatigue 1 h after intervention (P < 0.001). But there was no significant difference between them regarding fatigue 24 h after intervention. Applying one time acupressure may reduce the intensity of fatigue at 1 h post‑treatment. Therefore, acupressure could be recommended as an effective, non‑pharmacologic method for some CRF control. Applying one time acupressure did not have a long‑term effect.

Identification of the main needs of infertile patients is essential to provision of appropriate supportive services and care based on their needs. Thus, the present study aims to explore infertile couples’ counseling needs. This study was carried out with an inductive qualitative content analysis approach during 2012–2013. The participants of this study included 26 Iranian infertile couples and 7 medical personnel (3 gynecologists and 4 midwives). The infertile couples were selected through purposive sampling and considering maximal variation from patients attending state‑run and private infertility treatment centers as well as infertility specialists, offices in Isfahan and Rasht, Iran. Unstructured in‑depth interviews and field notes were utilized for data gathering and replying to this research main question, “What are the counseling needs of infertile couples?” The data from medical personnel was collected through semi‑structured interviews. Data analysis was carried out through conventional content analysis. Data analysis revealed two main themes. The first theme was “a need for psychological counseling,” which included four subthemes: Emotional distress management, sexual counseling, marital counseling, and family counseling. The second theme was “a need for guidance and information throughout treatment process,” which included three subthemes: Treatment counseling, financial counseling, and legal counseling. The counseling needs of infertile couples are varied, and they require various psychosocial support and counseling interventions. The participants of this study identified clearly the significance of psychological counseling and information throughout the long and onerous journey of infertility and its treatment.

A major problem of the first moments of childbirth, especially in “prolonged labor,” is perinatal asphyxia which necessitates neonatal resuscitation. This study aimed at evaluating the alert line of the partogram in recognizing the need for neonatal resuscitation 20–30 s after delivery. 140 full‑term pregnant women were kept under surveillance through using a partogram. In order to decide on the onset of resuscitation, the three indicators of fetal respiration, heart rate, and skin color were used 20–30 s after delivery. The findings from the evaluation of fetal conditions were compared to the position of the ultimate cervical dilatation graph to the alert line of the partogram, and through using appropriate statistical procedures, sensitivity, specificity, and positive and negative prediction values of the alert line to recognize the need for neonatal resuscitation were computed. There was a significant relationship between the need for neonatal resuscitation within 20–30 seconds after delivery and the graph of the cervical dilatations on the partogram (P = 0.001). The indices of the alert line for predicting the need for resuscitation 20–30 s after birth had a sensitivity of 97.5%, specificity of 80.2%, positive prediction value of 97.2%, and negative prediction value of 98.7%. In mothers who had normal vaginal delivery, with normal fetal heart rate, and with no oxytocin administration or omniotomy, the alert line showed appropriate sensitivity, specificity, and negative prediction value. So, it can assist in predicting the necessity of action for neonatal resuscitation 20–30 s after delivery.

Delivery is one of the most important crises with mental, social, and deep emotional dimensions in women’s life. Health providers’ respect to pregnant women’s Bill of Rights, as an important component of providing humanistic and ethical care, is of utmost importance. This study aimed to determine health providers’ compliance with the pregnant women’s Bill of Rights in labor and delivery and some of its related factors in 2013. This descriptive, cross‑sectional study was carried out on the subjects selected through census sampling (N = 257) from among the healthcare providers working in the labor rooms of four educational hospitals. The data were collected by a self‑reported questionnaire whose validity and reliability were established. Data were analyzed through descriptive and inferential statistics. The compliance with pregnant women’s Bill of Rights was found to be at a very high level in 22.8% of the midwifery students, 28.6% of the residents of obstetrics and gynecology, 21.9% of the interns, 50% of the obstetrics and gynecology faculty members (professors), and 31.9% of the midwives. There was a significant difference between the five groups of service providers in terms of overall compliance with mothers’ rights (P = 0.002). The results showed that the residents in higher years of education (P = 0.001), midwifery students in higher semesters (P = 0.001), midwives with more work experience (P < 0.001), and personal experience of being hospitalized in labor room (P < 0.001) had a higher compliance with Bill of Rights. Meanwhile, there was no significant difference in compliance with Bill of Rights between labor and age (P = 0.82). The results showed that the health providers’ compliance with the pregnant women’s Bill of Rights was not acceptable in the labor room. Therefore, necessary actions are needed to remove the barriers against pregnant women’s compliance of Bill of Rights and to facilitate the compliance with it in hospitals.

Postpartum blues is a transient change of moods occurring in the first few days after delivery. The present study aimed to investigate the effect of religious doctrines on postpartum blues in primiparous women. In this randomized controlled tria1, 84 primiparous women who had average or weak religious attitude were randomly divided into intervention and control groups. In the intervention group, religious doctrines were instructed from 20th to 28th weeks of gestation through 6 weekly sessions of 60–90 min each. The control group, however, just received the routine care. Spielberger’s anxiety scale and the questionnaires assessing religious knowledge and attitude were completed by both groups before, immediately after, and 1–2 months after the intervention. Also, postpartum blues were evaluated by Edinburg Postnatal Depression Scale (EPDS) 10 days after delivery. Then, the data were analyzed using Chi‑square, paired t‑test, independent t‑test, analysis of variance (ANOVA), and Pearson correlation coefficient. The results showed postpartum blues in 59.5% of the study participants. Besides, the results of independent t‑test revealed a statistically significant difference between the two groups regarding the mean score of postpartum blues (P = 0.036). Although the intervention group’s knowledge and attitude scores were higher than those of the control group, no significant difference was found between the two groups regarding the correlation coefficient between postpartum blues and religious knowledge (P = 0.088) and religious attitude (P = 0.7). The results of the study show that instruction of religious doctrines was effective in increasing the religious knowledge and attitudes and reducing the postpartum blues.

Cancer has significant traumatic effects on the family members of the patients, particularly in Asia’s tightly knitted families. Research evidence suggests a debilitating impact of cancer on the quality of life of the afflicted individuals, their spouses, and their families. Since a few studies have been carried out on the quality of life of adolescents living with parents diagnosed with cancer, especially in Iran, the research team decided to evaluate the quality of life of them and also investigate the effects of supportive‑educative program on it. The present quasi‑experimental, one‑group study had a pre‑test–post‑test design and was performed in Esfahan in 2014. The sample of this study consisted of 30 adolescents. The data gathering tool was the short form of quality of life questionnaire (SF‑36). Data were analyzed by descriptive statistics and paired sample t‑test. P‑value of 0.05 was considered significant. The paired sample t‑test showed that before and after presenting the program, there were significant statistical differences in some aspects of quality of life, such as physical functioning (P = 0.01), energy/fatigue (P < 0.0001), emotional well‑being (P < 0.0001), social functioning (P = 0.001), pain (P < 0.0001), and general health (P = 0.01). This research showed that supportive‑educative program can enhance some aspects of quality of life. Therefore, nurses and other health professionals can use this scheme or similar programs for helping adolescents living with a parent with cancer.

Pregnancy can be in conflict with sexual function which can be affected by physical and psychological changes during pregnancy. Therefore, comparison of the effect of face‑to‑face education with group education on sexual function during pregnancy in couples was the purpose of this research. In this quasi‑experimental pre‑test post‑test study, 64 pregnant couples were selected and randomized in two groups in Isfahan. The data were collected using the triangulation of Female Sexual Function Index (FSFI), Brief form of Sexual Function Inventory (BSFI), and demographic characteristics questionnaires. The data were analyzed by independent t‑test, paired t‑test, Chi‑square, analysis of covariance (ANCOVA), and analysis of variance (ANOVA) in SPSS. No significant difference was found in the demographic characteristics between the two groups. Education was effective on sexual function in the two groups of women (P < 0.001), but no significant difference was found between the two groups (P = 0.61). Also, education was effective on sexual function of men in both the groups (P < 0.001) and there was a significant difference between the two groups (P = 0.003). Meanwhile, there was no significant difference between couples regarding the education (P = 0.104). The results of the study showed that type of education plays a role in improvement of sexual function in pregnancy. In addition, sex education is effective in prevention of sexual disorders in pregnancy. Therefore, having a special approach toward sex education classes during pregnancy is important for the health providers, particularly midwifery professionals.

Acute coronary syndrome is one of the major cardiovascular diseases that leads to a significant amount of morbidity. The purpose of the present study was to investigate the effect of cardiac rehabilitation on quality of life in patients with acute coronary syndrome. This was a clinical trial study conducted on 50 patients with acute coronary syndrome admitted to the coronary care units of Shohada Hospital in Isfahan in 2013-2014. The participants were randomly assigned to control (n = 25) and study (n = 25) groups. The study group received cardiac rehabilitation in phase 1 and 2. Phase 1 was conducted in a hospital in Isfahan province that had no cardiac rehabilitation center but had minimal cardiac rehabilitation equipments. Phase 2 was conducted at home by follow‑up through telephone and referring the patients to the hospital. The control group received usual cardiac rehabilitation. The data were collected via a demographic questionnaire and SF‑36 quality of life questionnre before and 1 month after intervention by the researcher. Data were analyzed by independent samples t‑test. In the study group, the mean scores in all domains of quality of life increased significantly after intervention (P < 0.05). In the control group, the mean scores of quality of life were not significantly different before and after intervention (P > 0.05). A significant difference was found between the study and control groups in all domains of quality of life except for general health and social function (P < 0.05) in favor of the study group. The results of this study showed that cardiac rehabilitation program could lead to improving the quality of life in the patients with acute coronary syndrome.

Assessment of developmental skills is one of the most essential components of children’s health evaluation. Since several pubertal disorders are caused by parental negligence in diagnosis, prevention, and treatment of childhood problems, failure to make a timely diagnosis of these problems could have adverse effects on the health of children in future. This study was conducted to determine the developmental skills of 36-60‑month‑old children in Isfahan. In this cross‑sectional study, 196 children, aged 36-60 months, were recruited through random cluster sampling. “Ages and Stages” questionnaire was filled for each subject by their parents (father, mother, or both), and the frequency of developmental delay was determined based on cut‑off points. The data were analyzed by descriptive statistics using SPSS 20.0. About 52.6% of the children were male. Mean age of the children was 50.71 (SD = 8.16) months. The abnormal findings were in the five domains of communication (1.5%), gross motor (3.1%), fine motor (7.7%), problem solving (7.7%) and personal‑social (2%). The results suggest that some of the children had scores below or equal to the cut‑off points and needed more evaluation by a professional person. The domains in which the children had problems were fine motor, problem solving, and gross motor. Therefore, health staff should pay more attention to assessment of these domains and parents should be trained to develop their children’s skills in these domains.

The main goals in treating burns are to accelerate tissue renovation and prevent infection. Topical antibiotics are used in the treatment of burns, but they can cause side effects. Recently, a traditional ointment (Olea) has been used in Iran in the treatment of burns. This study examines the effect of topical honey ointment in healing of burn patients. In this randomized controlled trial (RCT), 30 hospitalized patients selected by conventional sampling (10 in Olea group and 20 in Acetate Mafenide ointment group) were evaluated. Inclusion criteria were: having second‑degree burns and body surface area equal to or < 40%. One group was treated using topical Olea ointment and the other with Acetate Mafenide ointment (8.5%). Chi‑square, Fisher exact test, and Kaplan–Meier were used. Significance level was considered as P < 0.05. None of the patients in the Olea group needed surgery for debridement, while in the second group, 13 patients (65%) needed debridement (P = 0.001). In the Olea group, 1 patient (10%) and in the second group, 19 patients (95%) had positive cultures after 7 days (P < 0.001). The mean time of granulation tissue formation in the Olea group was 12 days (10.3–13.6) and in the other group, it was 17 days (13.3–20.6) (P < 0.001). Olea ointment is a useful treatment for burns, and it can prevent infections, accelerate tissue repair, and facilitate debridement. Therefore, using this ointment is recommended for the treatment of burns.

Professional development is reiterated in the new definition of modern organizations as a serious undertaking of organizations. This article aims to present and describe a prescriptive model to increase the quality of professional development of Iranian nurses within an organization‑based framework. This article is an outcome of the results of a study based on grounded theory describing how Iranian nurses develop. The present study adopted purposive sampling and the initial participants were experienced clinical nurses. Then, the study continued by theoretical sampling. The present study involved 21 participants. Data were mainly collected through interviews. Analysis began with open coding and continued with axial coding and selective coding. Trustworthiness was ensured by applying Lincoln and Guba criteria such as credibility, dependability, and conformability. Based on the data gathered in the study and a thorough review of related literature, a prescriptive model has been designed by use of the methodology of Walker and Avant (2005). In this model, the first main component is a three‑part structure: Reformation to establish a value‑assigning structure, a position for human resource management, and a job redesigning. The second component is certain of opportunities for organization‑oriented development. These strategies are as follows: Raising the sensitivity of the organization toward development, goal setting and planning the development of human resources, and improving management practices. Through this model, clinical nurses’ professional development can transform the profession from an individual, randomized activity into more planned and systematized services. This model can lead to a better quality of care.

Chronic obstructive pulmonary disease (COPD) is currently the fourth cause of mortality worldwide. Patients with COPD experience periods of dyspnea, fatigue, and disability, which impact on their life. The objective of this study was to investigate the effect of short‑term inspiratory muscle training on exercise capacity, exertional dyspnea, and pulmonary lung function. A randomized, controlled trial was performed. Thirty patients (27 males, 3 females) with mild to very severe COPD were randomly assigned to a training group (group T) or to a control group (group C). Patients in group T received training for 8 weeks (15 min/day for 6 days/week) with flow‑volumetric inspiratory exerciser named (Respivol). Each patient was assessed before and after 8 weeks of training for the following clinical parameters: exercise capacity by 6‑min walking test (6MWT), exertional dyspnea by Borg scale, and pulmonary lung function by spirometry. Patients used training together with medical treatment. The data were analyzed using paired t‑test and independent t‑test. Results showed statistically significant increase in 6MWT at the end of the training from 445.6 ± 22.99 to 491.06 ± 17.67 meters? (P < 0.001) and statistically significant decrease in dyspnea from 3.76 ± 0.64 to 1.13 ± 0.36 (P = 0.0001) in the training group but not in the control group. The values for exercise capacity and dyspnea improved after 8 weeks in group T in comparison with group C (P = 0.001 and P = 0.0001, respectively). No changes were observed in any measure of pulmonary function in both groups. Short‑term inspiratory muscle training has beneficial effects on exercise capacity and exertional dyspnea in COPD patients.

Endotracheal suctioning (ETS) is an essential procedure performed for mechanically ventilated patients. ETS can be either performed by open or closed suctioning system (CSS). There may be some concern on how closed‑system ETS is practiced by intensive care nurses. This study was designed to investigate closed‑system ETS practices of critical care nurses and to compare their practice with standard recommendations. A prospective observational study was conducted during August and December 2012 to establish how critical care nurses (N = 40) perform different steps in a typical ETS practice and to compare it with the current best practice recommendations through a 23‑item structured checklist. The results were categorized into three sections: Pre‑suctioning, suctioning, and post‑suctioning practices. Pre‑suctioning, suctioning, and post‑suctioning practices mean scores were 7.5, 11.75, and 8.5, respectively, out of 16, 16, and 12, respectively. The total suctioning practice score was 27.75 out of 44. Most discrepancies were observed in the patients’ assessment and preparation, infection control practices, and use of an appropriate catheter. Spearman correlation coefficient indicated a significant statistical positive correlation between suctioning education period and suctioning practice score (P < 0.0001) and between working experience and suctioning practice score (P = 0.02). The findings revealed that critical care nurses do not fully adhere to the best practice recommendation in CSS. We recommend that standard guidelines on ETS practice be included in the current education of critical care nurses.

Chronic renal disease and hemodialysis cause numerous psychological, social, cultural, and spiritual challenges for both patients and their families. Overcoming these challenges is possible only through providing holistic support for the patients. Today, despite the support provided by family and professional caregivers for the patients, patients still express dissatisfaction with the support provided and believe it to be inadequate. In fact, patients and family caregivers and healthcare practitioners seem to have different understandings of the notion of support. Thus, the researcher decided to examine the concept of support from the viewpoint of hemodialysis patients. This descriptive phenomenological research was conducted on 17 patients with end‑stage renal disease (ESRD) who were undergoing hemodialysis. Purposive sampling was performed and continued until data saturation. Data were collected through 30–60 min unstructured interviews and analyzed using Colaizzi’s method. From the analysis of data, 4 themes (psychological support, accompaniment, social support, and spiritual support) and 11 sub‑themes were obtained. Psychological support consisted of two sub‑themes of psychological support by healthcare practitioners and emotional support by family and relatives. Accompaniment included three sub‑themes of assistance in transportation, providing and using medicine, and daily activities. Social support was identified with four sub‑themes of promotion of the society’s understanding of the patients’ condition, improvement of communication with others, the need for employment, and independence. Spiritual support was identified with two sub‑themes of the need for faith and trust in God or Imams and the need to resolve spiritual contradictions. The results showed that from the viewpoint of the participants, the concept of support consisted of psychological support, social support, accompanying the patient, and spiritual support. Hence, it can be concluded that this concept should be considered in healthcare planning, in order to improve the health and quality of life of these patients and their adaptation to the disease and its treatment process.

Sir, The World Health Organization has acknowledged that tuberculosis (TB) is one of the deadliest infectious diseases worldwide.[1] The global estimates suggest that in the year 2013, almost 9 million people were diagnosed with TB and around 1.5 million succumbed to the disease and its associated complications.[1] As an effective approach [viz. Directly Observed Treatment and Short‑course chemotherapy (DOTS)] is available for the disease, it is really unacceptable to digest that so many people die every year because of a preventable disease.[1,2]. .......