Journal of Holistic Nursing and Midwifery
Volume:25 Issue: 4, 2015

Increasing pressure to follow a vision on complete health care organizations، better quality and excellence selection systems has become one of the main concerns for organizations and their managers.. The aim of this study is to determine the relationship between the level of ISO 9001-2008 quality management system and altering indictors of quality effectiveness in Rasht Hospitals. This is a descriptive and correlational study which was performed in three ISO-certified hospitals. The degree of ISO implementation measured using the requirements of ISO 9001 standards through questionnaires. Data of quality effectiveness indictors were compared using dependent T-test before and after the implementation when determining the mean and coefficient of variation. There was a significant relationship between some indicators of quality effectiveness such as patient satisfaction، number of inspected complaints and improved procedure within implementations of ISO quality system (p<0. 05). On the other hand there was no significant difference between the mean alteration of the average length of patient's hospitalization before and after the placement. Create a systemic visualization of the powerful tool such as ISO quality management system and imperative practical performance system in one organization discriminent addition to correcting systems and improving staff performance، will improve some indicators of hospital.

Today medical world is facing the increase of chronic diseases. Rheumatoid Arthritis as a chronic disease causes pain, fatigue, limited mobility and daily activity, physical function disorder and disability. An important part of controlling chronic illnesses such as rheumatoid arthritis is enabling patients to conduct self-care and adjusting to condition of chronic disease. Present study aims to determine self-care ability of patients with rheumatoid arthritis. This is a cross sectional descriptive study which surveyed the level of self-care of 326 patients with rheumatoid arthritis referring to Rheumatology clinic of Razi educational center in Rasht. Data were collected using Health Assessment Questionnaire in order to determine the disability rate and Self-Care Inventory in order to determine the Self-Care ability rate through interview. Data were analyzed by descriptive and analytical statistical tests (Kruskal Wallis, Mann Whitney and Multiple linear regressions). The mean self-care ability of patients was 57.65±2.32 which was at a good level. Sex (P<0.0016)), age (P<0.001) marital status (P<0.001), education (P<0.001), jobs (P 0.001), income (P<0.004), duration of illness (P<0.000) and co morbidities (P<0.001) were significantly associated with self-care ability. Study findings indicate that baseline factors are effective in controlling rheumatoid arthritis disease; therefore it is necessary for nurses to determine self-care needs considering effective related factors to develop and implement training programs in order to improve patients’ empowerment.

Coronary artery bypass grafting surgery is a common therapeutic intervention in patients with coronary artery disease. This surgery has various complications. Electrolyte disorders are among common important complications among these patients. purpose of this study was to determine the level of electrolyte disorders and related factors in patients after coronary artery bypass grafting surgery hospitalized in cardiac care units. In this descriptive cross–sectional study, 288 Coronary Artery By Pass Graft (CABG) patients admitted to educational hospital were selected by gradual sampling. Data were collected by a three part researcher made questionnaire covering demographics, past medical history and levels of sodium and potassium through patients’ medical records. Statistical analyses were performed using appropriate tests (chi square test, fisher exact test and logistic regression). Findings showed that 16.7% of patients undergoing coronary artery bypass grafting were hyponatremia, 4.9% hypernatremia, 14.2% hypokalemia and 3.8% hyperkalemia. The results also indicated that there was a significant relationship between the factors such as body mass index, history of drug use, the number of vessels involved, the number of grafts, the length of time connected to mechanical ventilation, duration of artificial heart-lung machine use, aortic clamping time, and amount of intraoperative hypothermia, hemoglobin and hematocrit and postoperative electrolyte disorders (P<0.05). According to Logestic regression model, these factors were not associated to electrolyte abnormalities. The findings showed that many factors such as individual medical history and condition during surgery can affect electrolyte abnormalities after coronary artery bypass graft. Identifying these factors can be useful in planning for prevention, diagnosis and early treatment of possible complications which in turn may result in promotion of quality care.

Foot ulceration is one of the most serious and disabling complications of Diabetes Mellitus and identification of risk factors affecting foot ulcer can prevent it from causing irreparable consequences. Therefore the aim of this study was to comparing the situation of the foot skin in diabetic patients with and without foot ulcers. In this cross - sectional study of 355 diabetic patients referred to Razi Hospital in 2013 were randomly selected based on a questionnaire consisted of four parts: demographic profiles, clinical characteristics, skin situations and diabetic foot, by a trained nurse were studied. History of the disease based on Charlson Co morbidity Index and foot ulcers by Wagner ulcer classification system were evaluated. Patients were divided into two groups of foot ulcer and non-ulcer and each of the variables were compared between these two groups. We used Chi square test and logistic regression analysis to compare some variables. P-value less than 0.05 was considered significant. Based on these findings, 16.1% had foot ulcers. Dry skin with no sweating, pallor, fisher, edema, impaired growing toe nails in the group with ulcer was (89.47%, 42.1%, 26.31%, 21.05%, and 64.91%) and in the group without ulcer was (73.48%, 35.9%, 11.74%, 12.08%, and 48.65%). There is significant correlation between foot ulcers and dry skin (p=0.01), fissure (p=0.004) and impaired growth toenail (p=0.02).Risk of foot ulcers in people with dry skin 3.07 times, the people of Fisher 2.68 times in people with impaired growth and toenails 1.95 times higher. Since skin problems affecting the foot ulcer, nurses by identifying risk factors played a role in the prevention and treatment of foot ulcers.

Anxiety is a common psychological reaction in invasive diagnostic and therapeutic such as interventions electrophysiological, that requires nursing care management for assessment and application of effectiveness to reduce it. The present study have been conducted to determine the effect of Benson relaxation on anxiety in patients waiting for electrophysiological diagnostic and therapeutic interventions. This is a clinical trial study on 72 patients waiting for electrophysiological interventions, admitted in Heshmat Hospital - Rasht. Samples selected through convenience sampling method, and were allocated to intervention (usual care and relaxation) and control (usual care only) groups through Random Block method. Data were collected using the 2- part questionnaire include personal - clinical data and hospital anxiety and depression scale (only anxiety part) through interview and document records information. Data were gathered in 2 stages, first before 60-15 minutes and second 5-3 hours before electrophysiology intervention (personal-clinical characteristics and level of anxiety). Intervention group encouraged to listen to audio instructions Benson relaxation for 10 minutes using headphones, and then exercise for at least 3 times between two steps of study. Data were analyzed by X2, paired t- test and independent t-test The results showed that the mean and standard deviation of anxiety score in the intervention group after the intervention has been much lower than before (3/11 ± 3/43) compared to (7/91 ± 6/70). Paired t-test between the mean scores before and after relaxation in the intervention (P <0. 0001) and control group (P <0. 0001) was significant. Finally, independent t-test showed a significant difference (p<0. 0001) between the mean and standard deviation of anxiety score in the second step in two groups, which indicate the effect of relaxation on anxiety patients. According to the results of this study, Benson relaxation significantly reduced the anxiety level in these groups of study. Therefore nurses could use this method to reduce the level of anxiety in these patients.

Clinical governance is a framework in which the organization providing clinical services is accountable for continuing improvement of quality of clinical service excellence. This study aimed to determine obstacles of clinical governance administration from view point of managers and nurses in hospitals affiliated to Jahrom University of Medical Sciences. This is a cross-sectional study conducted on 280 nurses and 20 managers selected by census method. Data were gathered by a researcher made questionnaire, consisting of 48 items in 7 domains of clinical governance. Questionnaire validity was done by face and content determination style and its reliability was established through Test-retest method and Spearman test (r=0.73). Data were analyzed by descriptive statistics. Clinical audit and personnel management had the most negative effect in clinical governance administration from participants’ viewpoint. From all questions "inattention to personnel job satisfaction" in "personnel management" domain had the most negative effect. According to importance of clinical governance administration, such research results should be considered by health managers.

Nursing as a clinical discipline is developing daily in emergency wards and health care system managers should assess and prioritize clinical competence indicators in these wards continuously. Lack of clear clinical competence indicators challenges evaluation. This study aimed to determine general clinical competence indicators from nurses’ viewpoint working in emergency wards. This is a assessment study using Delphi method in three phases: the first phase (determine the General Clinical competence indicators), Phase II (classifying general clinical competence indicators by members of the expert panel) third phase (prioritizing general clinical competence indicators using exploratory factor analysis) through which 710 nurses were chosen by convenience random sampling working in emergency wards affiliated to Guilan Therapeutic Educational Centers during a two month period. Finally, exploratory factor analysis was used. In prioritizing phase of general clinical competence indicators, five factors statements were classified by the expert panel and provided a structured model in three domains which were divided as communication (10 items), disaster and emergency management (8 items) and personality characteristics (12 items). A present alternative to reduce the gap between theory and practice in nursing is through determination and prioritization of clinical competence criteria in emergency wards. Factor analysis can be used to prioritize these indicators. Further research in health care system is ed in order to achieve reliable and valid instrument.

The ethical standards compliance in nursing practice will lead to improve nursing services; therefore this must be regarded as main goal for hospitalized patients. The aim of study was to determine the professional ethics standards compliance in nursing practice from nurses and patients prospective in 2012. This is a descriptive comparative study that was conducted with partnership of 160 registered nurses were chosen by census and 504 hospitalized patients were selected by quota sampling from medical and surgical wards affiliated to training hospitals of the Medical Sciences Jahrom University.Study tool was a questionnaire list, 31 questions for nurses and 22 questions for patients. Data analysis performed using, SPSS 16, connected Chi-Square, correlation and Mann-Whitney tests. According to the nurse's perspective 72% had responsible aspect and respectful patients care quality performance was 70%. However from patient’s perspective 40% of nurses had responsible aspect, quality performance 45% and patients respect 69% to meet ethical standard.There was significant difference between nurses and patients perspective in sight of responsibility and quality care performance. The results showed that there is difference between patients and nurse's perspective about professional ethics standards compliance. To improve quality care performance education and training of ethical standards compliance is essential

Skilled nurses are needed to achieve health promotion strategies, so operation and assessment via staff development program is essential. The purpose of this study was to evaluate staff development program through west Mazandaran hospital nurses and its relationship with the level of their professional competency. This study was descriptive - correlations in 205 nurses from general ward who were selected by cluster sampling. Data was collected by two questionnaires for competency level and staff development programs. Face and content validity was approved and reliability of the instrument was assessed by the internal consistency. Analysis of variance and chi-square tests were used to analyze data. The majority of samples reported their competent level as ideal (75/6%), and the effectiveness of the program estimated as average (80/5%). variance analysis of data showed there are no significant difference in the mean scores of survey instrument staff development, among the nurses with varying levels of competence (p =0/4, df =2). Organizations spend enormous amounts of money to improve development programs. If these programs loss their effectiveness, it is time consuming and will damage the economy. These results could be useful for nursing organisation and executives

Coronary artery bypass grafting surgery is a common therapeutic intervention in patients with coronary artery disease. This surgery has various complications. Electrolyte disorders are among common important complications among these patients. purpose of this study was to determine the level of electrolyte disorders and related factors in patients after coronary artery bypass grafting surgery hospitalized in cardiac care units. In this descriptive cross–sectional study, 288 Coronary Artery By Pass Graft (CABG) patients admitted to educational hospital were selected by gradual sampling. Data were collected by a three part researcher made questionnaire covering demographics, past medical history and levels of sodium and potassium through patients’ medical records. Statistical analyses were performed using appropriate tests (chi square test, fisher exact test and logistic regression). Findings showed that 16.7% of patients undergoing coronary artery bypass grafting were hyponatremia, 4.9% hypernatremia, 14.2% hypokalemia and 3.8% hyperkalemia. The results also indicated that there was a significant relationship between the factors such as body mass index, history of drug use, the number of vessels involved, the number of grafts, the length of time connected to mechanical ventilation, duration of artificial heart-lung machine use, aortic clamping time, and amount of intraoperative hypothermia, hemoglobin and hematocrit and postoperative electrolyte disorders (P<0.05). According to Logestic regression model, these factors were not associated to electrolyte abnormalities. The findings showed that many factors such as individual medical history and condition during surgery can affect electrolyte abnormalities after coronary artery bypass graft. Identifying these factors can be useful in planning for prevention, diagnosis and early treatment of possible complications which in turn may result in promotion of quality care.

Primary dysmenorrhea is common in women during reproductive age. This study aimed to determine the effect of acupressure on sixth spleen point (SP6) on relief of primary dysmenorrhea. This study is a clinical trial. Students with primary dysmenorrheal living in dormitory were studied during three menstrual cycles. Pain intensity was measured on the first cycle without intervention. Subjects were divided into two parallel groups (pressure on SP6 and placebo groups), using a randomized block design with odds ratio of 1:1 based on the intensity of pain. In the second and third cycles, pressure was exerted by the samples. Pain intensity was compared with the visual analogue scale before and after intervention. Samples, person dividing the groups, data analyzer were blinded to study groups. At the end data related to 30 students in experiment group and 32 students in control group were analyzed. T test, chi-square, Friedman, Mann-Whitney and ordinal regression were used to compare the pain severity in experiment and control groups. Pain severity up to 3 hours after giving pressure on SP6 (p<0.004) and four hours after giving pressure on control point (p<0.001) was decreased compared to before intervention. There was no difference observed pain in groups before and after intervention. Since pain severity was less in both groups after intervention, more studies are recommended.

Marital satisfactions are the key to strength the family and heighten the physical, mental health and economic development which could effect on life and job satisfaction. Professional nurses are under various stresses during their shift work to provide excellent quality of life for patients. They have responsibility for their own personal life too. Due to multiplicity of nurse’s roles they suffer under several psychological and physical stresses. Understanding the factors related to their employment such as shift work can improve validity and efficiency of this force which is important in human. This study aimed to determine the role of shift work and predictor variables on marital satisfaction of employed nurses through educational – medical centers. In this cross – sectional study, 500 marital employed nurses from 8 training medical centers in Rasht were selected using stratified random sampling.Information was collected using ENRICH marital satisfaction questionnaire for demographic data, social and shift work. For data analysis spss16, descriptive and inferential statistical tests (linear regression, Pearson's test, Regression Logistic Ordinal Model) were applied. Results showed that there is a significant relationship between marital satisfaction and shift work (P=0/003), history job (P=0/0001), personal income (P=0/002), the place of service (P=0/0001), employment status (P=0/0001), age (P=0/002). The findings showed each child can increase 1.65 times chance of lower satisfaction. Psychiatric ward was only ward related to marital satisfaction (p<0.0001). But there was not significant relationship between marital satisfaction job degree, sex and educational level. According to this findings, shift work, and some occupational factors (history job, income, place of service, employment status) are related to marital satisfaction for nurses. Therefore, applying the appropriate ways and moderating factors to improve the marital and career state of nurses are essential.

Manpower providing health and treatment care has a crucial contribution to public health, therefore maintaining and improving the quality of health care providers is required for quality of providing service. An aspect that has impact on their health is occupation and job satisfaction. Present study is designed to examine predictive factors of public health based on job satisfaction of health service center's employees. This study is a cross sectional descriptive-analytic study conducted in 2012. In this study, census method was used for sampling. 252 personnel of health centers participated in this study and data collection tool included three questionnaires of Job Description Index (JDI), General Health Questionnaire (GHQ) and demographic characteristic questionnaire which were used after establishment of its validity and reliability. Data was analyzed using descriptive and analytical tests (Mann Whitney- Kruskal Wallis. Findings showed that only 47.6% of staff had good general health. About 63.16% of employees were satisfied most level of satisfaction was in colleague domain (76.83%) and least level of satisfaction was in salary domain (41.5%). Results indicated that from domain studied, only related and predicted areas of public health were colleague domain (p<0.049) and work environment condition (p<0.043) therefore the chance of general health increased by increasing level of satisfaction with colleague and work condition. Among the demographic characteristics, education (p<0.043) and management position (p<0.035) were identified as predictors of public health. In attention to obtained results, it can be said that the relationship between work and health is mutual and for improving the two concepts, planning and appropriate interventions are needed. And this intervention can lead to increased job satisfaction and staff physical and mental health.