مجله مراقبت پرستاری و مامایی ابن سینا
سال بیست و سوم شماره 3 (پیاپی 50، پاییز 1394)

Fatigue and sleep disorders are experienced by most patients with Multiple Sclerosis (MS). Since these problems can interfere with a patient''s daily functioning، this research examined the effects of Progressive Muscle Relaxation Technique (PMRT) on fatigue and sleep quality in patients with MS. This quasi-experimental study adopted a pretest-posttest single group design. A total of 67 individuals with MS received a PMRT intervention for seven weeks. A demographic questionnaire، a PMRT form، the Fatigue Severity Scale (FSS)، and the Pittsburgh Sleep Quality Index were used to collect data. Descriptive statistics، Wilcoxon test، and Spearman’s correlation analysis were used to analyze the data. The mean FSS scores were 5. 25± 0. 13 before the intervention 4. 37 ± 0. 13 after the intervention. Moreover، the mean sleep quality scores decreased from 8. 34± 0. 446 in pretest to 5. 18± 0. 345 in posttest (P < 0. 001). This study supported the beneficial effects of PMRT on reducing fatigue and improving sleep quality in patients with MS.

Diabetes is one of the most common and costliest chronic diseases whose treatment and control widely depends on patients’ sense of self-efficacy in self-management and adherence to self-care behaviors. This study was conducted to evaluate the effects of peer support on self-efficacy of patients with type II diabetes. In this clinical trial, 80 patients with type II diabetes were selected and allocated to the intervention and control groups (n = 40 each) using proportionate stratification. After creating a group of peers, the peers held 10 supportive training sessions for the intervention group over three months. A questionnaire was administered to measure peers’ knowledge before and after the training. Patients’ self-efficacy was assessed using the diabetes management self-efficacy scale (DMSES) before and after the intervention. Data analysis was performed in SPSS/18. There was no significant difference between self-efficacy scores of the two groups before the intervention (P = 0.1). However, the two groups had a significant difference in self-efficacy scores after the intervention (P < 0.001). Moreover, a significant difference was observed between the intervention groups’ scores of self-efficacy before and after the intervention (P < 0.001). Such a significant difference was not detected in the control group (P = 0.09). The peer group support program improved self-efficacy in patients with diabetes. This supportive training method is hence recommended as an efficient and cost-effective supplement to the routine diabetes care provided by healthcare personnel.

Understanding the relationships between demographic variables and learning organization is crucial to promoting the quality of educational and therapeutic services. The current study assessed the correlations between nurses'' demographic variables and learning organization in intensive care units of teaching hospitals in Hamadan، Iran. This descriptive cross-sectional study was conducted in 2014. The 30-item Dimensions of the Learning Organization Questionnaire (DLOQ) was distributed among 277 critical care nurses in teaching hospitals of Hamadan. The collected data were analyzed using Pearson’s correlation coefficients and analysis of variance in SPSS/18. The mean age of the nurses was 32. 0 ± 5. 56 years. Most nurses were female (83. 4%) and married (67. 7%). The majority of the participants had a work experience of ≤10 years (71. 47%) and held a Bachelor’s degree (97. 8%). The mean total score of learning organization was 128. 3 ± 29. 18. The subjects obtained moderate scores in continuous learning، inquiry and dialogue، team learning، embedded systems، empowerment، systems connection، and strategic leadership dimensions of the DLOQ (24. 46±5. 04، 18. 72±4. 68، 16. 81±4. 97، 18. 9±4. 59، 16. 93±5. 09، 16. 34±5. 15، and 18. 1±5. 2، respectively). Moreover، while learning organization had no significant correlations with age، sex، work experience in intensive care units، and employment condition، it was significantly related with marital status، overall work experience، intensive care units، and teaching hospitals. Moderate scores of learning organization are not appropriate for intensive care units. Therefore، managers of teaching hospitals should develop strategies to improve learning organization scores and promote nursing care quality in intensive care units.

The use of physical restraints is a major challenge in all healthcare systems throughout the world. The present study aimed to investigate the knowledge, attitude, and performance of intensive care unit nurses toward the use of physical restraints and to determine the factors affecting the mentioned variables. In this descriptive-analytical research, the study population included nurses working in intensive care units of teaching hospitals in Hamadan, Iran. Questionnaires containing demographic characteristics and knowledge, attitude, and self-report practice of physical restraint usage were developed to collect data. Descriptive and inferential statistics were used to analyze the data in SPSS/16. Most nurses were female (81.7%), aged 31-40 years (58.5%), and held a Bachelor’s degree in nursing (90.0%). Moreover, 87.8% of the participants had an experience of physical restraint use and facing its complications. The nurses’ mean scores of knowledge, attitude, and practice were 6.65 ± 1.73 (out of 13), 26.32 ± 4.94 (out of 52), and 20.79 ± 4.17 (out of 30). Knowledge and attitude were significantly related with education and practice. Furthermore, significant positive relationships were observed between of gender and practice and also practice and attending an educational course. Nurses did not show acceptable levels of knowledge, attitude, and practice of physical restraint use. Therefore, nurse education programs need to pay more attention to the significant issue of physical restraint usage.

High levels of stress caused by various medical procedures can affect developmental outcomes in preterm infants. Therefore, clustered care and direct observation of infant behaviors during care provision have been emphasized. The present study aimed to compare the behavioral responses of preterm infants to clustered care with four and five noninvasive procedures. This randomized crossover clinical trial was performed in Al-Zahra Teaching Hospital (Tabriz, Iran) during 2013. The behavioral symptoms of 31 preterm 32-week old infants were assessed following the administration of clustered care with four procedures (taking axillary temperature, changing the location of the pulse oximeter probe, gavage, and position change) and five procedures (the four mentioned procedures plus weighing). Data were analyzed with generalized linear mixed models and negative binomial link function in STATA 10. P values less than 0.05 were considered significant. The mean scores of behavioral symptoms indicating stability during clustered care with four and five procedures were 4.23 ± 2.33 and 4.03 ± 3.67, respectively. The mean scores of behavioral symptoms indicating stress during clustered care with four and five procedures were 4.03 ± 3.01 and 3.29 ± 2.67, respectively. There were no significant differences between the two groups before, during, or after the two interventions (P > 0.05). Clustered care with four and five noninvasive procedures led to behavioral symptoms indicative of acceptable stability in infants. Therefore, both care methods could be equally recommended for preterm infants.

The mean emergency department length of stay is an important indicator of the effectiveness of health services. It can be affected by several patient-related factors including gender, age, time of visit, main complaint, and allocated triage level. This study evaluated the relationships between these factors and emergency department length of stay. The present descriptive-analytical study applied convenience sampling to recruit 408 adult patients who presented at the emergency department of Besat Hospital (Hamadan, Iran) during a three-month period in 2013. A chronometer was used to measure the time interval between the patients’ presentation at the emergency department and their discharge (i.e. length of stay in the emergency department) through direct observation. The determined values were recorded in a relevant form. The Emergency Severity Index (ESI) form was also completed by triage nurses in charge. Analysis of variance (ANOVA), Kruskal-Wallis and independent-t tests, were performed to analyze the data. All analyses were conducted in SPSS/16 at a confidence interval of 95%. The mean emergency department length of stay was 133.26±41.91 minutes. There were no significant relationships between length of stay and the patients’ gender (P=0.52), referral type (P=0.14), and history of hospitalization (P=0.80). However, length of stay was significantly related with the patients’ age, time of admission, and main complaint (P<0.001). Considering the role of patients’ age, time of visit, main complaint, and level of triage in determining emergency department length of stay, these factors should be incorporated as indicators of effectiveness of healthcare centers.

The exclusive breastfeeding effects on growth and weight gain in infants. This study evaluated the effects of counseling on adherence to exclusive breastfeeding inmothers of late -preterm infants. This randomized experimental study was recruited 124 mothers of hospitalized late preterm infants in Fatemiyeh Hospital (Hamadan, Iran) during 2014. The participants were randomly allocated to the intervention and control groups. A checklist on lactation performance was completed by both groups. Five daily counseling sessions on lactation were then held for the intervention group. All analyses were performed in SPSS/21 at a significance level of P<0.05. The mean age of mothers was 27.13 ± 0.527 years in the intervention group and 27.19 ± 0.596 years in the control group. While 86 infants (69.4%) were born at 33-35 weeks of gestation, and 38 infants (30.6%) were born at 35 weeks to 36 weeks and six days of gestation. In the one-month follow-up, the two groups had a significant difference in terms of adherence to exclusive breastfeeding, i.e. frequency of breastfeeding and avoiding the use of formula, liquids other than breast milk, and supplements and lactation performance (P < 0.001). Moreover, the infants’ mean weight was 2818.62 ± 588.54 and 2422.58 ± 607.175 g in the intervention and control groups, respectively (P<0.001). According to our findings, breastfeeding-related counseling mothers can increase mothers’ adherence to exclusive breastfeeding, improve their lactation performance, and enhance weight gain in their late preterm infants. Therefore, lactation counseling sessionsare recommended for mothers of all preterm infants.

Lifestyle modification is an integral component of secondary prevention of cardiovascular diseases. Lifestyle is greatly influenced by the perception of disease. This study sought to evaluate the effects of pre-discharge education and telephone follow-up on illness perception and lifestyle in patients with myocardial infarction (MI). This non randomized controlled trial was performed in Imam Khomeini Hospital, Broujerd, Iran during 2014. Convenience sampling was applied to select 70 hospitalized patients with MI (35 patients in the intervention group and 35 in the control group). A demographic and disease characteristics questionnaire, the Brief Illness Perception Questionnaire (IPQ), and a lifestyle questionnaire were administered to collect data. Data analysis was conducted using descriptive and inferential statistics (independent t, paired t, chi-square, and Fisher’s exact tests) in SPSS/16. P values less than 0.05 were considered significant. In pre-test, the two groups had no significant difference in the mean score of illness perception (P=0.528). However, the mean score of lifestyle was significantly higher in the intervention group than in the control group (P=0.018). In the post-test, the two groups had significant differences in both illness perception (P=0.04) and lifestyle (P=0.01). Comparison of the mean differences between pre- and post-test scores revealed statistically significant differences in illness perception (P=0.018). In contrast, no significant difference was observed in case of lifestyle (P=0.826). According to our findings, pre-discharge education and telephone follow-up can correct illness perception in patients with MI. However, it seems that lifestyle changes will require long-term interventions.