نشریه پرستاری و مامایی ارومیه
سال چهاردهم شماره 2 (پیاپی 79، اردیبهشت 1395)

Being discharged on the contrary to the medical advice from the hospital can cause the premature discontinuation of treatment by patients or their family, and sometimes it results in the re-hospitalization or death of patients. It can be a detector of serious problem and patient dissatisfaction. This study aimed to assess the rate and causes of discharge against medical advice in inpatient and outpatient wards of Shahid Madani hospital in khoy.
This cross-sectional study was performed in Shahid Madani hospital in khoy city in 2014. All of inpatient and outpatient (1663 patients) that discharged the hospital against medical advice during the study period were included in the study. Data collection tool was a check list. Data were analyzed by using descriptive and inferential statistics in SPSS 18.
The patients, who were discharged from the hospital against medical advice, were 6/82% of all inpatients and 19/65% of all outpatients in emergency ward. The most important reason for discharging (47/8%) was prolongation of hospital stay. Other reasons were listed as feeling better, tending to stay in the hospital medical center, denial of treatment, dissatisfaction with the doctor, lack of facilities, dissatisfaction with the service provider and end stage of the patient.
As far as being discharged against medical advice can disrupt the patient's treatment, so it is advised to prevent it by increasing the patients awareness to the possible effects of illness, planning a better treatment protocol for patients, stabilizing the clinical social workers to identify and assessing the patient’s problems, creating a better space to relax patients and their relatives, and by creating a pleasant environment.

Due to the chronic nature of diabetes and its long process and the high prevalence of foot ulcer complications in patients with diabetes and spending a lot finance and service of for health care providers related to the care of wounds, using self-care programs such Orem's self-care program can be effective. This study aimed to determine the effect of self-care program based on Orem's model on self-care behaviors of patients with diabetic foot ulcers referred to Ayatollah Taleghani Hospital in Urmia.
The present study is a quasi-experimental study. 60 patients with diabetic foot ulcers referred to Ayatollah Taleghani hospital in Urmia were selected by available sampling approach. All the patients had inclusion criteria, and they were randomly divided into two equal groups control and intervention, each having 30 members. Data collection tools were demographic, measure of self-care and assessment based on Orem's model questionnaires that were completed In two stages, before and after the implementation of Orem's self-care program. The data were analyzed via SPSS software v.16, using descriptive and statistical testes.
The results showed that mean score of self-care status before intervention in the intervention and control groups was not statistically significant (P=0.11). But the t-test indicates a statistically significant difference between the two groups in self-care status after the intervention (P Implementing Orem's self-care program can cause the increase of self-care behaviors in diabetic patients. Therefore, it is recommended to improve the patient’s knowledge and adherence to self-care behaviors. The nurses should use different patient-centered communication approaches to improve it.

Family-centered education has an important role in diabetes control by establishing an effective relationship with self-care. This study aimed to evaluate family-centered education on self-care of patients with Type 2 diabetes.
This experimental study consisted of 60 patients with type 2 diabetes who were randomly assigned in two groups: control group (n=30) and treatment group (n=30). Data were collected using a questionnaire consisted of demographic characteristics and self-care items measuring. Family-centered education in the intervention group lasted for three months. Data collecting process was performed at two points; at the baseline of the study, and after 3 months. Data were analyzed by SPSS 21 using descriptive and inferential statistics.
The study revealed that family-centered education on self-care included five dimensions consisting of nutrition, physical activity, blood glucose control, and foot care. After intervention, the difference between two groups were statistically significant d (p0.05) between two groups.
Family-centered education by a nurse for three months could have important effects on self-care, and its dimensions included nutrition, physical activity, blood glucose control, foot care in the diabetes type II. Therefore, it is recommended to the nurses to include family education in patients with diabetes.

There are numerous errors in food-drug administration through feeding tube. Appropriate performance of nurses can improve patient safety and prevention of complications. The aim of this study is to assess the effectiveness of small group teaching on the nurses’ performance of food-drug administration.
This was an experimental study that was done in Urmia Emam Khomeini hospital. 80 nurses were enrolled in the study by using census method. The intervention group was divided into four groups, and for each group, four training sessions (one and half hour) with the creation of thoughtful learning situation was held. Knowledge and performance in relation to food-drug administration were evaluated before, and one month after the training program.
The results showed that before training, status of nurses’ knowledge was poor in the control (90/6 percent) and intervention groups (80 percent). After the implementation of training for the intervention group, 97/1 percent of status of nurses’ knowledge in the intervention group was good. Before the training, most of the nurses did not have good performance in both groups. Implementation of the training for the intervention group caused improving the performance of the nurses.
There are errors in the time of food-drug administration through feeding tube. This can cause adverse effects. Hence, improvement and use of proper techniques in food-drug administration can increase efficacy of drug feeding and nutrition, it can increase patient safety and reduce the occlusion number of tube feeding.

Proper sleep quality is essential for physical and mental health, and it is associated with many negative outcomes. The purpose of this study was to investigate the relationship between students’ cell phone overuse and their sleep habits and sleep disorders.
In this descriptive- correlational study, 400 students (50% male and 50% femal) have been selected from university students of Mohaghegh Ardabili in 2012-2013. The students completed a researcher made demographic questionnaire, Cell Phone Overuse Scale (COS) and the Pittsburg Sleep Quality Index (PSQI). The data were analyzed by Pearson Correlation Coefficient, and multivariate regression analysis on SPSS-16 software (p Results showed that the most common sleep problem was disability in sleep (69.75%) and cell phone overuse has positive relationship with bedtime and awakeness time, awakness duration before sleep, subjective sleep quality, delay in sleeping, sleep disturbance and daily dysfunction (p These results showed the necessity of double attention of health profesionals in order to prevent the adverse effects of cell phone overuse as a risk factor of sleep health, and promotion of students biopsychosocial health.

Evaluation of clinical and educational environment is a key determinant in qualitative student- center training programs. In order to evaluate and understand this environment a valid and reliable instrument is required. Reliable and valid measurement, however, can be problematic - especially as instruments developed and tested in one culture are translated for use in another. The aim of this study was to exam the psychometric properties of undergraduate clinical education environment measure (UCEEM) in internship nursing and midwifery students in Islamic Azad University in Iran.
In this descriptive-cross sectional study, 215 internship nursing and midwifery students completed the Persian versions of (UCEEM).The construct validity of the (UCEEM) was examined by using exploratory factor analysis and Pearson correlations. Cronbakh’s Alfa coefficient was calculated to determine internal consistency. Data analyses were performed with SPSS 17.
Exploratory factor analysis confirms the original four subscales of the UCEEM questionnaire. Overall internal consistency of the translated measure was good (a=0/93. (
The Persian version of the UCEEM appears to be reliable and potentially valid instrument for use in Iranian Nursing and midwifery Schools. It may be favorable in evaluating the clinical learning environments of nursing and midwifery programs nationwide.

Infant health and its consequences are the main concerns of women at risk of preterm birth, which can cause maternal anxiety. Some interventions can be effective on reducing the anxiety. This study was aimed to determine the effect of supportive counseling on the anxiety of women at risk of preterm birth.
This clinical trial study was performed on 88 women (43 in intervention group, and 45 in control group) at risk of preterm birth. The intervention was inclusive supportive counseling program, performed after determining the level of maternal anxiety by Spielberger Anxiety Questionnaire. After intervention, maternal anxiety was determined as well. The data were analyzed by Fisher's exact test, Mann-Whitney and also by using the SPSS-22 software.
In the intervention group, the findings revealed that supportive counseling decreased significantly trait and situational anxiety. In the control group, trait anxiety increased briefly, but situational anxiety reduced. The mean difference between the two groups was significant statistically.
Supportive counseling can significantly reduce maternal anxiety in women at risk of preterm birth. Therefore, it is recommended that health care personnel take into account supportive counselling sessions to reduce anxiety and to provide safe labor condition.

Background and "Organizing and Direction of operations" are important aspects of operational planning. One of the problems in management of hospitals is the lack of on time and correct organization and direction of operations for operational planning. This study has been conducted to evaluate the effect of organization and direction of operations on operational planning in hospitals in 2013-14 in Iran.
In this applied study, in which revisal, comparative , quantitative methods has been used, the theoretical models of operational planning were examined through Library Studies, and after determining the variables of different models of operational planning, a questionnaire was developed. A survey from 176 experts from academic and administrates of hospitals was carried out as well. The data was collected. Exploratory and confirmatory factor analysis was performed as well.
The effect of the “Organization of planning team " and "Direction of planning team" on operational planning in hospitals based on factor analysis of regression coefficients were estimated to be 0.761 and 0.916. Also in the results obtained from the survey from the experts, the question of "Formation of operational planning team and determining of their duties" with the mean of 4.60 and "Recognition of strategic problems and prioritizing them" with the mean of 4.31 have been the highest score. In factor analysis with varimax method, the questions of the “Collecting, protecting and analysis of data related to operational planning " and "Formation team that directs and supervises the plans performance process" with 0/628 and 0/797 have the highest score, respectively.
The use of appropriate and correct recognition of organization and direction of operations can improve the performance of operational planning in hospital.

There is lack of knowledge about features of midwife-mother relationship in different condition and setting where the midwife has different levels of responsibility in terms of the normal and high-risk pregnancy. This study aimed to develop a scale for evaluating the midwife- mother relationship in delivery room.
Methods & Materials: This is a methodological research. Participants were 480 mothers who hospitalized at post-partum ward in a university hospital of Arak, Iran in 2014. Preliminary item pool was developed by qualitative part of the study and literature review. Target group determined the validity of the instrument by using the impact item method. The validity of the questionnaire was determined with content validity ratio (CVR), content validity index (CVI), face validity and exploratory factor analysis. Reliability of the instrument was reported by Alpha Cronbach coefficient.
In the qualitative phase 66-item of questionnaire was developed. Those with impact item index over 1.5, CVR over 0.42, and CVI over 0.79 were considered as valid; while the rest were eliminated resulting in a 48-item scale. Exploratory factor analysis loaded a 43-item with a four factor solution that jointly accounted for 60.4% of observed variance. Cronbach’s alpha coefficient showed excellent internal consistency (α=0.95).
The findings showed that the designed questionnaire was a valid and reliable instrument for measuring midwife- mother relationship in delivery room. It is easy to use the scale, and it contains the most significant features of midwife-mother relationship.

APACHE IV could predict mortality rate and length of stay for ICU patients. At this study, we compared predicted mortality rate for patients who were admitted in the intensive care unit of Babol Ayatollah Rohani Hospital based on APACHE IV.

In this cross-sectional study which was carried out from April 2012 to April 2013, all the patients who were admitted in the medical intensive care unit of Ayatollah Rohani Hospital were evaluated. Exclusion criteria included all the patients less than 16 years of old, pregnant, after cardiopulmonary resuscitation, patients who died within 24 hours in the ICU. The method of data collection was based on questionnaires APACHE IV. All data were collected in the first 24 hours of ICU admission. The observed mortality rate and length of stay were compared with predicted mortality and the predicted length of stay.

The study was conducted on 106 patients admitted to ICU with 54 patients (50.9%) males and 52 (49.1%) were female. The mean age of patients was 64.43±18.62, and the mean length of stay was 19.3±17.54. During this study, 56 patients (53.8%) were transferred from the ICU, and 50 patients (47.2%) died. Mortality rate predicted by APACHE IV is %34.58±24.76, and the length of stay predicted by APACHE IV is 4.76±1.59 days. The actual and predicted mortality rate were statistically associated (P

The actual mortality rate was similar to the mortality predicted by APACHE IV. The length of hospital stay was greater than the expected time. The results indicated an acceptable quality of health care provided in the intensive care unit of Ayatollah Rohani Hospital.