فهرست مطالب

Nursing and Midwifery Research - Volume:22 Issue: 4, 2017
  • Volume:22 Issue: 4, 2017
  • تاریخ انتشار: 1396/05/31
  • تعداد عناوین: 15
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  • Mehdi Ranjbaran, Maahboobeh Khorsandi, Pegah Matourypour, Mohsen Shamsi Page 257
    Background
    Pain is a common experience for women during labor. Therefore, pain relief care for mothers during labor is very important. This meta‑analysis was conducted to evaluate the efficacy of massage therapy on labor pain reduction in primiparous women.
    Materials And Methods
    In this meta‑analysis, the databases of Web of Knowledge, PubMed, Scopus, Cochrane, Iranmedex, Scientific Information Database (SID), and Magiran were searched for published articles in English and Persian language up to January 2016. Among the studies, with regard to the inclusion and exclusion criteria, 10 studies were selected. Data were analyzed by using Stata software version 11, and standard mean difference (SMD) of effects of massage therapy was calculated. The heterogeneity among studies was evaluated by the Chi‑square based Q‑test and I2 statistics.
    Results
    The results of Chi‑square based on Q‑test and I2 statistics showed heterogeneity among studies in the latent phase (Q = 63.52, P value
    Conclusions
    This study provides valid evidence for the effect of massage therapy in Iran for labor pain relief. Therefore, the use of massage therapy can be recommended in the primiparous women.
    Keywords: Delivery, Iran, labor pain, massage, meta‑analysis, obstetric
  • Seyedmeysam Jafary, Mousa Alavi, Alireza Irajpour, Tayebeh Mehrabi Page 262
    Background
    Attitude towards physician–nurse relationship is fundamental to achieve health care quality. Such attitude maybe determined by some personality traits such as differentiation of self. Hence, the present study aimed to investigate the relationship between differentiation of self and attitude to professional physician–nurse relationship.
    Materials And Methods
    This cross‑sectional study was done in three hospitals in Isfahan in 2015. The study included all nurses and physicians. In total, 400 participants were recruited through convenience‑sampling method. Data gathering instruments included a three‑part questionnaire [demographic data sheet, Jefferson Scale of Attitudes toward Physician–Nurse Collaboration (JSAPNC) and differentiation of self‑inventory (DSI)]. The data were analyzed through descriptive and inferential statistics [t‑test, analysis of variance (ANOVA), and multiple linear regression) by the Statistical Package for the Social Sciences (SPSS) version 16 software.
    Results
    The mean [standard deviation (SD)] of the scores of differentiation of self in physicians and nurses were 86.43 (9.62) and 159.28 (9.53), respectively. The results showed that the predicting model of attitudes towards physician–nurse relationship based on dimensions of differentiation of self both in nurses and physicians were significant. Moreover, the findings from linear regression analyses showed that predictor variables explained 0.18 and 0.14 of the variance of attitudes towards physician–nurse relationships in nurses and physicians, respectively.
    Conclusions
    Considering the significant role of differentiation of self to predict attitudes towards physician–nurse relationship, it is worthwhile to suggest provision of training programs particularly in the nursing and medical students to enhance differentiation of self both in physicians and nurses to improve culture of interprofessional relationships and to achieve optimum professional relationships between doctors and nurses.
    Keywords: Attitude, communication, Iran, physicians, nurses
  • Tahmineh Farajkhoda, Mahshid Bokaie, Mahmoud Abbasi, Saeedeh Najafihedeshi, Zahra Alavi, Mahin Rahimdel Page 267
    Background
    Professional ethics culture should be taught to students appropriately. Studies have shown that midwifery students are not entirely familiar with the skill of obtaining informed consent. Using a new and applicable model to teach this skill to midwifery students is necessary. This study was conducted to determine the effect of a new standard model, PREPARED, on the skill of obtaining informed consent in midwifery students of Shahid Sadoughi University of Medical Sciences.
    Materials And Methods
    This interventional study was conducted on 37 5th semester midwifery students through a census method. After determining psychometric indices, in two phases with a 4‑week interval (before and after the training), the PREPARED checklist was completed by the professors of the research team in the presence of students in the delivery room while they were performing midwifery care considering their compliance to the checklist. Descriptive statistics paired t‑test were used for data analysis.
    Results
    The lowest mean score before the training belonged to alternative methods (1.00) and treatment expenses (1.00). After the training, treatment plan had the highest mean score (3.54 (0.69)). The mean and standard deviation of scores before and after training the students were 9.12 (2.00) and 30.6824 (5.25), respectively. Based on the results of the paired t‑test (P = 0.001), the difference was statistically significant.
    Conclusion
    Results showed that the implementation of the new model of PREPARED would increase the skill of obtaining informed consent in midwifery students and could be applied for educating students of other medical majors in Iran.
    Keywords: Education, informed consent, Iran, medical professionalism, midwifery
  • Saeid Pahlavanzadeh, Samira Abbasi, Nasrollah Alimohammadi Page 271
    Background
    One of the factors that could influence the quality of life in patients with multiple sclerosis, which is usually overlooked, is its psychological aspects. Considering the increasing acceptance of complementary medicine in the health system, this study was designed and conducted to determine the effect of group cognitive therapy on the stress, anxiety, and depression of women suffering from multiple sclerosis.
    Materials And Methods
    This clinical trial was conducted among 70 women suffering from multiple sclerosis who were referred to the health centers of Isfahan Participants were randomly allocated into two groups of intervention and control, each containing 35 patients. The intervention group received cognitive behavioral therapy as 8 90‑minute group sessions (a session per week), and the control group participated in 4 group sessions to express their feelings and experiences. Data were gathered using the Depression Anxiety Stress Scale (DASS‑24).
    Results
    There was a significant difference between the mean score of stress (P = 0.03), anxiety (P = 0.02), and depression (P = 0.03) of the intervention and the control group immediately after and 1 month after the intervention. Least squares difference test showed that the mean score of stress (P = 0.02), anxiety (P = 0.02), and depression (P = 0.03) immediately and 1 month after the intervention was significantly lower in the intervention group.
    Conclusions
    According to the results of the present study, cognitive behavioral therapy could decrease stress, anxiety, and depression in patients suffering from multiple sclerosis.
    Keywords: Anxiety, cognitive behavioral therapy, depression, multiple sclerosis, stress
  • Ehteram Nasrazadani, Jahangir Maghsoudi, Tayebeh Mahrabi Page 276
    Background
    Dormitory students encounter multiple social factors which cause pressure, such as new social relationships, fear of the future, and separation from family, which could cause serious problems such as tendency toward drug abuse. This research was conducted with the goal to determine social problem‑solving skills, dysfunctional attitudes, and risk of drug abuse among dormitory students of Isfahan University of Medical Sciences, Iran.
    Materials And Methods
    This was a descriptive‑analytical, correlational, and cross‑sectional research. The research sample consisted of 211 students living in dormitories. The participants were selected using randomized quota sampling method. The data collection tools included the Social Problem‑Solving Inventory (SPSI), Dysfunctional Attitude Scale (DAS), and Identifying People at Risk of Addiction Questionnaire.
    Results
    The results indicated an inverse relationship between social problem‑solving skills and risk of drug abuse (P = 0.0002), a direct relationship between dysfunctional attitude and risk of drug abuse (P = 0.030), and an inverse relationship between social problem‑solving skills and dysfunctional attitude among students (P = 0.0004).
    Conclusions
    Social problem‑solving skills have a correlation with dysfunctional attitudes. As a result, teaching these skills and the way to create efficient attitudes should be considered in dormitory students.
    Keywords: Attitude, drug abuse, Iran, social problem‑solving, student
  • Atefeh Ghanbari, Fateme Hasandoost, Ehsan Kazemnezhad Lyili, Rasoul Tabari Khomeiran, Maryam Momeni Page 280
    Background
    Nursing as a clinical discipline is developing in the emergency wards. Health care systems should continuously assess and prioritize indicators of clinical competency in these wards. The lack of clear standards of clinical competency indicators challenges evaluation. The purpose of this study was to determine clinical competency indicators and its priority based on nurses’ views in educational and therapeutic centers in Guilan.
    Materials And Methods
    The Q methodology was conducted in three phases, that is, phase I (determining the clinical competency indicators), phase II (classifying clinical competency indicators by an expert panel), and phase III (prioritizing clinical competency indicators). The subjects were selected by convenience sampling among nurses working in the emergency wards of teaching hospitals affiliated to Guilan in 2013. Finally, clinical competency indicators were prioritized using exploratory factor analysis.
    Results
    In the prioritizing phase, data were collected from 710 nurses over two months. Five factors with 30 general competencies were found in three domains: communication, professional maturity, and personality characteristics. Six factors with 37 specific competencies were also found in two domains: scientific and technical capabilities and basic clinical skills that can provide a structured instrument for assessing clinical competence in emergency nurses.
    Conclusions
    Achieved competencies can be used as a reference for nursing education and practice in emergency. Further research on health care system is needed in order to achieve a reliable and valid instrument.
    Keywords: Clinical competence, emergency service, hospital, Iran, nursing staff
  • Akram Moradi, Mahin Moeini, Hamid Sanei Page 287
    Background
    Lifestyle modification is an essential factor in the promotion of health in patients with acute coronary syndrome (ACS). One of the interventions to promote lifestyle is interactive follow‑up, which, according to the traditional methods, requires spending significant amount of time and cost. Therefore, this study aimed to determine the effectiveness of interactive text message follow‑up on health promoting lifestyle of patients with ACS.
    Materials And Methods
    This was a randomized controlled trial among 100 patients suffering from ACS during October–February 2016. The participants were randomly assigned to the experimental and control groups. Collection of data on lifestyle was performed before, 3, and 4 months after the beginning of the intervention using Walker’s Health Promoting lifestyle questionnaire. Six messages were sent to the intervention groups each week, and participants asked the questions by sending text message, each week 1 message were sent to the control group for 12 weeks. The statistical analysis of data was performed using independent t‑test, Chi‑square, Mann–Whitney U test, and repeated measures analysis of variance (ANOVA).
    Results
    Before the intervention, there was no significant difference between the mean score of lifestyle of the two groups, however, 3 months and 4 months after the beginning of the intervention, the mean score of lifestyle in the intervention group was significantly higher than that of the control group (P
    Conclusion
    The interactive text message follow‑up is effective in promoting the lifestyle of patients with ACS and can be considered in the planning of follow‑up of patients with ACS.
    Keywords: Acute coronary syndrome, follow up, health promoting lifestyle, interactive text message, Iran
  • Ziba Taghizadeh, Maryam Pourbakhtiar, Masoud Ghadipasha, Kamran Soltani, Khadijeh Azimi Page 294
    Background
    Obstetricians, gynecologists, and midwives are the most common specialists of the medical sciences group against whom medical malpractices are claimed, many of which are avoidable and preventable. Therefore, the present study was conducted to investigate the causes of claims regarding medical malpractices resulting in maternal and perinatal mortality.
    Materials And Methods
    A descriptive cross‑sectional study was conducted and 7616 claims of medical malpractices in the field of obstetrics, gynecology, and midwifery that were referred from all 31 provinces to the central commission of legal medicine were studied during 2011–2012. Therefore, the present research is a national inclusive study covering all the provinces across Iran. To collect information from the transcript of medical malpractices cases, a researcher‑made checklist was used, and the collected data were analyzed.
    Results
    The results of the present study showed that among all the medical malpractice claims regarding pregnancy and childbirth (42.24%), the majority concerned perinatal death (71.82%) and maternal death (28.16%).
    Conclusions
    Medical malpractice complaints are increasing; although, most of these claims are preventable. To achieve this aim, it is necessary for obstetricians, gynecologists, and midwives to try to reduce the complaints by paying more attention to the signs and symptoms of diseases, performing all the diagnostic and therapeutic measures according to the scientific criteria, and fully document patients’ records. In addition, patients’ acquaintance with the importance of measurements and examinations, before and during pregnancy care and even after childbirth is crucial.
    Keywords: Iran, maternal morbidity, medical error, midwifery, obstetric, perinatal mortality
  • Asiyeh Pirzadeh, Firoozeh Mostafavi, Fazlollah Ghofarnipour, Marjan Mansourian Page 299
    Background
    The low level of physical activity is a risk factor behind several chronic diseases.Evidence shows the level of physical activity is decreasing, especially in women. This study aimed to apply the transtheoretical model to identify physical activity behavior in women who referred to health centers of Isfahan.
    Materials And Methods
    This cross‑sectional study was carried out among 400 women in Isfahan’s health centers. Data were collected using a questionnaire including demographic factors, the standard of exercise behavior, stages‑of‑change questionnaire, processes of change, self‑efficacy, and decisional balance. Data were analyzed with the Statistical Package for the Social Sciences (SPSS) (version 16). Descriptive statistics, the Mann–Whitney test, one‑way analysis of variance (ANOVA), and Pearson correlation were used.
    Results
    The mean (SD) of age was 31.46 (8.92); 81.5% of women were housewives and the others employees. The mean score of physical activity per day for women was 10.66 min. Ninety‑six persons (24%) were classified in the pr‑contemplation stage, 100 (33.3%) in the contemplation stage, 102 (25.5%) in the preparation stage, 29 (7.2%) in the action stage, and 40 (10%) in the maintenance stage. The results showed the stages of change significantly correlated with the decisional balance (P = 0.04), processes of change, and self‑efficacy (P
    Conclusions
    With regard to the low level of physical activity in women and the role of the stages‑of‑change model in determining effective factors behind behavior, there should be an attempt to develop continuous and organized educational programs to promote physical activity in women by using the transtheoretical model.
    Keywords: Iran, physical activity, transtheoretical model, women
  • Zahra Boroumandfar, Masoud Kianpour, Ali Zargham, Samereh Abdoli, Katayoun Tayeri, Mehrdad Salehi, Godratollah Momeni, Farzin Khorvash Page 303
    Background
    The first step in health education is awareness of the people and their acceptance to change their behavior. Therefore, the aim of this study was to investigate the effects of empowerment program towards the concept of self‑care and prevention of sexually transmitted diseases (STDs) in women at risk of STDs.
    Materials And Methods
    The present study was conducted as a qualitative approach (step of action and observation of an action) by using conventional content analysis method. An empowerment program regarding STDs (Action) was performed among 32 (with convenient sample) drug user women with addicted husbands referring to the counseling center for vulnerable women (drop in enter) in Isfahan in 2015. The knowledge of quiddity, transmission, and prevention of STDs, as well as some items of life skills such as self‑awareness, interpersonal communication, and assertive behavior were taught in an educational program. Teaching methods were lectures, group, and individual training and role play. The impact of the program on modified belief and behavior change regarding STDs was evaluated with structured interviews.
    Results
    Analysis of the obtained results yielded three categories. The categories were awareness of STD, believing in being at risk, and decision and change.
    Conclusions
    Promoting self‑care and prevention through education programs based on action research can make a significant reduction in the incidence of problems and cause a behavior change in women with the disease or those at risk for STDs.
    Keywords: High‑risk sex, qualitative research, sexually transmitted diseases, unprotected sex, vulnerable population
  • Ali Zargham‑, Boroujeni, Azamolmolouk Elsagh, Majid Mohammadizadeh Page 308
    Background
    Untreated procedural pain leads to long‑term and short‑term complications in neonates. Preventing pain in sick infants and neonates, whose conditions are getting worse, not only is a professional and legal duty but also a prevention measure to decrease future psychological and even neurological complications. Therefore, nurses should prevent newborns’ pain. The aim of this study was to compare the effects of massage and breastfeeding on the pain of the neonates.
    Materials And Methods
    This was a clinical trial conducted among 75 full‑term and near‑term infants who underwent venipuncture. The newborns were randomly allocated to the following groups (n = 25 for each): group 1, breastfeeding; group 2, massage; and group 3, control. In the first group, venipuncture was done 2 minutes after breastfeeding. In the second group, massage was done with effleurage technique for 3 minutes and venipuncture was done 2 minutes after massage. The Neonatal Infant Pain Scale (NIPS) was used for pain measurement in the first 30 seconds of venipuncture. Data were analyzed by t‑test and one‑way analysis of variance (ANOVA).
    Results
    The lowest mean pain score recorded in the massage group (0.92) whereas it was 4.84 in the breastfeeding group and 6.16 in the control group. ANOVA test and post‑hoc statistics revealed that both interventions resulted in a significant reduction of the pain scores.
    Conclusions
    According to the findings of this study, the lowest pain score was in massage group, then in breastfeeding group and control group accordingly. Considering the fact that massage and breastfeeding are natural, useful, and cost free interventions and do not need any special facility, these methods are suggested in pain management and pain control during painful procedures administrated for infants.
    Keywords: Complementary therapies, Iran, Neonatal Intensive Care, nursing, pain, venipuncture
  • Leila Asadi, Marjan Beigi, Mahbube Valiani, Fardin Mardani Page 313
    Background
    Medical errors are the main concerns in health systems, which considering their ascending rate in the recent years, especially in the field of midwifery, have caused a medical crisis. Considering the importance of evidence‑based health services as a way to improve health systems, the aim of this study was to suggest a guideline for preventing malpractice in midwifery services.
    Materials And Methods
    In this cross‑sectional study that was conducted in 2013, we investigated 206 cases that were referred to the Isfahan Legal Medicine Organization and Medical Council of Forensic Medicine from 2006–2011. Data were collected by a checklist and were analyzed using SPSS‑16 software. Descriptive statistical tests (mean, maximum, minimum, standard deviation, frequency, and percentage agreement) were used to describe the data. Then, we used the Delphi technique with the participation from 17 experts in midwifery, gynecology, and legal medicine to provide an evidence‑based draft guideline for prevention of midwifery errors.
    Results
    A total of 206 cases were reviewed. In 66 cases (32%) the verdict for malpractice in midwifery services was approved. A practical draft guideline for preventing clinical errors for midwifery in the fields of pregnancy, delivery, and postpartum period was developed.
    Conclusions
    This evidence‑based draft guideline can improve the attention of all the healthcare providers, especially midwives and physicians to prevent urgent problems and offer effective health services for mothers and infants.
    Keywords: Complaint, guideline, Iran, malpractices, medical council, midwifery
  • Parkhideh Hassani, Masoumeh Otaghi, Mansoureh Zagheri‑, Tafreshi, Alireza Nikbakht‑, Nasrabadi Page 319
    Background
    Transition is a passage or movement from one state, condition, or place to another. Patients with chronic disorders such as end‑stage renal disease experience transitions. This study aims to explore the process of transition to hemodialysis.
    Materials And Methods
    This is a qualitative grounded theory of a doctoral dissertation. Twenty‑four participants (19 patients on hemodialysis, 2 family members, 2 nurses, and a physician) were selected through purposive and theoretical sampling until data saturation. Data collection was conducted through semi‑structured interviews, as well as field notes and memos. Data analysis was done concurrently with data collection in three levels of open, axial, and selective coding according to the Strauss and Corbin (1998) method. Core variable was appeared at the end of selecting coding stage.
    Results
    Confronting unexpected situation of hemodialysis, challenge of accepting hemodialysis, comprehensive and pervasive changes, efforts made to self‑management, and integration of hemodialysis with everyday life were considered to be the main themes of the process of transition to hemodialysis.
    Conclusions
    The results would increase evidence‑based knowledge regarding the process of transition to hemodialysis. Through identification of this process, effective factors such as determining strategies for management would lead to facilitate more specialized care of people undergoing hemodialysis, appropriate nursing interventions and more effective training programs to prepare patients and their families during the process of transition to hemodialysis. These results can be used for conducting and preparing other qualitative and quantitative studies.
    Keywords: Grounded theory, hemodialysis, Iran, nursing
  • Maryam Eghbali‑, Babadi, Nasrin Shokrollahi, Tayebe Mehrabi Page 327
    Background
    Cardiovascular diseases are the most important causes of morbidity and mortality in the world, and cardiac surgery is one of the treatments that have complication for patients. One of the most important current psychological complications after cardiac surgery is delirium. For its prevention and treatment, considerable attention should be paid to the role of family. This study has been conducted for assessing the effect of the relationship between the family and patient on the incidence of delirium in hospitalized patients in cardiovascular surgery intensive care unit (ICU) of Isfahan Shahid Chamran hospital.
    Materials And Methods
    This study is a two‑group, single‑blind (for the questioner) clinical trial that was conducted among 68 patients in the cardiac surgery ICU of Shahid Chamran hospital affiliated to the Isfahan University of Medical Science in 2013. Sampling was convenient sampling, and the patients were allocated to two groups (n = 34 patients) based on random numbers table. The day after the surgery, one of the family members in the intervention group who had received education the day before was allowed to visit the patient in the morning shift. In the control group, patients received routine care. Two groups were assessed for delirium twice a day for a total of three times (two times in the morning and one time in the evening) with use of Richmond Agitation Sedation Scale and Confusion Assessment Method –ICU (CAM – ICU) scale.
    Results
    In the intervention group, 41.18% patients were females and 58.82% patients were males, and in the control group, 29.42% patients were females and 70.58% were males. Mean and SD of patients’ age in the intervention group was 55.11 (12.11) and in the control group 54.12 (13.11) years. Based on study results, incidence of delirium in the morning after surgery (second day) in intervention group was 11.76%, and in control group it was 23.53%. In the third day, it was 8.83% in intervention group and 20.58% in control group. Chi‑square test showed a significant difference in incidence of delirium during the second (P = 0.04) and the third (P = 0.03) days of surgery in the two groups. In the control group, the incidence of delirium in the evening was 32.35%, which was more than that in the morning. Cochran test showed a significant difference in the morning and afternoon shifts in the control group (P = 0.004).
    Conclusions
    Effective communication between the patient and family, as a nonmedical method, can reduce delirium after cardiac surgery, especially, at the end of the day; nurses should pay more attention to the prevention of delirium.
    Keywords: Delirium, family, intensive care unit, nursing care, open cardiac surgery, therapeutic relationship
  • Mahdi K. Jahromi, Mohsen Hojat, Saiede R. Koshkaki, Faride Nazari, Maryam Ragibnejad Page 332
    Background
    Identifying and correcting the modifiable risk factors reduces the prevalence of coronary artery disorders (CAD). Nurses, with regards to their employment conditions, can be prone to cardiovascular disease (CVD). This study aimed to determine the prevalence of cardiovascular risk factors among nurses.
    Materials And Methods
    In this cross‑sectional study, census sampling was conducted among nurses of Jahrom, Iran, in 2014. Data were collected through interviews, blood pressure measurement, anthropometric parameters, and blood sample collection. To analyze the data, descriptive statistical analysis, and comparative (independent t‑test) and correlation (Pearson) tests were used; the significance level was considered to be P
    Results
    In this study, 263 (89.76%) nurses participated, 79.8% of whom were women. The mean age of the participants was 31.04 (6.97). In terms of body mass index, 41.7% was the waist‑to‑hip ratio, 16.7% was the waist‑to‑height ratio, and 63.1% were in the range of obesity. In addition, 5.7% had abnormal triglyceride, 4.9% had high cholesterol, and 15.1% had high blood pressure. The mean percentage of the Framingham risk score of the participants was 1.07 (1.84).
    Conclusions
    In this study, the total mean percentage of the Framingham risk score of the nurses was 1.07, which showed a low risk of CAD in the study population over the next decade.
    Keywords: Coronary artery disease, Iran, nurse, risk factors