فصلنامه پرستاری، مامایی و پیراپزشکی
سال پنجم شماره 1 (تابستان 1398)

As the most important part of the health system employing a comprehensive health approach, nurses significantly affect the effectiveness of the healthcare system and play an important role in the promotion of health, prevention of diseases and treatment and care (1). This issue is in favor of individuals, societies, and populations in the healthcare center. The importance of the role of nurses in investments of the healthcare area and improvement of economic growth of communities is undeniable (2). One of the most crucial issues in the move toward social justice and equality in the healthcare systems of countries is simple and constant access of societies to the required healthcare services (3). Access to timely use of services is personalized based on the requirements of individuals. Equality in access to health services is defined as receiving healthcare services required by individuals based on their health problems (4). On the other hand, access means the fit between several factors, such as the ability to pay the cost, access to services that are often provided physically, accessibility, admissibility, which is often recognized as culture accessibility, and matching of services with needs (5). In achieving services, these five factors act as a chain, meaning that the improvement of only one of them will not necessarily lead to the enhancement of the level of access and fair provision of healthcare services (6). Justice in access to services can be established through the formation or improvement of primary care centers and advancement of public coverage. As the primary health care providers, nurses provide effective care and positive health outcomes, such as decreased costs and shorter hospital stay. The public health coverage is access to the main health interventions, including improvement, prediction, treatment, and rehabilitation at an affordable level of cost (7). In fact, society-centered and public-based care results in the improvement of treatment care and increased satisfaction of families (8). Today, nurses are trained for clinical services in Iran, in a way that they are forced to directly refer to the second and third levels of the service provision system to receive services by spending time and money.
In addition, lack of knowledge of nursing abilities reduces the presence of nurses in healthcare providing centers at the society’s level, and the majority of authorities focus on the second level of prevention, which is clinical care in hospitals. Therefore, care provided by nurses is very limited at other prediction levels and service-providing environments in society. While community health nurses are trained at a higher education level, most of them carry our clinical work in hospitals. Meanwhile, nurses are one of the strongest providers of primary health care at the society level in advanced countries, which leads to switching the role of nurses from hospitals to society (9). Furthermore, therapists play an important role in the diagnosis, treatment and education of nurses in most countries, such as the United States, England, Australia, and Colombia.
 
In addition to hospitals, these nurses can be employed for in-home visits and sometimes for rural and remote regions (nursing based on the community’s need). The presence of these nurses leads to simple and quicker access of patients to healthcare services, reduced costs and waiting time and increased satisfaction of these individuals. In addition, these nurses are valuable to patients and are trusted by these people (10). This issue improves the public image of nurses in the society, develops the role of nurses and decreases the costs, which overall improves the provision of healthcare services in remote and rural regions. Given the fact that nurses are not allowed to legally prescribe medications even at the PhD level, there are some challenges in educational, research and cultural-social aspects of this issue, which require fundamental changes in healthcare policy-making and education of students (11). According to the mentioned issues, it seems that nurses play an insignificant role in the improvement of access to healthcare services. Therefore, the following items are proposed to improve the position of nurses in this area:- Precise estimation of workforce, equipment, and facilities of centers based on the demand of the covered population to increase access of more people of the region to the related services
- Improvement of the public image to trust and accept nursing services by the society through promoting the inner belief of nurses, increasing their presence in scientific gatherings and healthcare organizations and active interactions with the media to attain a positive professional identity and enhance the public belief to accept nursing services
- Specialization in nursing and development of the role of nurses to lay the proper foundation for solving legal and educational issues so that the legal authority of nurses could be increased and eligible nurses could be employed as nurse therapists
- Education of community-oriented nursing through the provision of periodic educational programs for clinical nurses and laying a foundation for education and work of nurses in the society. In addition, education of students since entering the university is a solution to realize this goal. Review of the curricula based on SPICES is one of the most valid strategies in the modern educational system, one of the principles aspects of which is community orientation.

An invisible factor, gender has caused a shortage of male specialists in the nursing profession despite the obvious and hidden organizational needs. The aim of this study was to review the causes, barriers and solutions to the problem of shortage of male nurses in the hospitals. In this review article, we found 96 English and Farsi articles by searching the databases of Web of Science, Scopus, PubMed and Scientific Information Database (SID) using the keywords of male nurse, shortage of nurses, and nursing field during the period of 2008-2018 with no limitations in type of research. After reading and assessing the articles, 26 papers were entered into the study based on the research goals and objectives. The nature of some nursing curricula, lack of sufficient knowledge of the field, misbeliefs such as considering nursing as a feminized profession, dissatisfaction with the profession and lack of adequate support have led to unwillingness or improper employment conditions of men or even turnover. In order to obtain goals of care, measures must be taken such as eliminating barriers to university attendance and recruitment, using guidance tutors, assessing educational and clinical environmental barriers, increasing the income and benefits of the job, providing voluntary shifts, and guiding male individuals since high school. Some factors have visibly or invisibly prevented the sufficient and appropriate presence of men in the nursing profession along or in combination with each other. Nevertheless, given the benefits of the entrance of men into the nursing profession, steps can be taken toward the satisfaction of nurses, patients, and the community by recognizing and eliminating barriers to this issue.

Urinary tract infections are among the most prevalent diseases in children and can lead to serious complications if improperly treated with antibiotics. This study aimed to determine the bacteriological factors and resistance of children to urinary infection antibiotics. This descriptive and cross-sectional research was performed on 160 children, who referred to Motahari Hospital in Urmia with a positive urine culture. The desired strains were recognized and identified using biochemical tests and differential culture media. In addition, antibiotic resistance pattern of the strains was determined by disc fusion method (Kirby-Bauer) as recommended by CLSI. Moreover, data analysis was performed using Chi-square, and P-value of less than 0.05 was considered significant.  Of 160 children assessed, 119 were female, and 41 were male. According to the results, the highest prevalence of urinary infection was related to the age range below two years. In addition, the most and least strains separated from urine cultures included E.coli (81.3%) and S.saprophyticus (1.9%), respectively. Furthermore, E.coli isolates had the most resistance to cotrimoxazole (64.6%), and nitrofurantoin was recognized as the most effective antibiotic with 90% sensitivity. According to the results of the study, the use of nitrofurantoin, ciprofloxacin, and gentamicin antibiotics is recommended for primary treatment of urinary infections. Given the different frequency distribution of antibiotic resistance in various regions and periods, it is suggested that antibiotic resistance be assessed periodically to control infection.

Anxiety disorders are conditions with the similar feature of extreme fear and anxiety and related behavioral disturbances. This study aimed to evaluate the role of cognitive avoidance, metacognitive beliefs, and cognitive failures in prediction the state-trait anxiety in nurses. This descriptive and correlational research was performed on 100 nurses working in hospitals of Tabriz, Iran in 2018. The research tools included cognitive avoidance questionnaire, metacognitive beliefs questionnaire, cognitive failures questionnaire, and Spielberger anxiety inventory. Moreover, data analysis was performed in SPSS version 24 using Pearson’s correlation coefficient and multiple regression model. In this study, while there was a negative and significant relationship between the anxiety state of nurses and cognitive avoidance (P=0.01), no significant association was found between the mentioned state and variables of metacognitive beliefs and cognitive failures. Furthermore, a negative and significant correlation was observed between anxiety trait of nurses and cognitive avoidance (P=0.01). However, no significant association was found between the mentioned trait and variables of metacognitive beliefs and cognitive failures. Regression results demonstrated that the predictive variables determined 37% of the total variance of anxiety state and 33% of the variance of anxiety trait. Given the important role of nurses in the improvement and promotion of health of society members, eliminating the stress-causing factors in nurses, especially cognitive avoidance which had a significant relationship with state-trait anxiety of nurses, must be recognized as a health priority.

Feeding intolerance is a major concern in preterm infants. Facilitate milk tolerance in infants is one of the interventions that nurses can exploit in order to improve the feeding tolerance in preterm infants. This clinical trial was performed on 60 preterm infants with the gestational age of 28-32 weeks hospitalized in the NICU. Samples were randomly divided into two groups. In the intervention group, in addition to the routine light reduction care(dragging the wards curtains, turning off the extra lights and placing a thick cover on the incubator), an insulation cover was also placed over the faces of infants, which in the control group only the routine light reduction care of ward was applied. The study lasted for 6 days and during the days of intervention, the regurgitation and feeding tolerance rate of infants in two groups were assessed and recorded with a checklist. The data were entered into SPSS18 and analyzed by descriptive and inferential statistics. Demographic characteristics of premature infants were not significantly different in both groups by applying more light reduction in the NICU, there was a significant difference in the amount of milk intake in newborns (p=0.002), and the average amount of milk remaining in the stomach of the infant (p=0.001) in each meal of infants in the intervention period. The results show the positive effect of light reduction on feeding tolerance and reduction of residual milk volume in premature infant, which can lead to appropriate to feeding infant.

Today, increased use of antibiotics to treat infections has led to increased resistance to antibiotics in bacteria strains. Therefore, extensive efforts have been dedicated to finding new compounds as a suitable replacement for antibiotics. This study aimed to compare and evaluate the antibacterial effects of Allium Sativum methanol extract on the growth of several pathogenic bacteria. In this empirical-laboratory research, the methanol extract of the plant was prepared after collecting and conducting pharmacognosy studies. Afterwards, the antibiotic effects of the plant were assessed at 20-400 mg/ml concentrations using the well diffusion method. Moreover, the minimum inhibitory concentration (MIC) was determined applying the tubular dilution method. In this research, the methanol extract of Allium Sativum prevented the growth of Staphylococcus aureus and Escherichia coli. At 6.25 mg/ml concentration, the methanol extract of Allium Sativum had the highest inhibitory effect on the growth of Staphylococcus aureus. Meanwhile, the concentration of 12.5 mg/ml had the most bactericidal effect. According to the results of the study, Allium Sativum might be recognized useful when used to treat bacterial infections independently after completing additional research. Therefore, this compound might be applied as a substitute for conventional chemical drugs to treat infections.

One of the major goals of the health system is to ensure customer satisfaction with services provided, which shows the degree of matching of services to the desired quantity and quality of customers. Therefore, this study aimed to determine the relationship between the psychological capital of managers with the work quality of life of nurses and client satisfaction. This correlational research was performed on 371 nurses, senior managers, and clients of Shafa Hospital in Semnan, Iran, in 2015-2016. Data collection tools were psychological Capital Questionnaire (PCQ), quality of work life questionnaire, and client satisfaction questionnaire. In addition, data analysis was performed in SPSS version 21. In this study, a positive and significant relationship was observed between the psychological capital of managers and the work quality of nurses (P=0.03) and client satisfaction (P=0.01). Results of multiple regression showed that hope and self-efficacy of managers had a significant share in the prediction of the variable of work life quality of nurses (P=0.01). In addition, the variable of optimism of nurses only predicted the satisfaction of clients (P=0.01). Improving the psychological capital of managers will increase the value added in the performance of nurses, provision of suitable services, and increased satisfaction of clients. Therefore, it is suggested that interventions be carried out to improve psychological capital.

Given the fact that spiritual and emotional intelligence increase nursing care quality in nurses through improving beliefs and overcoming stress, respectively, this study aimed to evaluate the relationship between spiritual and emotional intelligence with nursing care quality in nurses working in Ayatollah Taleghani Hospital in Kermanshah, Iran in 2018. This descriptive and correlational research was performed on 225 nurses selected by convenience sampling. Data were collected using King’s spiritual intelligence self-report inventory, emotional intelligence questionnaire by Petrides & Furnham, and quality patient care scale (QUALPAC). In addition, data analysis was carried out in SPSS version 21 using Pearson’s correlation coefficient and simultaneous multiple regression. According to the results, there was a significant and reverse relationship between nursing care quality and components of spiritual intelligence, including personal meaning-making (r=-0.229, P=0.042) and transcendental consciousness (r=-0.386, P=0.001). On the other hand, the same relationship was observed between nursing care quality and components of emotional intelligence, including the perception of emotions and feelings of oneself and others (r=-0.433, P=0.001) and optimism and positive attitude (r=-0.276, P=0.018). Furthermore, the results of multiple regression analysis demonstrated that the components of spiritual and emotional intelligence explained 0.17 and 0.32 of changes in nursing care quality, respectively. Given the fact that higher emotional and spiritual intelligence improve the nursing care quality of nurses, it is suggested that necessary training be provided to these individuals to enhance the quality of their emotional and spiritual intelligence.

the breast cancer is the most common malignant tumor in women in recent years' incidence in young women is increased. According to dense breast in this group sensitivity of mammography is decreased. The aim of this study was to investigate young women with breast cancer. In this cross-sectional study, 2160 patients who referred to the Hamadan's Mehr Imaging Center during the October of 2015 to October 2018, 220 patients (30 to 20 years old) were included in the study. Patients were selected by available sampling method as research sample. All patients who came to the study were enrolled according to the inclusion criteria. Patients with suspected lesions were referred for further evaluation and biopsy. Also, definitive results were reported after pathology examination.  Data analysis was performed by using descriptive and analytical tests in SPSS software V.21. The significance level was p < 0.05. Mean age of patient was 27.5 years. Approved malignancies in 16 patients were seen. %50 of patients were single. The minimum age is 23 years. Most frequent symptom was palpable mass. About 2 of patient have positive family history. The most pathology was invasive ductal carcinoma grade 3. About 25 % of mass was discovered in the lactation state. Mortality rate at 2 years was 25% which was during the breastfeeding period. Place of mass, degree of differentiation and type of pathology had a significant relationship with breast cancer (p=0.001). Considering the significant incidence of breast cancer in the under-30 age group and the detection of cancer in about 40% of patients studied during lactation, there is a great need to pay close attention to the masses discovered during lactation. Rapid examination of mass and screening at an early age is also important.