نشریه پرستاری و مامایی ارومیه
سال هفدهم شماره 10 (پیاپی 123، دی 1398)

Breastfeeding is an important public health strategy due to its benefits in reducing the morbidity and mortality of infants and helping to control health care costs.
Breastfeeding with various macronutrients and micronutrients plays its nutritional and biological roles in optimal growth and development of the infant. Based on the importance of breastfeeding, this study aimed to determine the levels of macronutrients in mature human milk, and the affecting factors.

This case-control study was performed in Tabriz during September-February in 2018. A total of 102 women who were delivered by cesarean section or vaginal delivery were selected using convenience sampling. Breast milk samples were collected at 15 ± 1 day postpartum, and using the Lactoscan, milk macronutrients (lactose, fat, protein) and milk energy were measured.

Mean lactose, protein, lipid, and energy mature human milk’s in both groups were (7.30) g/ml, (2.78) g/ml, (3.65) g/ml, and (68.81) kcal/ml, respectively.
Factors affecting breast milk lactose and fat levels included mother's current weight, infant's birth weight, and delivery mode.

The results of this study showed that variables such as delivery mode predict the levels of macronutrients in breast milk. Due to the importance of macronutrients for infant growth and health, paying attention to these factors, especially promoting vaginal delivery, is important.

Spirituality as one of the human being aspects, is associated with all domains of health and disease as well as the source of power and improvement in patients (1). Although, all of patients have spiritual needs, but end of life patients that encounter with unassertiveness, spiritual needs are very important (2). Nurses have responsibility to carry out spiritual care ethically and professionally (3). Spiritual care providing can create mental comfort and make purpose and meaning in patients' lives (4) so that it has caused the American Nurses Association (ANA) has included the spiritual care as own standards and ethical codes and also has integrated it as component of nursing education curriculum (5).
 Considering the vital importance of spiritual care, evidences has showed that spiritual care providing has not performed by many health professionals in throughout of world so that it is one of health care delivery system challenges in end of life care arena. However, has performed some actions about spiritual health education, few of nurses has acquired enough knowledge about this issue (3). Meanwhile, according to literature although the most of nurses consider spiritual care as vital component of whole nursing, only half of them carry out spiritual practice and often this care was neglected by them (6).
 In Iran based on patient right charter end of life care must be done to provide comfort to patients including pain relief, and considering psychological, social and spiritual needs in the time of death (7). In IRAN, as an Islamic country there is not spiritual nurse in the hospitals even practitioner nurses do not train about spiritual dimension of care result in they are not prepare to provide spiritual care. Although, there are religious oriented clergies in some hospitals but there is not an integral guideline for important issue (8). Many studies in IRAN indicated that nurses do not have necessary competencies to provide spiritual care (3, 9). According to literature in the western countries spiritual care was included in the nursing practice and all of nurses accepted it as an important component of daily nursing care (10). One of the unanswered spiritual needs in Iran is the inability to die peacefully in hospitals (11). For end of life patients feeling value and experiencing love can create feeling of wellbeing because when the medical actions are useless spiritual care can improve their health status (12).
 The most of nurses in IRAN know what is spirituality and spiritual care but they cannot provide spiritual care due to some practical problems such as lack of hospital specified policy (1). According to some studies in our country the main barriers to provide spiritual care are following: high nurses work load, time restrictions, cultural limits, lack of nurses knowledge about spiritual needs, having routine nursing practices, lack of eligibility in some nurses, complexity of spirituality with religious rituals and sex differences between nurses and patients (11). Adib Hajbaghery found that motivation of nurses are very low due to lack of support system from nursing managers. He added there is a climate of lack of spiritual support in the nursing system. When nurses don't receive enough spiritual and financial support to meet own and their clients, they do not capable to meet patients basic needs such as spiritual needs (13). In other side, the requirement of spiritual care is applying client center approach (14). There is a basic problem because in IRAN health care system medical system is a dominant system and all of patients' actions must be ordered by doctors. Today nursing routine based practice is under debate and all of nursing pioneers try to find an alternative approach as client centered and holistic focused (15).
 Considering to effectiveness of spiritual care in promotion of patients' quality of life in end of life period, spiritual care must be emphasis by nursing managers. All of health policy makers must consider to this vital issue in health care delivery system. Also, according to main role of nurses in addressing patients spiritual needs in spiritual crises it is necessary spiritual education must be integrated in all nursing education programs and clinical nursing in service.

Evaluation of dietary and medication adherence in the patients undergoing dialysis is a necessity, and laboratory index is the most objective method for measuring adherence to treatment in these patients. The aim of this study was to evaluate the effectiveness of educational interventionsbased on collaborative care model on the level of laboratory indicators in patients undergoing hemodialysis.

In this clinical trial study, 66 patients with chronic renal failure undergoing hemodialysis were selected initially based on the inclusion criteria and easy sampling and then they were assigned into intervention and control groups base on random allocation rule. The intervention group received educational content in eight sessions based on four stages of participatory care model (motivation, preparation, engagement, and evaluation) then the interventions were implemented in intervention group. The data collection tools were a demographic questionnaire and also a checklist of laboratory index which were completed at baseline and three months after intervention in both groups. The data were analyzed by SPSS software using independent t-test, chi-square, and Fisher's exact test.

Mean and standard deviation of calcium index after intervention were 9±1/765 and 8/16 ±/893 in intervention and control groups, respectively. The results of the independent t-test showed a significant difference between two groups (p = 0.001). Phosporous index after intervention in intervention and control group were 4/31±/52 and 5/83±3/37, respectively, therefore independent t-test was significant between two groups (p = 0.015). There was no statistically significant difference between the two groups with regard to mean of potassium and BUN index.

The level of laboratory index in the patients undergoing hemodialysis after intervention based on the participatory model has shown improvement in adherence to treatment in these patients, which should be considered in the process of educational and supportive care in these patients.

In the intensive care unit, critical patients are admitted to care.  The family visits in these units are different from other units. Different hospitals impose restrictive regulations or even prohibitions for visiting or the form and type of visitings are different. These restrictive visitings can be stressful for the patient and family and they may have consequences. The reasons for these special regulations are different, but they are not known and well-defined. The aim of this study was to investigate the practices and barriers of visiting in adult intensive care units.

This study is an integrated review of texts related to the methods and barriers for visiting the adult intensive care units.  Studies in CINAHL, Medline, Scopus, Cochrane Database of Systematic Reviews, Iran Medex, Scientific Information Database (SID), and Google Scholar databases were reviewed from 1990 to 2017. During the search, 51 articles, 1 dissertation and one book in this field were reviewed and selected. Data analysis was performed using Russell's (2005) method.

  Analysis of the data showed that there are four methods of visiting in the intensive care units: restricted, open, liberalized, and according to the patient's preferences. There were various barriers to visiting in the intensive care units, the most important of which is the belief that the staff has a negative experience in the field of visiting and they believe that it is not beneficial for the patient.   Some of the negative beliefs that were mentioned in most studies are increased risk of infection, interference with treatment and care, increased psychological and physiological stress, and patient and family fatigue.

The choice of method or type of visiting in the intensive care units is influenced by the assumed, experienced or subjective obstacles of personnel and managers. Given that one of the main barriers to visiting is the negative beliefs regarding visits to the intensive care unit, it is recommended that appropriate training be provided for ICU staff in order to modify their beliefs regarding patient visits.

The aim of this study was to examine the effect of fetal movement counting on the maternal-fetal attachment in primiparous women.

This semi-experimental study was conducted on 110 pregnant women which were selected by available sampling from primigravid pregnant women referred to the therapeutic centers of social security of Urmia in 2017: The demographic information, GHQ28 questionnaire, and Cranley's MFAS were used for data collection. Before the intervention, the demographic information and the Cranley's questionnaires were completed for both groups. After training the fetal movement counting to the intervention group, they all received fetal movement counting form and a ribbon. They were asked to count and record fetal movements every day for two weeks and tie the ribbon. The control group only received the routine care. The intervention group delivered the form and ribbon after two weeks. Both groups re-completed MFA questionnaire. The mean scores of MFA before and after intervention were compared between the two groups. Data were analyzed by SPSS 16.

The mean score for MFA before the intervention was 3/93 ± 0.48 and 3/87 ±0.55 in intervention and control groups, respectively. However, after the intervention, the mean score was 4/06±0.45 and 3/84±0.54 and they were statistically significant (p=0.030).

Counting fetal movements by the mother during pregnancy increases maternal attachment to the fetus. This promotes the mental health, social maternal health, and fetal health.

Nasogastric tube insertion is one of the most important therapeutic functions usually performed by nurses in the intensive care units and proper placement of it requires the skill and proper performance of nurses to meet the established standards and reduce potential complications. Obviously, this requires training of nurses. However, non-attendance education can be a good way to improve nurses' performance. Accordingly, this study aimed to investigate the effect of non-attendance education on the performance of Bachelor and higher degree nurses in adhering to nasogastric tube insertion standards in university hospitals in Urmia.

In this semi-experimental study about 60 nurses working in intensive care units in Urmia were included. Samples were randomized and divided into case and control groups. The case group was taught by an educational pamphlet and a CD. Data were gathered by a 25 question checklist about NGT insertion based on valid standards practice with an observational method by researchers. The performance of the subjects was evaluated by two stages: pre-test in both groups and post-test in the case group. Data were analyzed using descriptive and analytic statistics by SPSS version 22.

The mean age of participants in case group was 31.05 and it was 30.89 in the control group. The mean years of service was 7.68 and 7.77 in the control and case group, respectively. It was also found that the practice of nurses working in intensive care unit is far from the standards in the field of nasogastric tube insertion. The mean performance score (out of 100) in the control and case groups before the intervention was 71.58 and 70.48, respectively, and the mean score of the case group after the intervention was 86.80 which increased by 16.32 and was statistically significant (p = 0/0001).

Promoting nonattendance education in a variety of ways in the clinical setting for nurses can improve performance levels in therapeutic procedures, including adherence to standards of nasogastric tube insertion in specialized units, and ultimately improve the quality of treatment and reduce the adverse effects of mistakes in a positive way. Similar training methods are recommended.

Drug dependence is a social issue and women as half the population are involved with it. The foundation of societies and families depends on the health of all people, especially women. Therefore, the aim of this study was to determine the factors affecting the tendency for narcotics and psychotropic substances among women referred to the Welfare office in Tehran.

 A causal-comparative study was conducted on all drug-dependent and non-drug dependent women referred to the Welfare office and Quds clinic in Tehran. A sample of 150 patients in the case group and 150 subjects in the control group were selected. The data gathering tool was a researcher-made 2-part questionnaire. The first part of the questionaire was about demographic characteristics, and the second part was about the 5 causes of narcotics and psychotropic substance tendencies. The validity and reliability of the questionaire was confirmed. Data were analyzed using the t-test and Chi-square.

Findings showed that addicted women were more likely to havephysical illnesses (back pain) and mental illnesses (depression, irritability anxiety, severe anger. Also, with regard to behavioral attributes, they had positive attitude towards drugs, had low self-esteem, suffered emotional deficits, and they had inability to adapt to problems. Also, family causes showed that family members were addicted, unrestrained, tense, and also intense family sensitivity was observed among these women.. Furthermore, with regard to social causes lack of access to healthy recreation, lack of recreational and service facilities - counseling, having addicted friends were observed among addicted women.Cultural causes showed academic stress).

Women’s addiction has an irreparable damage to the individual, family, and society. Discovering the factors affecting the drug tendency in women can prevent many social and health problems in society.

Nowadays, implementing the interventions to improve self-care behaviors of coronary artery bypass graft surgery patients is considered more than ever. The aim of this study was to determine the effect of implementingeducational intervention based on self-care behaviors on self-efficacy in coronary artery bypass graft surgery patients in Seyyed-Al-Shohada Hospital in Urmia.

In this semi-experimental study, 56 patients undergoing coronary artery bypass graft surgery who were eligible for inclusion in the study, were randomly divided into two groups: educational intervention (based on self-care behaviors, n=28) and control (routine care, n=28). The researcher taught self-care behaviors during eight sessions of 30 minutes every other day, and provided an educational pamphlet during discharge for them. The control group only received the routine care. Data collection tools included the Demographic characteristics and Chronic Disease Self-Efficacy Scale. The data were analyzed using SPSS v. 20. The chi-square, independent t, and paired t-test were utilized.

The mean score of self-efficacy before implementing educational intervention based on self-care behaviors was 126.70 ± 40.13 and 120.88 ± 10.33 in the intervention group and control group, respectively, and no statistically significant differences were observed between the two groups (p=0.221). But after implementing educational intervention based on self-care behaviors, the mean score of self-efficacy in the intervention group (175/07 ± 42/49) was significantly higher than the control group (130/44 ± 9/65), (p<0.001).

According to the findings of this study, implementing educational intervention based on self-care behaviors can help improve the self-efficacy of patients undergoing coronary artery bypass graft surgery.