نشریه پرستاری ایران
پیاپی 51 (پاییز 1386)

Nursing care in burn centers requires a heavy work which is influenced by many factors. The quality care of nurses as the largest group care providers in burn centers is of great importance and complexity and pan dimensionality of the care in these centers requires multiple interpretations that necessitate exploring and describing the perspectives of whom involved in care giving to understand the factors affecting the quality of care. The study was carried out with the aim of exploring and describing the factors involved in quality nursing care in burn centers of Tehran. Grounded theory was used as method. Thirty- eight participants were recruited through purposeful and theoretical sampling. Data were generated by unstructured interviews and participant observations. Constant comparison was used for data analysis. Data revealed that two categories of structural factors including intra and extra organizational conditions have influenced the quality of care. Intra organizational conditions included conditions related to administrators, staff, financial problems, workload, team members, facilities and equipments, environmental elements, and patients. Extra organizational conditions included self-management of burn centers, lack of supportive organizations for patients and heavy expenses of treatment, high living expenditure and low salary of governmental personnel, lack of employment permission, inattention of senior managers and inspectors to the work processes and their over attention to documentation, troublesome rules related to official violations, physicians governorship, and negative social perspective into nursing profession. Interaction between intra and extra organizational conditions resulted in physical and psychological stress, loss of motivation and dissatisfaction of staff nurses and poor quality of care. Findings were suggestive of correcting and modifying the intra and extra organizational factors and implementing stress reduction programs.

Working errors are inevitable in every profession including health care professions, but in nursing it is of greater importance, because of its inalienable damages to patients. Study of predisposing factors of these errors is the first step to control and decrease errors during nursing care. The purpose of this study was to survey predisposing causes of working errors in nursing cares from perspectives of nurses and their managers and also to examine the importance of different predisposing domains in different wards in year 2007. This research is a descriptive study in which cluster random sampling method was used. Ninety six nurses and nursing managers from 3 selected educational hospitals in Tehran participated in this study. Data were collected by a questionnaire and analyzed by descriptive and inferential statistics. From perspective of nurses and nursing managers, different factors in domains of management, environment, and care and nursing were considered as predisposing factors to nursing errors. Also, there were a statistically significant difference between wards in terms of predisposing causes of working errors (P<0.001). Regarding impossibility of absolute suppression of nursing errors, struggle for controlling and decreasing nursing errors depends on using a systematic approach with emphasis on management, environment, care and nursing domains when assessing predisposing factors and planning appropriate intervention.

Endotracheal suctioning is one of the most frequently used methods for airway clearance in patients under mechanical ventilation. Chest physiotherapy techniques such as expiratory rib cage compression before endotracheal suctioning can be used as a means to facilitate mobilizing and removing airway secretions and improving alveolar ventilation. This study was carried out to determine the effects of expiratory rib cage compression before endotracheal suctioning on arterial blood gases in patients mechanically ventilated patients. This research was a clinical trial study with a crossover design. The subjects consisted of 70 (35 females, 35 males) mechanically ventilated patients who were admitted to medical and surgical intensive care units and emergency department of Hazrat-Rasool Hospital in Tehran. Subjects were selected with consecutive sampling. The patients received endotracheal suctioning with and without rib cage compression, with a minimum 3-hours interval between the two interventions. Expiratory rib cage compression was performed for 5 minutes before endotracheal suctioning. Arterial blood gases were measured 5 minutes before and 25 minutes after endotracheal suctioning. Data were recorded on the data recording sheet. Data were analyzed using Wilcoxon and paired t-tests. There were a statistically significant differences in the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (Pao2/Fio2), Paco2, and arterial oxygen saturation (Sao2) between before and after endotracheal suctioning in both methods (endotracheal suctioning with and without rib cage compression) (p=0.000). Moreover, there were statistically significant differences in the ratio of arterial partial pressure of oxygen to fraction of inspired oxygen (P=0.000), Paco2 (P=0.048), and arterial oxygen saturation (P=0.000) between the two methods. Findings showed that expiratory rib cage compression before endotracheal suctioning improves arterial blood gases exchanges in patients under mechanical ventilation, so, performing expiratory rib cage compression before endotracheal suctioning in these patients is recommended.

The main goal of medical education is preparing experts in health care fields. Medical education should answer the population needs and develop in accordance with technology changes. The aim of this study was to evaluate the effect of active education on knowledge of health care workers of Golestan University of Medical Sciences about avian influenza. In 2005-2006, this semi-experimental study was conducted through before-after design. At the beginning, knowledge of the samples regarding to avian influenza was evaluated with self-administered questionnaire. After intervention (active participation in lectures and group workshops) the questionnaires were distributed once again. Data were analysed by non-parametric tests (Wilcoxon, Mann-Whitney, Kruskal-Wallis) to evaluate the effect of active education on knowledge about Avian Influenza. The mean score of knowledge increased significantly after educational intervention (P-value< 0.001). Previous information was significantly related to pretest scores. The mean score of knowledge was not significantly related to gender and age. Educational workshops are effective in increasing knowledge of healthcare workers about avian influanza. While educational programs of the mass media are effective knowledge, it doesnt meet the special educational needs in the field of health.

Although hemodialysis is one of the most useful and modern treatment methods for patients with chronic renal diseases, there has not been considerable achievement in understanding and treating physical and psychosocial problems of these patients. Decrease in mental health status of hemodialysis patients affects their quality of life and may produce performance disorder. The purpose of this study was to investigate the relationship between mental health and quality of life of hemodialysis patients referred to hospitals affiliated to Shiraz University of Medical Sciences. Ninety patients were selected through convenient sampling and data was collected by a demographic questionnaire, General Health Questionnaire, and Short form quality of life questionnaire (SF-36). Mental health was assessed in four domains: somatoform symptoms, anxiety, social dysfunction and depression. The SF-36 questionnaire is summed into eight scales of health: physical function, social function, limitation in role due to emotional problem, mental Health, vitality, bodily pain, and general health. The data were analyzed using t-test, spearman’s correlation, and Anova. The results revealed that most domains in quality of life were correlated with mental health domains. General health perception and physical function domains were correlated significantly with three domains of mental health: anxiety, social function and depression (p<0.012, 0.p<0.001,p< 0.004). Somatoform symptoms were correlated significantly with mental health domain of quality of life (p<0.02). Finally, social function was correlated significantly with social dysfunction domain of life quality (p<0.05). Also, anxiety and somatoform domains of mental health had more significantly relationship in women than men (p= 0.006 and p= 0.25, respectively). Of quality of life domains, physical function had more significantly relationship in men than women (p=0.03) and bodily pain had more significantly relationship in women than men (p= 0.006). The result of this study indicated that many quality of life domains were correlated with mental health domains and hemodialysis had effect on different aspects of patient’s life. The results also indicated that such demographic characteristic as age, gender, marital status, other diseases and length of hemodialysis treatment had relationship with some aspects of life quality and mental health.

Despite tremendous progressions in medical science and technology, there is no way yet to escape death. Logical attitudes of nurses toward death could be influential on care giving of dying patients and their families. If the health care professionals view death as a terrible and dire thing, they couldn’t handle patients’ death in a fair and effective manner. So, it seems that the first step toward designing an appropriate care and support system for dying patients and their family is exploring nurses’ beliefs and point of views. The aim of this study was to determine the concept of death from Iranian nurses’ perspective to reach a new explanation for this concept in community. This study was conducted by qualitative research approach. Data collection was done via semi structured interviews with 12 Nurses from 4 hospitals. They had 2 to 18 years working experience in emergency departments, ICUs, CCUs and oncology wards. All interviews were taped, and then transcribed on paper and analyzed using Strauss and Corbin method. Four main categories emerged: non avoidable ending, ambiguity and uncertainty, feedback for personal behaviors, and changing attitudes toward life and death. This study showed that one of the most important ideas which help nurses to better dealing with death is belief in life after death. Recognizing death as fate of all lives could also bring peace to the man. This sort of attitude gives the nurse a peace of mind which helps to make dying patients and their families comfortable. The perspective of death which emerged from nurses’ perspectives in this research is a spiritual one. They believed that their occupation with nursing reinforces this attitude and decreases their uncertainty about life after death. This study provides a deep understanding about nurses’ point of view about death which could be a base for nursing education about death and dying

The health care services have an essential role in saving human life at the time of disaster impact. Disasters always have prominent effects on health, public health and welfare of affected people. The way throu which health care services are delivered at the time of disaster impact is one of the most important challenges in crisis management. Although he Islamic Republic of Iran is the sixth-most disaster-prone country in the world and average of 4,000 people have killed and 55,000 affected annually by natural disasters over the last decade, a few studies about health care services at disasters have been done. Therefore, in this paper that is a part of a greater study, we have tried to explore how well the health care services at the time of disasters have been delivered. This study is developed on the basis of grounded theory. Seventeen participants consisted of 5 nurses, 1 social worker, 1 psychologist, 2 psychiatrists, 1 general physician, 1 health professional, 1 epidemiologist, 1 master in health, 1 nurse aid and 3 Bam residents. All of them have at least one experience at disasters. Of those, 15 were male and 2 were female and their average age was 37. Semi-structured interviews and observational field note were used for data gathering. All of interviews were transcribed verbatim (word by word) and simultaneously constant comparative analysis was used according to Strauss and Corbin's method. The way of delivering health care services is one of the important concepts that implied from collected data of the study. This concept comprises four aspects: quality and quantity of health care services, equipment supplies, personnel situation and management. This concept represents the way of delivering health care services at the time of disasters. Unpleasant personnel situations, insufficient quality and quantity of health care services at the time of disaster, deficiencies of equipment and instrument, poor management and lack of coordination are the most important factors that hindered delivering comprehensive, continuous, accessible and qualified health care services at the time of disaster. Providing enough well educated and experienced personnel, enough and qualified health care services, enough instrument and equipments, and appropriate and coordinated management can facilitate on time, comprehensive, continuous and accessible health care services at the time of disasters. Health sector mission of prevention, investigation and treatment of injured and sick people is more prominent in parallel with greater expectation of community at the time of disaster.,Health care services as the most significant foundation of crisis management should be delivered in a suitable and efficient way. Finally, the way of delivering health care services at the time of disaster was emphasized by participants in this study.

Nowadays, one of main and critical subject is preparation of a healthy and fair environment for children who are biggest national sources in every society, because, factors that disturb children living environment can affect children’s health. Some problems such as families’ bad function, abuse, poverty, divorce and parental substance abuse are the reasons usually lead to place children in foster care centers. On the other hand, entry to these foster care centers and living in these centers face children with lot of social and health problems. In regard to this issue for assessing social health status of 7-11 years children living in foster care centre in Tehran, we performed a cross sectional study with 105 children (57 boy, 48 girl). In this research, sampling was of census type and information about children social health was obtained through Vienland Adoptive Behavior Scale by guardians who recognized these children and their behavior. Results showed that 45.7% of participants in this research were considered as moderate regarding social health, and 19.1% were considered as poor. Chi-square test also showed that between social health and sex (p=0.053) was a statistically significant relationship, but there was no significant relationship between social health and age (p=0.462) and social health with duration of stay in these centers. While children in foster care centers are one of the high risk groups in societies related to their social health status, based on findings of current study and results of researches in other countries, full attention should be directed towards social health of children and conducting more studies is recommended to survey factors that affect their social health.