Iranian Journal Of Nursing and Midwifery Research
Volume:14 Issue: 3, summer 2009

In this research Primary Health Care systems were reviewed and the nurses'' roles were determined and then a model was designed for health networks in Iran. This was a triangulation research done in comparative method. In first step, PHC systems reviewed in different countries such as UK, Australia, Canada, Sweden and Turkey selected in purposive sampling. In second step, the process of management of PHC services in selected countries were determined from accessibility, providers and referral system, and then compared to PHC system in Iran. Afterward a primary model was designed. In third step, the model was validated using experts judgment (n = 30) and the results analyzed by descriptive statistics and final model was designed. In all of the studied countries, PHC services were delivered by health team including family physicians, nurses, midwives, and health technicians in systematic network including local health centers, family physician offices and nursing clinics. Family physicians and nurses had a basic role in delivery of services. Also other health practitioners such as psychiatrists were practiced with health team. PHC services in most cases on the bases of people''s need and health information were transmitted between the providers by health files. The effective referral system exists between health services. The model of PHC delivery was on the bases of health team with systematic network of the local health centers and provides accessibility, quality and comprehensively of services. We suggest to employee educated nurses in health centers to provide more health services.

Breast cancer is the most common cancer among women in the world and chemotherapy is the most common therapeutic approach for it. However, chemotherapy has many side effects which deteriorate patients'' quality of life. This study aimed to find the effects of exercise on quality of life among breast cancer patients undergoing chemotherapy. In this clinical trial study, 60 breast cancer patients undergoing chemotherapy at the Seyed Alshohad Hospital in Isfahan were selected. The patients were randomly divided into two groups of intervention and control. Both groups completed a questionnaire of quality of life before the intervention. The intervention group had six weeks of exercise. At the end of exercise intervention, all patients of the two groups completed the quality of life questionnaire again. Data were analyzed via SPSS15 software using independent and paired t-test. In the intervention group, even though the mean score of physical aspect of quality of life was increased, the difference was not significant (p = 0.107). The mean score of physical aspect of quality of life in the control group was decreased, but there was no significant difference between the physical aspect of quality of life before and after the intervention (p = 0.187). After the intervention, the mean score of the physical aspect of quality of life was significantly higher in the intervention group (p = 0.001). This study showed that exercise intervention is useful for enhancing physical aspect of quality of life in breast cancer patients undergoing chemotherapy.

Cesarean section rates are rising in many countries and the result of it is increase in maternal and prenatal morbidity and mortality rates. We assessed the content and concurrent validity of constructs of Behavioral Intention Model (BIM) scales to evaluate safer choices by pregnant women to select their method of delivery. This was a quasi-experimental study that carried out on 140 women with their first pregnancies in Khomeiny-shahr (2006). Data were collected using a researcher-made questionnaire, before and after education, in experiment and control groups. For data analysis, t-paired, t-test, chi-square, and Wilcoxon test were used (α ≤ 0.5) The mean grade scores of knowledge of experiment group about information of delivery, before intervention was 5.7 out of 10 that increased to 8.7 after intervention. There were significant differences between attitude of experiment group before and after intervention (p < 0.001). T-paired test revealed significant difference between the intention of participants in experiment group for vaginal delivery, before and after intervention. The data showed that the proportion of cesarean section in participants was 57.2% that in control group is very higher than experiment group (60% to 40%). Chi square test revealed significant difference between the methods of delivery of participants in two groups (p < 0.026). The BIM has potential for providing the foundation to educational intervention at the individual and community. It can be therefore, recommended that the application of this model may change and improve different behaviors including method of delivery.

This study aimed to determine the effects of immediate and continues skin-to-skin contact in first two hours post-birth on breastfeeding initiation and the infant success in first breastfeeding. 92 pairs of primi-gravid women and their neonates were randomly divided into two groups, in Om-ol-banin hospital of Mashhad in 2007. In "routine care" group, after performing neonatal primary care and repairing mother''s perineum, mother and infant were connected and breastfeeding was started. In "intervention" group, mother-infant skin to skin contact performed in the first two hours post-birth and feeding was started as soon as the infant''s pre-feeding behaviors were appeared. The duration of feeding was calculated based on infant tendency to feed. Infant Breast Feeding Assessment Tool (IBFAT) was used to measure infant success in breastfeeding. The rate of infants initiated breastfeeding in the first 30 minutes post birth was 89.4% in intervention and 2.2% in control group (p = 0.000). Duration from birth to first breastfeeding was lower (p < 0.001) and the rate of success and duration of first feeding was significantly higher in intervention group (p < 0.05). Early and continues skin-to-skin contact in the first two hours post-birth eases the first experience of successful breastfeeding that can promote breastfeeding success in the future. So, immediate and continues skin to skin contact between mother and infant and continuing it during repair of mother''s episiotomy, is recommended. If it is possible, usual cares of infant should be done after establishing the first successful breastfeeding.

This research aimed to identify midwifery roles in Iran and the world to offer suggestions about desired roles of a midwife in health care service delivery system, considering the goals of national plan for maternal health. This study was conducted using a mixed (triangulation) methodology in 3 steps. First, the roles of a midwife were extracted using documents existed in libraries, on the internet, announcement of ministries, and related organizational resources. Then, with Delphi method, the ideas of authorities were collected using a semi-open questionnaire. Finally, a questionnaire, according to last steps, was sent to 65 qualified individuals across the country to nationally measure the ideas, 53 of which were answered. The obtained results were finally analyzed. Midwifery roles were divided into 2 categories: general and professional. General roles include: supervision, management, consultation, research, teaching, legal and judicial, social work, participation in team work and reference, and participation in different managerial positions; professional roles include: care during pre-pregnancy, pregnancy, delivering time, post partum, neonatal care, maternal examination and family planning and the role of the midwife in offering services in the absence of a gynecologist. Third step showed that all roles are highly desirable (> 70%). All of the roles, except supervision and social work, are in position in Iran and are faced with barriers in Iran because of not having adequate information about these roles and also some problems in proper execution of rules. It is needed a well-organized plan and human resources standardization to perform them better.

Nursing is a skill oriented discipline. In clinical training, learning process is mainly related to performance. Moreover, developing skills is one of the main goals of clinical training, because it is through frequent practice that one can develop a skill. This study aimed to determine the frequency of practicing basic skills during nursing students'' traineeship. This was a cross-sectional descriptive analytic study, using two questionnaires, one for students taking a traineeship course and the other for graduated students and professors. From among seventeen skills studied in this research, the following have not met the expectation of professors and graduated students: subcutaneous injection, blood transfusion, urinary catheterization, nasogastric tube insertion, lavage and enema with the average frequency of 0.06, 1.49, 0.79, 0.80, 0.08 and 0.17, respectively. There was a significant difference between professors'' and graduated students'' opinions about the frequency of performing skills of muscular injection, serum preparation with ordinary infusion set and micro-infusion set, blood transfusion, dressing, Intake/Output control, oxygen therapy, airway suctioning, gavage, and lavage procedures. It seems that nurses do not have enough opportunities to practice some of the basic skills and the reason is that during their traineeships in wards the incidence of a need for these skills are few, and usually interns, residents and nursing-students perform these skills together. This should be considered in curriculum planning.

One of the effective factors in human resources in hospitals is organization commitment. The most common definition for organization commitment is considering it as "a kind of emotional dependence in organization" or "a kind of loyalty feeling to organization". This was a descriptive analytic survey. The population of study was all 110 nursing managers of 9 educational hospitals. Data gathering was done via Job Stress questionnaire and organization commitment questionnaire. Data analysis was done in SPSS software. The mean score of organization commitment was 65.6 (12.1) among nursing mangers. There was a significant relationship between organization commitment and age and also job experience based on ANOVA test. There was not any relationship between job stress and job experience. Generally there was a relationship between job stress and organizational commitment. Study results showed that organization commitment is in a good level among nursing mangers of educational hospitals of Isfahan University of Medical Sciences. The study also revealed that there was a significant correlation between job stress and organization commitment. An organization cannot be successful without managers'' commitment, so the organizations especially hospitals should plan for more commitments. On the other hand a stressful work environment can influence on mangers'' organization commitment and if the stress in work decreases, the positive effects on organization commitment will happen.

Child abuse is a big social and health problem. This study aimed to compare child abuse by parents among healthy children and those with chronic diseases. This was a descriptive comparative study between two groups carried out in 2007 in Isfahan. The samples included 212 children of 11 to 18 years old, 106 of them were referring to the health centers of the Isfahan University of Medical Sciences suffering from a chronic disease (asthma, epilepsy, cancer, thalassemia, hemophilia, etc). The healthy group included 106 children matched with the case group in age and sex as well as socio-economic class. Sampling was done by convenient method and data were gathered using a researcher-made questionnaire including demographic characteristics along with questions related to various types of abuse (neglect or physical, emotional and sexual abuse). Validity and reliability of the questionnaire were determined by content validity and Cronbach''s alpha (0.78) and data were analyzed using SPSS software by descriptive statistics, chi square and independent t-test. There was no difference between the two groups regarding sex, age, career, parents'' education and birth rank. Independent-sample t-test showed no significant difference between total mean scores of abuse and mean scores of physical, emotional and sexual abuse in both groups. But there was a significant difference between the mean score of neglect in both groups (p = 0.01). We found that the way our society pay attention to sick children is different from other societies'' and it can be related to our culture.

Since the mortality rate of mothers and infants is due to preventable factors, this study aimed to determine the effects of interventions on decreasing the mortality rate of pregnant women in Isfahan province, Iran. This was an interventional study. The study population included all dead mothers in Isfahan province from 21 March 2002 to 20 March 2005 and after intervention from 21 March 2006 to 20 March 2007. Data were collected using a questionnaire completed by information on medical documents (clinical and health files) as well as interviewing families, physicians and the health personnel. There were 47 death cases out of which 13 were caused by bleeding, 8 by Eclampsia, 9 by embolism, 2 cases by infection, 11 by background diseases, 2 by anesthesia complications, and 2 cases had unknown causes. After interventions, the mortality rate decreased from 15 cases in 2005 to 11 cases in 2006 and 8 cases in 2007. Also, the pattern of death causes changed, so that in 2007 there was no death caused by Eclampsia, and bleeding caused just one death. Considering the results of this study, it is necessary to provide professional health care during pregnancy and delivery as well as counseling services before pregnancy or marriage.