مجله دانشکده پرستاری و مامایی مشهد
پیاپی 19 (بهار 1387)

Background and Although during the last decades, the most frequent cause of death in major thermal burns has been infection, the purpose of this study was to compare infection assessing methods on burn wounds based on diagnostic value of swab sampling and wound local criteria in comparison with tissue sampling (gold standard) to identify burn wound infection. This study was designed as one group cross-sectional non-experimental research. In 1385-86, 45 patients were included by purposive sampling from those admitted to the burn ward at Imam Reza Hospital in Mashhad. After preparations, first of all, burn wounds were assessed by wound local criteria tool (designed by researcher) to identify infection; then in the same place swab and tissue sampling were don simultaneity. Swab samples were cultured to identify presence of microorganism which exceeds more than 105 in square centimeter as infection in microbiology lab and tissue samples were assessed histological to identify presence of microorganism in sub-scar vital tissue in pathology lab. Age mean was 36.5±14.25 years old. The frequency of burn wound infection was obtained by wound local criteria, swab sampling and tissue sampling and no significant differences between wound local criteria and tissue sampling were identified. Wound local criteria have advantages to identify infection in burn patient management; therefore, burn wounds in case of presence of increase on exudates, foul odor, necrotic tissue and edema need more extensive attention. Negative results were obtained by swab sampling are more useful than positive results.

Background and Blood samples obtained for blood gas analysis usually contains on air bubble which could be a source of error in blood gas pressure. Therefore, in this study, the effect of extrusion or remaining of air bubble in syringe time delay on analysis of blood gas under different temperature was assessed. Forty samples of arterial blood in seven groups including two groups with 10% & 20% extrude air bubble, two groups with 10% & 20% non extrude air bubble, that sample analyzed immediately after blood letting, two samples without air bubble analyzed 10 minutes after blood sampling, one in room temperature (26°c) and the other in refrigerator (0°c). Results Showed that extrusion of air bubbles leads to a significant decrease in both po2 and pco2. Results of samples contain air bubbles showed a significant increase in pco2 & non significant increase in pao2. Variation in blood gas pressure in samples without air bubbles there variation was not according pressure gradient. In samples with delays analysis results indicate the leakage of gases. From wall of the syringe in both conditions (26°c & 0°c) and continuation cellular metabolism in samples with delay in 26°c. The results of this study suggest that blood samples for gas analysis should be free of air babble when possible, if immediately gas analysis was not available. The samples should be kept in ice crush and glass syringe prefer for blood letting. Immediate gas analysis of blood samples contains air bubbles without extrusion of air bubble is recommended.

Background and According to large number of false negative results of pap smear and admission of women in progressive stage of cervical cancer, this study carried out to increase the quality of pap smear. So, this research aimed to compare the quality of pap smear done by cervix brush with a combined of spatula and cotton swab in women admitted to A.E.M.-Reza and Sh. Rostami medical center during the year 2004 in Babol city. The study was done by one blind clinical trial on 120 women. First it achieved based on the purposive sampling, then assign randomized in two different groups. All of case were non pregnant, without observed diseases (vaginitis, cervicitis), non of cases were in bleeding period, not have intercourse in past 24 hour or used vaginal douche they did not used any vaginal drug a week before examination, without prior pap smears within 6 months, and prior cervical surgery. Data gathering instrument of research included interview, visit and observation form, microscope, assessment form. Sampling were done separately for each person, first, a sample was gathered by cervix brush and then another sample by combined spatula and cotton swab. Then cytologist assess the sample based on Bethesda system and classified them in 3 group "satisfactory for evaluation", "satisfactory for evaluation but limited" and "unsatisfactory for evaluation". Also sequence and type of sampling were not defined to cytologist. Analysis was done by, –test, fisher Exact test, Mann–Whitney by utilizing SPSS software and 95 percent coefficient. Significant statistical difference was not observed between satisfactory quality percentages, but a significant difference observed in total cell amount. Significant differences have not shown in pap smear quality in the two methods, and the cervix brush offers no advantage over combine spatula and cotton swab to increase satisfactory quality pap smear. Therefore we recommended this kind of research is done in more samples.

Background and Nursing documentation is the nurses professional task and one of important component of patients file and a documentary report of patient condition, progress of disease, nursing cares and the patients response approach. So, it must be complete, factual & accurate, organized & legal guidelines for recording. Today, it is recorded in different methods. The studies carried out in Iran show the quality of nursing documentation are low. The objective of this study is comparing the effect of two kinds of nursing documentation, POMR and Farabi specialty hospital under supervision of Mashhad social security organization in autumn 1385. In this one-group only post test study clinical trial, the purposeful sampling was used; 38 subjects were selected randomly and divide into two groups. They were asked assess their patients by the assessment tool and record their nursing documentation in one of two kinds. For at least 3 patients of the odd beds number in on of two methods and in the other week in other method. Finally, one documentation selected from all nursing records of each nurse on each method and compared with check list. Based on findings there was a significant difference between characteristics of POMR and traditional method so that the total score of POMR can improve the quality of nursing documentation. According to results of this study, the problem oriented medial record method was more effective than the traditional record on characteristics nursing progress note.

Background and Nosocomical infections are of the problems of all societies and the most common way for it s transference is contaminated hands. According to the recommendations of W.H.O on using alcohol–base formulation for hand hygiene and it got used to some hospital sections for some time, this study is done with the aim of comparing alcohol–based hand rub with antiseptic soap and plain soap on colonization of microorganisms on hand of nursing personnel. this study is a randomized, three–group, single blind, clinical trial. 134 nursing personnel including nurses and nurse assistances selected randomly by classified sampling, has been studied. The sample of prevailing hand was provided before, immediately after, and 1 hour hater and one week after intervention by using Agar culture and interpreted after 48 hours incubation in 37c the number and the kind of colonies were counted and the results were interpreted. Furthermore, intervention carried on after teaching hand hygiene based on W.H.O. standards and the study cases were studied concerning possible skin complications and the measure of compliance during one week. Kruskal Wallis, Wilcoxon, Man-withney and Chi–Square statistical tests were used for analyzing data by SPSS software, version 14.5. Based on findings the most common micro-organism was the negative coagulase staphylococcus (92% of cases), the others were antrococus, kurine, Basilus and E-coli, respectively. All independent variables significantly decreased microorganisms immediately after intervention. Among three groups, the alcohol-based hand rub in comparison with two other methods showed more reduction, while two kinds of soaps showed no significant difference. Regarding this fact the on of the most important ways of transferring nosocomical infections is personnel’s hands, as the alcohol- based hand rub is more effective in microorganisms reduction in comparison with soap and regarding its easy application even without water, it is recommended to use it instead if soap for hands as an antiseptic.

Background and Health in the physical, mental and social aspects is one of the subjects had involved human communities for long time ago. The environment of the house and the household and family organize the center of mental health of population, and its role and performance affect other social units considerably. Hence for access to this object it is very important to consider about unsuitable minds changes more effectively and efficiently. Searching for relation between marital satisfaction and irrational communicative belief is one of the important cases. This research is a periodic analytic descriptive method, single-group and with two-variable that it was performed among married nurses at the collegiate hospital in Mashhad. Sample volume was estimated 200 cases. The characteristic variables such as age, sex, level of education, title and the number of children and independent variable research, marital communicative belief and dependent variable and marital satisfaction was studied with the questionnaire of communicative belief scale (RBI) and with the questionnaire of marital satisfaction scale (MHS). The satisfaction-correlation measure in total satisfaction choice the sum of satisfaction in 10 other choice was studied in separate field and with communicative belief (the total score of belief). The correlation between the sun of marital satisfaction and communicative belief was calculated r=-0.337 with p<0.001 with total satisfaction r=-0.311 with p<0.001. There was reverse meaningful relation. The correlation of total marital satisfaction and the sum of marital satisfaction with irrational communicative belief was reverse meaningful relation in separate fields such as destructive disagreement, different sex and spouse incompatibility, but in fields of the expectation of minds exploration and sexual perfectionism don’t achieve meaningful relation. In this research, the results indicate that hypothesis of this research, between marital satisfaction measure and irrational marital communicative belief is reverse relation, is confirmed. The increment of marital satisfaction is a way that products tranquility in household environment and develops the mental and physical health and also it is a way for solving social problems and dilemma due to marital and family problems. With improvement of communicative belief we can prevent from problems of communicative encounter between people, or we can solve these types of problems easily if they happen.

Background and Episiotomy is the most common operation in obstetrics. There is no reliable evidence for routine use of episiotomy and it is recommended to perform selective episiotomy for fetal maternal indications. So, this research was done by the objective, comparison of perineal trauma and pain in primiparous women with routine and selective episiotomy at Modarres hospital in Kashmar in 1382. In this clinical, randomized trial, 100 primiparous women, were between 17 and 35 years old. Sampling was made by purposeful method. Trial allocation data were obtained from interviewing, observation forms, visual analog scale and measurement of pelvic muscle strength data were analyzed with t-test, chi-square, Mann-Whitney and Fisher test in SPSS software. Also perineal pain 24 hours after delivery in supine and sitting position was less in selective group. In this study, two groups were not statistically different from view of variables effectiveness on perineal pain. Selective episiotomy can reduce perineal pain, and it is safe method with less time and costly, selective episiotomy should be replaced instead of routine episiotomy

Background and Coronary artery diseases are the most important cause of death and disability in new years. Various medical and surgical methods such as CABG surgery are used for controlling these diseases. The results of these methods are often assessed with values such as rates of mortality, diagnostic result testes and that this is unable to assess all aspects of health. One way for assess the psychosocial aspects of health is using of the quality of life concept. This research is done to assess effect of coronary artery bypass graft surgery on quality of life of patients with coronary artery diseases. This descriptive cross-sectional study was done in cardiac surgical department of Emam Reza hospital in Mashhad in 1382. 71 adult cardiac surgical patients were studied. Data was collected with interview. Quality of life was measured 24 hours before and 3 months after surgery with SF-36 survey. Demographic data and data related to disease. Data analysis is done with SPSS and by using statistic tests such as Wilcoxon and T-test. The results of dependent T test show significant difference between the mean of SF-36 score 24 hours before surgery and 3 months after surgery. Because the result of this research show significant improvement in quality of life after CABG, therefore, this surgical method not only can reduces pain and other physical signs of coronary artery patients; but also is able to improve psychosocial status of this patients and can used as a good method for treatment of this patients.