نشریه پرستاری ایران
پیاپی 62 (اسفند 1388)

Nurses as the biggest group of caregivers provide patients with continuous caring services. The effect of these services on health care quality and also, patient's satisfaction is obvious. Regarding the key role nurse play in health care team, it is up to the manager to plan for improving nurse's knowledge and practical skills. Peer review process is seen as an approach of authority delegation by managers for nursing quality assurance. The aim of the study was to examine the effect of peer review process on quality of nurse's performance and patient satisfaction in cardiac care units in governmental hospitals located in the city Arak, Iran. This was a quasi-experimental study in which four cardiac units (CCU and PCCU) in two governmental hospitals in Arak city were selected as the study environment. The staff nurses of two units with higher number of nurses (n= 25) were selected as experimental group and the nurses of the other two units (n= 19) were selected as control group. The study tools were the quality of nurse's performance checklists and patient satisfaction questionnaire. Before intervention, checklists of quality of nurse performance were completed by co-researcher based on nursing care observations in every group. The patient satisfaction checklists (35 checklists) were completed by patients or by the interview. After the intervention (2 months duration) and supervision by the researcher without any intervention (1 months duration), the study tools were completed again for every group. Both groups were similar in terms of their demographics (age, years of study, the level of living welfare, and…). Chi-square and paired t-test did not show any statistically significant difference between two groups, before and after the intervention. Also, there was not found any statistical significant relationship between nurse's demographic variables and their performance. There was a statistically significant relationship between patients’ satisfaction and their age and level of living welfare in control group before the intervention and the same was true for patients’ satisfaction and their level of living welfare in experimental group after the intervention. Mann-whitney U test showed a statistically significant difference for quality of nurse's performance between two groups after the intervention (P < 0.001). Also, there was a statistically significant difference in patient's satisfaction between two groups after the intervention (P < 0.001). The results of the study showed that the peer review process has effects on quality of nurse's performance and patient's satisfaction.

The quality of clinical education as the main part of nursing education depends on many factors, including the performance of clinical nurse instructors. The aim of this study was to determine and compare the viewpoints of nurse trainers and student nurses of Bonab and Marageh Azad Islamic Universities regarding the performance of clinical nurse instructors. In this descriptive-comparative study, all clinical nurse instructors (N= 34) and student nurses (N= 200) of two universities were recruited by census sampling. Inclusion criteria for trainers were having Bachelor of Science (BS) degree, having at least one year working experience of clinical teaching, and not participating in clinical teaching in other universities. An inclusion criterion for students was studying in third or fourth year of BS nursing education. For data gathering, a composed questionnaire was used. The first part of the questionnaire consisted of the demographic data of student nurses and nurse trainers. The second part contained 27 items assessing the viewpoints of the subjects regarding clinical performance of clinical nurse instructors in six dimensions including theoretical and skill competency, instruction skills, communication skills, supportive role, directive role and encourage role. Questionnaires were completed by self report method. Findings showed that both students and trainers believed that the performance of clinical nurse trainers is weak, but, there were statistically significant differences between their views, as students gave lower scores, in all dimensions, than nurse trainers. These findings demonstrated the weak performance of BS degree clinical nurse instructors in the universities under study. BS degree clinical nurse instructors play an important role in clinical education of student nurses in Azad Islamic Universities, therefore the nursing responsibles of these universities should provide continuing education for clinical nurse instructors.

Lack of knowledge about correct life style and prevalence of unhealthy behaviors play an important role in increasing cardiovascular diseases. The purpose of this study was to determine knowledge, attitude and performance of educational staff about cardiovascular diseases. This cross-sectional study was done in 2007 in selected educational districts of Tehran affiliated to ministry of education. In this study, 703 teachers and health instructors participated. Multi-stage sampling was used and the data was collected by a self-report questionnaire consisting 20 awareness questions and 15 attitude questions about cardiovascular risk factors, and 21 questions about performance in diet, physical activity and smoking. The validity and reliability of the questionnaire was confirmed by content validity and test-retest reliability within a 10 days period. The results showed that 67% of the subjects had good knowledge of and 83.8% of the subjects had positive attitude towards cardiovascular risk factors. The majority of the subjects had moderate or weak performance in nutrition (71.6%) and physical activity (64.4%). Also, 77.7% of the subjects had no smoking history. There was a significantly statistical positive relationship between knowledge and attitude of the subjects (P ≤ 0.0001). According to the findings, although knowledge and attitude of educational staff about cardiovascular risk factors was good their performance in some aspectss was not acceptable. Therefore, it is suggested to provide effective educational programs for improving the nutrition and physical activity status for teachers and prevention and control of cardiovascular diseases.

Self-efficacy in hemodialysis patients has been found to be associated with increased adherence to treatment and decreased physical, psychological and social problems. The aim�of this study was to determine the relationship between therapeutic regimen self-efficacy�and clinical/ laboratory outcomes as adherence in hemodialysis patients. In this cross-sectional study, 200 hemodialysis patients were selected by convenience sampling method. The questionnaire, "Strategies used by people to promote health", assessed self-efficacy with therapeutic regimen.�Clinical/Laboratory outcomes such as phosphate, nitrogen urea, potassium, calcium and weight gain between dialysis sessions were obtained from patients’�medical records. Data were collected from hemodialysis patients in a teaching hospital affiliated to Iran University of Medical Sciences and Health Services. Data were analyzed by SPSS-14. self-efficacy with therapeutic regimen was positively related to laboratory outcomes such as phosphate, nitrogen urea, and potassium (P<0.05). However, there was no significant association between calcium and self-efficacy (P>0.05). Also, weight gain between dialysis sessions was significantly correlated with self-efficacy (P<0.05).� The findings indicated that patients with greater�self-efficacy with therapeutic regimen had lower levels of serum potassium, phosphate, nitrogen urea and weight gain between two session of dialysis. Based on these findings, it was suggested to nurses for planning educational programs to increase self efficacy in patient with renal failure, therby, helping the patients to enhance self care and compliance with therapeutics regimen.

Neonates are more sensitive to pain and more susceptible to long term effects of pain than children and adults. Therefore, pain management has become a crucial part of neonatal care and cure. The aim of this study was to examine the effect of being in mother's hug and routine clinical procedure on neonates’ pain during immunization injections in health centers of west Tehran. This randomized controlled trial study was performed on 76 healthy term infants aged between 2-4 month, referred to the health centers of Iran University of Medical Sciences in west of Tehran for DPT immunization. One group were given in their mother's hug, 2 minutes before, during, and 15 seconds after the injection, and the other group were lied on the examining table according to routine of the clinic. Objective changes in appearance of neonates were assessed by Modified Behavioral Pain Scale (MBPS) from 5 second before immunization to 15 second after it. There was statistical significant difference between behavioral pain scores of the groups (P≤0.0001). Regarding�statistical�significant difference between behavioral pain responses of the groups, simple and safe practice of hugging infants by their mothers is suggested to reduce pain during immunization and muscular injections, too.

Pregnancy is a physiological event that may cause significant complications (5-20%) in mother and fetus. One of the dangerous factors in the pregnancy is abnormal Body Mass Index (BMI) before pregnancy. The purpose of this study was to determine the relationship between maternal pre-pregnancy body mass index and childbirth outcomes in primiparous women. This was a correlation and Ex-post facto study. Through consecutive sampling method, 300 primiparous women with the singleton pregnancy who received prenatal care in the first trimester (14 weeks) were selected. A record sheet (questionnaire) was used to collect data. The findings showed that there was a statistically significant relationship between body mass index and duration of first (P=0.007) and second stage of labor (P=0.01). Besides, increase in the body mass index was correlated with higher in cesarean rate. So, statistically significant relationship were found between body mass index and mode of delivery (P=0.03). However, no statistical significant relationship was found between body mass index and postpartum hemorrhage. According to the finding, it seems that it would be necessary to plan educational and counseling programs before the pregnancy for the mothers.

Each year, more than 150 millions women become pregnant in the developed countries and most of the pregnancies result in the birth of one living newborn from a healthy mother. But, for some of the women, labor has not been easy and gladly and it follows with the feeling of fear, pain, suffering and even death. Hard labor or dystocia of labor is one of the main reasons of the death of mothers which is preventable or curable by correct and on-time control. Prevalence of dystocia has been reported in different points and has been from %4 to %15. Up to the present time, a comprehensive research has not been obtained from prevalence of labor distocia in Iran therefore, the aim of this study was to determine the prevalence of hard labor and the related factors in women referring to the public maternity hospitals of Qom in 2005-2006. The present research is a descriptive analytic study on 4325 women ready for labor referring to the public hospitals of Qom within 5.5 month. The instrument for collecting data was a questionnaire completed with observation, interview and examination. Finally, data were analyzed using SPSS. The findings showed that the prevalence of long and hard labor was 7.5±0.78. In this regard, non-proportion of the head of fetus with pelvic of mother, disorder of womb forces, having epidural anesthesia, receiving narcotic sedative more than one hour to labor, mental fatigue of mother and not cooperating the woman and polyhydraminos were most related to hard labor, respectively. The most related fetal factors were macrosomia, malposition and the existence of umbilical cord around the neck of newborn, respectively. The results showed that hard labor had a statistically significant relationship with the age of mother, level of education, occupation, weight gain during pregnancy, kind of center for receiving prenatal services, record of hard labor and the record of abortion, and existence of diabetes (P<0.000). The results showed that the prevalence of hard labor is moderate as compared with some of the regions of the world. Anyway, by considering that up to now, a comprehensive epidemiologic study has not been reported in Iran about the labor dystocia, and with regard to its dangerous effects on mother and fetus, further study is recommended.

Parenting style has a range of different outcomes for adolescents, their family relationships, achieving to autonomy, confidence and decision-making capacities. The results of studies about relationship between parenting style and autonomy in adolescents are different and controversial. The aim of the study was to examine the relationship between parenting style and authonomy among adolescents studying in Tabriz high schools. This was a cross sectional study with multistage cluster sampling of 360 adolescents studying in Tabriz high schools. Questionnaires used in this study were parenting style inventory II, Emotional Autonomy Scale (EAS) and perspective on adolescent decision-making – B. Data were analyzed using SPSS (Version 11). According to the finding, the majority of adolescents (%39.7) reported authoritative parenting style and there was a statistically significant relationship between parenting style and emotional autonomy (F = 78.6, P<0.05) and behavioral autonomy (F = 6.4, P<0.05). Regarding the findings, it is suggested that nurses plan education programs about adolescence’s characteristic and parenting style outcomes for parents in order to achieve healthy autonomy for the adolescents.