فصلنامه حیات
سال هجدهم شماره 2 (پیاپی 53، تابستان 1391)

Oral care and using mouthwash help to prevent stomatitis. The aim of this study was to investigate the effect of two mouth wash protocols on prevention of head and neck radiotherapy induced-stomatitis. Methods & Materials: In this single blind clinical trial, 120 individual were recruited. The experiment group (N=40) gurgled with 3cc of Matrices mouthwash and the control group used water mouth wash. The participants were assessed using the WHO grading scale. Data were analyzed using the Fisher exact test and Mann-Whitney U test as appropriate. There was not significant differences between the experimental and control groups regarding stomatitis intensity in the first day (P=0.371). Tere were significant differences between the two groups regarding stomatitis intensity in days 7 and 14 (P<0.001). Oral stomatitis is a common condition in patients with head and neck radiotherapy. It makes painful ulcers, dehydration, malnutrition, and potentially life-threatening infection. Matrica mouth wash could prevent and treat induced-radiotherapy ulcer stomatitis

Multiple structural factors preside over burn units influence nurse's quality of care and their activities. The complexity and multy-dimensional nature of nursing care in these units, creates many challenges. Understanding the perspectives of people's involved is recommended. This study, with a theory-to-research approach, was conducted to assess the frequency of confronting intra and extra organizational factors preside over burn units, the intensity of its related pressure, and correlations among these variables from nurse's perspectives. Methods & Materials: In this cross-sectional, correlational study, 98 nurses working in the Shahid Mottahari burn center were recruited by census. Data was collected using the intra and extra organizational factors instrument, provided based on the previous grounded theory study of the researchers. Intra-organizational factors questionnaire consisted of 58 Likert type statements in eight subscales and two dimensions of frequency (α=0.94) and intensity (α=0.96). Extra-organizational factors questionnaire consisted of eight Likert type statements (α=0.74). Data were analyzed using the SPSS version 14. The results revealed that the frequency of nurse's confrontation with factors related to environment and patients as well as its intensity were more than other factors. Moreover, the intensity of the whole factors was more than its frequency. All the extra- organizational factors were significantly correlated with all intra-organizational factors except for the "absence of employment permission" (P<0.05). This study explained the importance of intra-organizational factors of a burn center in inducing stress on nurses. In addition to verification of some relationships in the previous mid-range theory, the results of this study also modified some of its aspects. Therefore it added to the existing body of knowledge about organizational factors and job stress in burn units. Moreover, it produced some evidences to use in nursing administration and service, and finally it resulted in some directions to control stress in nurse's jobHAYAT2012;18(2): 11-26 Original Article[Frequency and Intensity of Nurse's Confrontation with Intra and Extra-Organizational Factors Governing Burn Centers][Article in Persian]Forough Rafii* (Ph.D) - Seyedeh Fatemeh Haghdoost Oskouie** (Ph.D) - Fahimeh Mohammadi Fakhar*** (MSc.) - Mohammadreza Zarei*** (MSc.) - Hamid Haghani**** (MSc.). * Dept. of Medical and Surgical Nursing, Center for Nursing Care Research, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran ** Dept. of Public Health Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran *** Dept. of Medical and Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran **** Dept. of Biostatistics, School of Management and Information Technology, Tehran University of Medical Sciences, Tehran, Iran Corresponding Author: Forough Rafii e-mail:foroughrafii@yahoo.com Received:February 4,2012Accepted: May 1,2012Available online:June 6,2012 Abstract: Multiple structural factors preside over burn units influence nurse's quality of care and their activities. The complexity and multy-dimensional nature of nursing care in these units, creates many challenges. Understanding the perspectives of people's involved is recommended. This study, with a theory-to-research approach, was conducted to assess the frequency of confronting intra and extra organizational factors preside over burn units, the intensity of its related pressure, and correlations among these variables from nurse's perspectives. Methods & Materials: In this cross-sectional, correlational study, 98 nurses working in the Shahid Mottahari burn center were recruited by census. Data was collected using the intra and extra organizational factors instrument, provided based on the previous grounded theory study of the researchers. Intra-organizational factors questionnaire consisted of 58 Likert type statements in eight subscales and two dimensions of frequency (α=0.94) and intensity (α=0.96). Extra-organizational factors questionnaire consisted of eight Likert type statements (α=0.74). Data were analyzed using the SPSS version 14. The results revealed that the frequency of nurse's confrontation with factors related to environment and patients as well as its intensity were more than other factors. Moreover, the intensity of the whole factors was more than its frequency. All the extra- organizational factors were significantly correlated with all intra-organizational factors except for the "absence of employment permission" (P<0.05). This study explained the importance of intra-organizational factors of a burn center in inducing stress on nurses. In addition to verification of some relationships in the previous mid-range theory, the results of this study also modified some of its aspects. Therefore it added to the existing body of knowledge about organizational factors and job stress in burn units. Moreover, it produced some evidences to use in nursing administration and service, and finally it resulted in some directions to control stress in nurse's job.

Caregivers of elderly with Alzheimer's disease, particularly females, encounter challenges. Their different roles in giving care to the patients could result in physical and mental disorders. The self-efficacy seems to be an essential factor in empowering individuals coping with stressful situations and challenging tasks. The aim of this study was to investigate general self-efficacy among women as family caregivers of elderly with Alzheimer's disease. Methods & Materials: In this cross-sectional descriptive study, 112 women reffered to the Iran Alzheimer Association, Tehran were selected through convenience sampling method. The General Self-Efficacy Scale (GSE-10) was used to collect data. Data were entered into the SPSS-16 and then processed using descriptive statistics and independent t-test, ANOVA and Scheffe. The mean score of the general self-efficacy was 28.24±6.34 indicating that considerable percentage of the participants had unsatisfactory level of self-efficacy (65.2%). In addition, there were significant relationships between the women's general self-efficacy with educational and economic statuses (P<0.05). There were no significant relationships between general self-efficacy with age, marital status, occupational status and duration of caring. According to the findings, a considerable percentage of the participants had unsatisfactory level of self-efficacy. Therefore, it is essential to promote the caregivers self-efficacy in order to give them the ability of better adaptation with the life's challenges. In particular, the self-efficacy promotive programs should be implemented among caregivers with lower educational and economic status.

Endotracheal suctioning (ETS) is a common invasive nursing procedure. Hemodynamic parameters changes during and after the procedure. If appropriate strategies do not be applied during the ETS, hemodynamic changes can be significant and life threatening in critically ill patients. The purpose of this study was to assess the effect of education of endotracheal suctioning on patient's hemodynamic parameters. Methods & Materials: This was a non-equivalent quasi-experimental study conducted in two critical care units in Hazarat Rasool hospital. All nurses working in these two units participated in the study in a period of two weeks. Systolic blood pressure, diastolic blood pressure and mean blood pressure of all patients who needed suctioning were measured before and after the endotracheal suctioning. We analyzed the data using the SPSS. At baseline, the systolic, diastolic and mean arterial blood pressures increased significantly (P=0.02) in the first and third minutes post-suctioning. In post-education phase, diastolic and mean arterial blood pressure increased significantly (P<0.001) in the first minute post-suctioning. In the third minute post-suctioning, systolic, diastolic and mean arterial blood pressure decreased (P=0.43). The study findings showed significant changes in hemodynamic parameters after post-endotracheal suctioning. In this study, conducting endotracheal suctioning education improved the outcomes of hemodynamic parameters in patients. Educational programs can improve nursing care outcomes by preventing and minimizing hemodynamic changes during and after the suctioning in critically ill patients.

Shoulder pain is a consequence of hemiplegia among patients with stroke. It makes patient to be dependent to others in their daily living activities. This study aimed to determine the effect of the slow stroke back massage (SSBM) on shoulder pain and hand function among patients with stroke. Methods & Materials: In this semi-experimental study, 34 patients were recruited among from 70 patients who reffered to rehabilitation center in 2010, according to the inclusion criteria. Participants were randomly allocated into two groups of control and experiment. In the intervention group, the SSBM was implemented for 10 minutes through seven consecutive sessions. Shoulder pain and hand function were measured using the visual pain scale (Visual Analog Scale), and the researcher-made "affected hand function in ADL" instrument, respectively. The measurement was done before and 24 hours after the last session of the intervention. Data were analyzed using descriptive and inferential statistical tests (independent t-test and paired t-test).

At baseline, the mean scores of shoulder pain were 8.4 in both experimental and control groups (P=0.999). After the intervention, the mean scores of shoulder pain were 1.13 and 8.40 in experimental and control groups, respectively (P<0.001). At baseline, the mean scores of hand function were 7.46 and 8.93 in the experimental and control groups, respectively (P=0.752). After the intervention, the mean scores of hand function reached 9.13 and 8.6 in the experimental and control groups, respectively (P=0.918).

According to the results of the study, applying the SSBM as a treatment procedure and care plan by health care providers can be considered as an effective intervention to prevent or reduce shoulder pain and consequently to improve motor function of affected hand in patients with hemiplegia after stroke.

Breast milk provides many healthy nutrients to infants. Support provided by health care provider has positive effects on duration of breastfeeding. The purpose of this study was to determine the effects of telephone counseling on continuity and duration of breastfeeding among primiparus women. Methods & Materials: This clinical trial was conducted on 140 primiparus women referred to the selected health centers of Tehran University of Medical Sciences in 2010. The participants were randlomly allocated into two equal groups (each: 70 indviduals). The participants in the intervention group received telephone counseling by one of the researchers. The control group received routine care. Data were collected using a questionnaire including demographic characteristics and a breastfeeding check list. Exclusive breastfeeding rates were recorded one and three months after childbirth in both groups. Also, the continuity and duration of exclusive breastfeeding were recored three months after childbirth in both groups. Data were analyzed using the Chi-square test, Fisher's exact test, standard logistic regression and linear regression in the SPSS-16 and the Win Pepi. The average duration of exclusive breastfeeding in the intervention group (8.05±3.99) was significantly more than the control group (6.23±4.03) (P=0.008). In the third month of delivery, continuity of exclusive breastfeeding in the intervention group was more than the control group (P=0.03). Results also showed that telephone counseling was effective in the duration of exclusive breastfeeding (P=0.02). Telephone counseling was effective in continuity and duration of exclusive breastfeeding. Using this inexpensive and easy method can help to increase exclusive breastfeeding, especially in primiparus women.

Administration of medications is an important part of treatment and care provided by nurses. Medication errors can create serious problems to patients and health system. The aim of this study was to determine the reasons of medication errors and the barriers of error reporting from nurse's viewpoints.Methods & Materials: In this study, we randomly selected five hospitals in Tabriz and Maragheh. Then, 200 nurses who were randomly selected for the study completed the study questionnaire. The questionnaire included 21 items about medication errors and 19 items about the barriers of error reporting, based on five degree Likert scale. Collected data were analyzed using SPSS-15. In this study, from the viewpoint of nurses, the most important reasons of medication errors were hospital units (3.70±0.84), shortages of nursing staff, nuring burn-out and high workload. Regarding barriers of error reporting, the most cited barriers were management factors (3.78±0.89), fear of legal issues, inappropriate definition of medication error and inappropriate reactions of authorities. We recommend increasing the number of nursing staff, adjusting the workload of nursing staff, using special forms for reporting errors and providing an atmosphere of intimacy between authorities and staffs.

Premature infants undergo painful and stressful procedures during care and treatment. Nurses can help to reduce short- and long-term effects of pain caused by diagnostic and therapeutic procedures using various methods including music therapy. The aim of this study was to assess the effect of music therapy on physiological pain responses of premature infants during and after blood sampling.Methods & Materials: This was an experimental study with crossover design conducted on 20 premature infants hospitalized in the intensive care unit of a hospital affiliated to the Tehran University of Medical Sciences for a five months period in 2010-11. Infants were randomly allocated in two groups of experiment and/or control. Each infant was considered as its own control. We assessed the physiological pain responses caused by blood sampling such as heart rate and oxygen saturation level. Infants in the experiment group listened to the Transitions music five minutes before until 10 minutes after the blood sampling. The responses were recorded and reviewed ten minutes before until ten minutes after the blood sampling in both groups and physiological changes were detected. Data were analyzed using ANOVA and Chi-square tests in the SAS and SPSS.

Results showed significant difference in heart rate between the experiment and control groups during needle exit (P=0.022). There was also significant difference in heart rate between experiment and control group in the first 5 minutes of blood sampling (P=0.005).

Results showed that music therapy could reduce some physiological responses of pain during and after blood sampling. Music therapy can be used as a beneficial intervention following painful procedures such as blood sampling in the NICU.