نشریه پرستاری و مامایی ارومیه
سال دهم شماره 3 (پیاپی 38، امرداد و شهریور 1391)

P atient safety is an important part of the nursing management. But with this huge amount of nursing errors, patient safety seems out of reach. In order to catch a practical strategy to reduce the nursing error; this research evaluated the incidence and disclosure of nursing errors and their predisposing factors in critical care units. A descriptive- analytical study was conducted in critical care units: ICU, CCU & hemodialysis from 3 educational hospitals in Urmia city. A sample oftwo hundred-two nurseswas selected by census method for this study. Data were collected by questionnaire and analyzed by descriptive and inferential statistics by using Statistical Program for the Social Science (SPSS 16. 0) for windows. The results indicated that the majority of nurses were female (86. 6% female). The average age was 32. 2±4 year, and the average work experience was 8. 4±4. 7 year, while the average experience in critical care units was 3. 7±2. 6 year. Our data showed that from nurse’s view point, different factors in domains of management, team working, environment and education were considered to be predisposing factors of nursing errors. Also, there were a statistically significant difference between nurse’s view point with different ages and experiences. Regarding to the importance of different factors in domain of management, teamwork, environment and education; we should have evidence base knowledge; and practical strategy to decrease nursing error.

the aim of this study was awareness of women which were refer to family planning and kowsar center in Urmia about emergency contraception. this prospective and cross sectional study was carry out in family planning and Kowsar center of Urmia Medical Sciences University in West-Azarbayjan in 2008 via 2009. A questioners were filled by medical students and demographic characteristic such as age, education, marital duration, parity and history of unwanted pregnancy.Questions about type, effectiveness, previous using and source of their information about Emergency contraception were written.Awareness were divided to good (score ≥ 20), moderate (score 7-19) and poor (score ≤6). P - value was considered significant if ≤0.05. The study comprised of 600 women. mean age of them and marital age were 29.8 ±7.2 and 19.7 ±3.2, respectively. The mean parity was 2.2 ± 1.6.88.8 % had poor, 9.8% intermediate and 1.8% good awareness about EC. Awareness was positive related to academic education, history of unwanted pregnancy and didnt related to age, duration of married and parity. Awareness of ECn in our study was very poor, So education of women is very important.

The critical requirement of healthcare services on information and also disabilities of paper chart to meet these serious needs has been caused to increase trend to use of the Hospital Information Systems (HIS). The goal of this research is to determine advantages and disadvantages of HIS. This descriptive cross-sectional study was conducted in 2011.The study sample selected by multistage cluster sampling method andconsisted of 160 HIS users from teaching hospitals ofUrmia University of Medical Sciences. Data collected by using a self-structured questionnaire that reliability of which had been measured by specialists and validity evaluated by internal consistency method. Collected data analyzed by SPSS software descriptive statistics and analytical statistics (t-test and chi-square). Maximum mean of scale in advantage of HIS related to the promotion of healthcare quality (4/55 from 5) and better accessibility to accuracy information (4/42 from 5).Maximum mean of scale in disadvantage of HIS related to the new skills acquisition (3/82 from 5) and high costly (3/48 from 5). The results of the present study demonstrate that, for building a successful hospital information system, users must be acquired sufficient training to increase their skills and knowledge in order to utilize of that system and an appropriately support should also be organized to maintain and promotion of system.

high quality of work life (QWL) is known as basic prerequisite for empowering human resources in health system. While nurses have a significant position in health organizations’ success their clinical competencies play an important role for their proficiency-which recently has been criticized-. Sounderstandingclinical competency determinants and its promotion is considerable for health care and medical educational systems at all times. As research studies’ involving this issue seems rare in our country, we aimed toseek for the relationship betweennurse's quality of work life andtheir clinical competency. This descriptive –correlation study was conducted with a multi stage random sample of 136 nurses working in hospitals of Urmiauniversity of medical sciences. Data were collected through self- administered questionnaire including demographic characteristics, QWL based on Brooks and clinical competence scale Mertoja Rita. The information was analyzed by non parametric spearman correlation andchi -square test by using Statistical Program for the Social Science (SPSS 16.0) for windows. Our findings showed a weak correlation between QWL and level of nurses’clinical competency (r= 0/245, p= <0/004). But a significant relationship (p=0/041) has been showed between these two indices by cross tabulation with x2= 4/579. The results of this study indicated that desired levels of quality of work life could lead to the clinical competency development. Health systems and nursing managers should apply the appropriate strategies to promote nurse's QWL and provide proper facilities for improving the quality of care and clinical competency of nurses.

Justice in an organization symbolizes equity and consideration of ethical behavior in an organization. Numerous studies have shown that increase of justice perception affects different aspects of organizational behavior. The purpose of this research is to study the relationship between perception of organizational justice with turnover intention, job satisfaction and organizational citizenship behavior among the medical staff of Urmia Imam Reza hospital. The methodology of the correlative-descriptive study was followed. The study population consisted of all medical staff of Urmia Imam Reza hospital including 462 persons among whom 209 persons were randomly selected as sample size, based on Cohen, Morgan and Krejcie's formula. In order to collect data on organizational justice, turnover intention, job satisfaction and organizational citizenship behavior variables; Nihoff and Mormman's (1993), Cammann's (1979), lucas (1990) and Podsakoff’s (2000) questionnaires were used, respectively. Data analysis was performed using Pearson correlation test, analysis of variance test and step wise multiple regression method. This study indicated that there was a significant positive relationship between perception of justice with job satisfaction (p=0/000 & r=0/533) and organizational citizenship behavior (p=0/000 & r=0/248), also there was a significant negative relationship between perception of justice and turnover intention (p<0/05 & r= -0/164). The obtained results from multiple regression showed that among three components of organizational justice, distributive justice and interactional justice were significant in predicting job satisfaction(R=0/626 & R*=0/392) and procedural justice and interactional justice were significant in predicting organizational citizenship behavior(R=0/491 & R*=0/241). Interactional justice was only about three percent significant in predicting turnover intention(R= -0/16 & R*=0/03). The mediator role of job satisfaction variable in relationship between organizational justice and organizational citizenship behavior and turnover intention was not confirmed. The results of our study give us an understanding of the role of different aspects of justice in job satisfaction, organizational citizenship behavior and turnover intention. Understanding of this issue will be helpful for managers to take appropriate actions for improving the perception of justice in their organizations.

greater than 75% patient that hospitalized in intensive care units has anemia. Blood transfusion in icu is not recently and about 40-70% patients in intensive cares receive transfusion. blood transfusion is not safety and many of patients that received transfusion have some serious side effects. Therefore to decrease such unwanted events there are some limits in blood transfusion. Because there is no decreased in o2 extraction until hemoglobin above 9 gr/dl. Therefore it seem the o2 extraction is the best categorized to blood transfusion need evaluation. in this study we want to determine the effect of blood transfusion on tissue o2 extraction in intensive care patients. 30 non cardiac and active bleeding intensive care patients that has ordered blood transfusion by physician were selected. before and I hour after transfusion the veinuos and arterial samples obtained to determine Sao2, Svo2 and Hg. And then datas were analysed. the study showed that hemoglobin level and arterial o2 content (Cao2) has increased in all patients after transfusion. In 66/66% the o2 extraction decreased after transfusion and in 26/66% patient it elevated. There was no significant correlation between hemoglobin level and o2 extraction after transfusion. although there was significant correlation between Hg and o2 extraction before blood transfusion it was losedafter transfusion that similar studies are needed. It seems that the o2 extraction was decreased after transfusion without related to Hg levels. In order to evalution intensive patients need to blood transfusion, Hg and o2 extraction levels must be insighted together by nurses and physicians.

Delayed gastric emptying among mechanically ventilated patients is common. According to evidence ginger can be accelerated gastric emptying. This study conducted to determine the effect of a ginger extract on gastric residual volume of patients hospitalized in Intensive Care Unit (ICU). This study was a double-blind randomized control clinical trial with before and after design. Twenty-four mechanically ventilated patients who hospitalized in ICU were enrolled into intervention and control groups (12 in each group). Patients were matched in items of gender and illness severity. After 48 hours gavage feeding with a standard solution among two groups; intervention and control groups respectively received 120 mg (5ml) of ginger extract and 5 ml of water as a placebo for 4 days. Residual volumes of the fifth and sixth days were recorded. Data analysis was performed using independent t-test and paired t test also significance level was determined as 0. 05. Mean gastric residual volume in first 48 hours between both groups was not significantly different. But mean and standard deviation of mean residual volume of fifth and sixth days in intervention and control groups were respectively (81/16 ± 58/24) and (09/15 ± 33/108) whichaccording the independent t test, showed significant difference (p <0.0001). Results showed that ginger extract reduces gastric residual volume compared with placebo in mechanically ventilated patients who hospitalized in ICU.

Diabetes is a chronic and disabling disease. In diabetes, self-caring promotes the quality of life and reduces the number of hospitalization and with continuous of its pursuit, the acute and chronic side effects can be prevented. Self- efficacy is a basis to reinforce of self-caring in diabetes. The purpose of this study is assessment of relationship between perceived self-efficacy and self-care in diabetic patients. This descriptive-analytical study was performed on 100 diabetic patients who referred to EmamKhomeiny Hospital, Urmia. They were selected by easy sampling. Data collection tools were demographic information, self-efficacy assessment using Confidence in Diabetes Self- Care Scale (CIDS) and self-care scale evaluation using Glasgow and Toobert measures for diabetes. Data analysis was performed by SPSS. Results indicated that average score of self-efficacy among patients was 73.8± 18.3 and the average score of self-care was 83.9±16.2. The most of the patients had an average score of self-efficacy and self-care. The spearman correlation coefficient showed a direct significant relationship between self-efficacy and self-care scores of patients. Patients’ beliefs about self-efficacy to the implementation of self-care and performing self-care behaviors were in medium rate. Since self-efficacy is the most important element to determine of self-care behaviors, it is necessary to promote the self-efficacy for increasing the self-care behaviors and consequently, prevention of side effects of diabetes. Therefore educational program on self-efficacy for improving this skill among diabetic patients should be considered.

The transition from nursing student to clinical nursing is a major challenge.The aim of this study was to clarify concept of transition in new graduate nursing, understand and identify its attributes, antecedents and consequences in nursing context. Rodger's evolutionary concept analysis method was used to facilitate clarification of transition concept in nursing. The search, performed on scientific databases using the keywords: ' transition', 'nursing student' and ' new graduate nurse' covering the period 1999 to 2010 represented concerning nursing. Search limited to english-language articles and the full text and all research and review articles were compiled. After applying the inclusion and exclusion criteria, a total of 30 articles included for the final analysis. The process was audited by one independent expert to ensure neutrality and credibility of the study and to reduce the potentials for bias. This study showed that the concept of transition has five basic and global properties: process, disconnectedness, personal perception, awareness, and human responsepatterns. Thisconcepthasalsopositive &negative consequences.Positive consequences of transition in novice nurses are from felt empowerment and more power to promote quality of patient care and increased cost -effectiveness. Negative consequences are anxiety, separation, incompetence to job dissatisfaction, decreased quality of patient care. Transition is a multidimensional and complex concept. Transition is also a dynamic concept. This analysis identified characteristics of transition concept, but the dimensions of this concept still require to further analysis.

Adjustment and its different aspects is considered as a basic and extensive discussions in psychology, therefore identifying of related factors –apart from increasing domains of related knowledge – can cause a reduction in the individual and inter individual problems. The aim of present research was to investigate the relationship between types of thinking style and academic adjustment. This research was a descriptive and co relational study. The sample study was included 65 nursing students who were studied in Islamic Azad University, khoy city. The study was conducted using the cluster sampling method within each cluster units were then chosen bysimple random sampling. To gather the data, two standard questionnaires on thinking styles of Strenberg and Zang and academic adjustment of Baker and Siryak were used. Gathered data were analyzed by statistical methods of correlation test of person and multiple regressions. The results showed that thinking style of judiciary, executive, hierarchy, liberalism, external and the style of the type I had positive significant relationship and thinking style of anarchism had negative significant relationship with academic adjustment.In addition %20.4 of variance academic adjustment based on thinking style was explicable. It was also evident that, there were average high score of academic adjustment among nursing students in this study. Based on our research academic adjustment has relationship with the kind of thinking. Therefore it seems necessary to notice on the typeI thinking style for improvement and promotion of the academic adjustment among nursing students.

Perineal trauma is common outcome of vaginal birth, and can cause short term and long term problems for new mothers. The aim of this study was to determine the effectiveness of physical therapy techniques during child birth on severity and degree ofperineal ruptures and also its effect on the amount of stitches required for perineal repair following perineal trauma in nulliparous women. This randomized clinical trial study (RCT) carried out on 120 nulliparous women that expecting normal birth of singletonfetuses; they were randomly selected and divided into three groups; two physical therapy techniques (warm compresses and massage perineal) and one control groups (40 women for each group). All processes have done during the second stage of labor. Midwife held a clean, wash and warm cloths to the mother’s perineum and her external genitalia for the warm compress group, during and between pushes. Woman in the massage group received massage and stretching of the perineum with each contraction. In the control group, women received Ritgen's maneuver, routine and standard care for the second stage of labor. The data have been analyzed with descriptive statistical methods, Anova, chi-square test and non parametric test, Kruskal -Wallis, using SPSS 15/0 (p<0/05 was significant). Our finding indicated that there were not any significant differences regarding to the severity and degree ofperineal ruptures (p= 0/513), the rate of the lacerations in the anterior perineal region (p=0/134) and the amount of stitches required for perineal repair (p=0/775) among three groups. The practice of the physical therapy techniques in the second stage of labor cannot probably prevent from perineal trauma.

Cardiac arrhythmia is one of the most common cardio-vascular diseases and pacemaker is a curative method which reduces most of problems in patients with arrhythmia. In spite of benefits of pacemaker, it may lead to some complications such as physical and psychological problems that can affect patients’ quality of life. Thusfollow up is necessary for pacemaker users after discharge. The aim of this study was to detect effects of nurse-led group educational sessions on the different dimensions of quality of lifeamong patients with implanted pacemakers. In this clinical trial study sixty patients with pacemaker implantation divided into two groups. Case group patients participated in the group educational sessions while participants in the control group receivedtheir routine care (educational material) for four weeks. We used Assessment of Quality of Life (AQOL) and Short Form Questionnaire (SF36) for assessing the quality of life and semi structure interview was used for data collection. Data were analyzed using Statistical Program for the Social Science (SPSS 13.0) for windows. Independent and Paired-T test also Fisher test analyses were used in this study. Alpha was set at p<0.05 for all data analyses. Prior to the intervention, mean quality of life scores was same between two groups [(57/44 ± 19/27 for intervention group and 52/23 ± 15/84 for control group), p=0/20]. After 4 weeks intervention independent-t-test showed a significant differences among the mean scores between two groups in all aspects of quality of life [76/19 ± 15/62 for intervention group and 54/11 ± 14/86 for control group, (p<0/001)]. Our results confirmed the effect of group educational session to improve the different aspects of quality of life among patients with implanted pacemakers. Consequently employing post-dischargegroup educational session can improve the quality of life among these patients as a cost effectiveness method.

Multiple sclerosis (MS) is one of the most common diseases of the central nervous system. MS is the result of damage to myelin. There is the exact relationship between stress and the onset or progression of MS so stress management is important in MS patients. This study intended toinvestigatethe effect of stress management educational program based on Basnef model to improve behavior in MS patients. This was a quasi-experimental study that was performed on 100 MS patients between the ages of 15-50 years from Sina and Shariati hospitals, Tehran. Participants in the study randomly divided into two groups: experimental and control groups.The instruments for data collecting were a questionnaire which was developed by the researcher and established based on the Basnef model. The both groupscompleted the questionnaires before and one month after intervention, while only the patients in the experimental group participated in 3 educational intervention sessions. Eventually, the data were analyzed by using independent-t, chi-square and mann-whitney statistical tests. Our findings indicated that both groups didn’t have any significant difference based on Basnef model variables (attitudes, subjective norm, enabling factors, and intention) before intervention. But the mean scores of Basnef model variables were significantly increased in the experimental group compared to the controls after intervention. Also behavioral methods of stress managementimproved significantly among the experimental group, compared to control group. Since stress management is highly recommended for MS patients, applying the Basnef model is very effective for developing an educational program for MS patients in order to control their stress.

The copper bearing intrauterine device (IUD) is a long-term, reversible contraception method that is as effective as tubal sterilization. Its insertion pain or fear of it may make women hesitate to use an IUD. This study aimed to determine the effect of lidocaine gel on pain from copper IUD insertion. This study was done among 96 women at a health center in Tabriz. The subjects were allocated into three groups using random blocking with 6 and 9 block sizes considering allocation concealment. Inone group, lidocaine 2% gel and in the second, lubricant gel was placed in the cervical canal by a sterile swab one minute before IUD insertion and the third group got no intervention. IUD inserter was blind for the gels used and subjects and the pain assessor were blind for intervention. One expert midwife inserted all the IUDs. Immediately after IUD insertion, pain during the insertion was measured using 0-10 cm visual analogue scale, with the value of 10 meaning ‘‘worst imaginable pain.’’One way ANOVA, Kruskal-Wallis, unpaired t-test, Mann-Whitney and linear regression in SPSS-13 were used to identify effect of lidocaine gel on the pain. Overall, the mean pain score was 3.5±1.8. In univariate analysis, there was no significant difference in pain scores between three groups. Comparison of frequencies and univariate analysis showed difference in some possible confounding factors between the groups. Results of linear regression model by controlling effect of the possible confounding factors including history of vaginal delivery, interval from the last delivery, situation of lactation, history of IUD insertion and the interval of cervix wash and pain assessment showed no significant effect of lidocaine gel on the insertion pain. The mean pain score in the lidocaine group was 0.39 less than in the control group but it was no significant (CI 95% of the difference: -1.3, 0.57). Use of 2% lidocaine gel and also use of lubricant gel into the cervical canal, one minute before putting on cervical tenaculum, has no effect on reducing overall pain during IUD insertion.

According to reports, intimate partner violence is a serious threat to public health. While the most of therapies focus on the victims, it seems necessary to study viable therapies for offenders. To survey the effectiveness of dialectical behavioral therapy with a religiosity approach on intimate partner violence, 38 men who had committed physical violence against their partners were assessed in a randomized controlled trial. Blocking randomized allocation was used to divide the sample study into intervention and comparison groups. The therapy used in the intervention group was dialectical behavioral with religiosity approach. Cognitive therapy was used for the comparison group. Violence and religiosity has marked two months before and after treatment with a validated intimate partner violence questionnaire of Iran Medical University and modified religiosity project scale of Boston University. According to this study dialectical behavioral therapy with religiosity approach in treatment of physical or psychic violence is more effective than cognitive therapy (p=0.018 for physical violence and p=0.011 for psychic violence). Our results have also shown that religiosity has a negative correlation with intimate partner violence. Dialectical behavioral therapy with religiosity approach should be considered as the effectual method for treatment of intimate partner violence. Religion has a strong influence on preventing of violence among partner.

Mothers are the firstattentive for infants, any factor may have impact on mother health, will affect wellbeing of infantandconsequently community health. The aim of this research was to identify the effect of post partum home care on mothers’ practices in infant care. This randomized, controlled clinical trial study was conducted at a health center in Tehran city in 2011. The sample study included 200 mothers who had attended to Akbar Abad health care center with the purpose of screening test for their infants. They were equally randomized into two case and control groups (100 in each group).Control group mothers received second and third post partum care in health care center while case group received their post partum cares at their home. Data collection tools were questionnaire, checklist, growthcharts, barometers, babyscales, thermometers and meters. The questionnaire was aboutdemographic information of participantsand the quality of mothers’ practices in infant care. Data were analyzed by descriptive and inferential statistics (Chi-square tests, Mann-WhitneyandWilcoxon) by usingSPSS 18.0and data with p<0.05 were significant. In this study the most of mothers were aged 20-29 years old(59%).After intervention, averagescores of maternal practices in infant care was statistically different (for homevisitgroup 11.59±2.00 andcontrols 9.58±2.28, p<0.001). Maternal practices between two groups was statistically different in dimensions of breastfeeding, care of cord, supplementation, pacifieruse and exposure tocigarette, but in Swaddling and milk complement use w as not statistically different. Postpartum home care has positive effect on maternal practices in infant care. So, post partum health care is recommended to health care providers.

To reach a holistic approach for treating patients, being familiar with patient's perception of their own health be an important matter. This study was carried out to determine the meaning of health from the viewpoint of diabetic women. The study was conducted using the qualitative phenomenology method. 22 diabetic women who were suffering from type 2 diabetes for at least one year and were willing to express their experiences were selected employing purposive sampling technique. Data were collected with the use of semi-structured interviews. All interview were tape recorded and transcribed verbatim and were analysed simultaneously with the Van Manen method. The patient's perspectives of their health introduced health as a multi-dimensional phenomenon which was divided into four groups of physical, psychological, sociological and spiritual dimensions. All the groups were closely connected, however the psychological and spiritual aspects were considered more important. Most of the responses in the physical dimension were related to having independence. Feeling comfort and happiness was one of the main points in the psychological dimension and in the spiritual aspect; disease as Gods will had an important role in the answers. In this study, participants reported health as not just feeling physically healthy. The attention of the patients towards other health dimensions especially psychological and spiritual aspects shown that if patients are not feeling physically healthy, intervention the other dimensions of health could help for improving the physical aspect as well as all the other aspects of health.