نشریه پرستاری ایران
پیاپی 77 (شهریور 1391)

Some patients with diabetes do not follow the foot care recommendations. Methods of patient education may affect the rate of compliance and ulcer healing. The present study aimed to compare the effects of teaching by lecture and multimodal method on compliance with foot care recommendations and healing of diabetic foot ulcers in kashan city، during 2011. A controlled clinical trial was conducted on three groups (n=60) (including teaching by lecture، teaching by multimodal method، and control group) of diabetic patients with foot ulcers who had been referred to the Kashan''s Beheshti hospital. The two intervention groups were taught by similar content. After three months، the surface and the depth of ulcers and the patients’ rate of compliance with recommendations were evaluated (by observing the ulcers and using a daily foot care checklist). Data analysis was done by t-test، paired t test، ANOVA، ANCOVA and Chi-square using SPSS-PC (v. 11. 5). (Trial Registration Number: IRCT138901143618N1) Ulcers surface and depth were significantly decreased in all groups after the intervention (p<0. 05). However the decrease was more prominent in educated groups and especially in multimodal group. The mean score for compliance with foot care recommendations was 66. 4±9. 3 in lecture group and 79. 6±7. 4 in the multimodal group (p=0. 009). It is recommended that multimodal patient teaching be integrated in the health care system to empower the diabetic patients to manage their own foot ulcers. Repeating the study considering other factors affecting the healing of foot ulcers is also suggested.

Given the high cost of medical treatment to control the symptoms of Multiple Sclerosis (MS) and the resulted numerous complications، the use of complementary therapy has been increased by these patients. This study aims to determine the status of complimentary therapy in patients with MS who refer to MS Association in Tehran in 2008. It was a descriptive cross- sectional study. Two hundred patients with MS were recruited by convenience sampling. Data was collected by a researcher made questionnaire using face-to-face interviews and analyzed by descriptive and inferential (Chi-square and ANOVA) statistics using SPSS-PC (v. 11. 5). More than half of sample (60%) has used complimentary therapy. All of them had used non-pharmacological treatment as a supplement and not as a replacement to therapy. The most frequently used methods were exercise، meditation، nutrition therapy، herbal medicines، energy therapy، acupuncture and acupressure respectively. The results also showed that the majority of participants (44/5%) have used one non-pharmacological method and just 11. 5% have used two methods or more. The findings showed that there is o significant relationship between using complimentary therapy and demographic characteristics of patients except for educational level (P=0/04). Regarding the widespread use of complementary therapy by patients with MS، these patients are exposed to potential risks and side effects of the treatments. So it is recommended that patients be provided with necessary training. Doing more research on the methods of complimentary therapy and assessment of the reasons for tendency to this type of treatment is also recommended.

Obesity which is produced due to excessive accumulation of fat in body compartments could result from imbalance between intake and consumption of energy and is related to the food habits of each person. The aim of this study was to assess obesity and its relationship with female adolescents’ food habits in Tehran. It was a predictive correlational study. The sample consisted of 385، 14-18 year old female students in west of Tehran. The students were recruited by multistage random sampling. Data was collected by Food Frequency Questionnaire، caliper، tape measure and measurement scale and analyzed by ANOVA، Pierson correlation and multiple regression tests using SPSS-PC (v. 14). According to the findings، %18 of the students were overweight and obese based on Triceps skin fold thickness and %15 were overweight and obese based on body mass index. Frequency of daily consumption of bread and cereals، rice، fat، soft drinks and egg among overweight and obese students were significantly higher than other groups (p<0. 05). Due to the high consumption of unhealthy food among overweight and obese girls the prevalence of chronic diseases associated with obesity in the future is disturbing. Therefore، promotion of healthy nutrition and health education in schools and families by those involved in the health sector particularly community health nurses seem to be necessary.

Although surgery as a means of therapy is used today and saves many patients’ lives but it has also some complications. One of its most important psychological complications is preoperative anxiety. The aim of this study was to determine the effect of nursing process based care on patients'' anxiety of candidates for women’s elective surgery.

Using a randomized clinical trial، 60 candidates for women’s elective surgery in kosar hospital of Qazvin city were randomly assigned to either control or experimental groups. The experimental group was assessed based on nursing process after admission. If any nursing diagnoses including anxiety، knowledge deficit، or fear were found، then the required training was provided to the patients. The control group just received routine care. Data was collected using Amsterdam Preoperative Anxiety and Information Scale (APAIS) and a laboratory test for measurement of serum cortisol level. Data analysis was performed by descriptive and inferential statistics (Chi-square test، fisher’s exact test، paired t test، independent t test، Wilcoxon and Pearson correlation) using SPSS-PC (v. 17).

Paired t test results showed that the mean score for preoperative anxiety in the experimental group (13. 6 ± 3. 3) compared to the time of admission (23. 33 ± 3. 6) has been significantly decreased (p= 0. 001، t= - 4. 7). Whereas the mean score for preoperative anxiety in the control group (23/4 ± 4. 28) compared to mean score of anxiety at admission time (17/03 ± 3. 96) had been increased (p=0. 001، t = -7. 39). Results of independent t test showed that the mean preoperative anxiety score in the experimental group was significantly less than control group (p=0. 001، t = -10. 3).

According to the results، nursing care based on nursing process as an effective and non pharmaceutical intervention can be recommended for reducing anxiety and concerns of these patients

Attachment styles of nurses as caregivers and members of healthcare teams and empathy as individuals'' basic capacity which contributes to the management of relationships، the supporting of communal activities، and insight to the quality of nurse-patient relationship; are therefore considered to be an important topic worth studying. This study examined the relationship between attachment styles and empathy in nursing students living in dormitories of Tehran University of Medical Sciences. A sample of 260 university students (130 males، 130 females) participated in this study. All participants completed the Attachment Style Questionnaire (ASQ)، and the Interpersonal Reactivity Index (IRI). Data was collected and analyzed using Pearson correlation coefficient and regression analysis using SPSS (v. 18) The results showed that secure and insecure attachment styles had significant positive and negative correlation with empathy، respectively. The results of regression analysis revealed that secure attachment style is shown to be the predicting 67% of the variance of empathy variable; whereas anxiety attachment styles is shown to be the predicting 61% and avoidant attachment styles is shown to be the predicting 54% of the variance of empathy variable. Assessing attachment styles and relationship of attachment styles with empathy; can be valuable guidelines in order to provide mental health for nursing students. The meaning and limitation of this study and the suggestion for the further study are discussed.

The pain related to invasive procedures such as venipuncture، causes physical and psychological stress in children and therefore should be given relief. Methods that reduce the pain related to invasive procedures in children are among the major priorities in nursing profession. This study compared the effect of two methods of distraction and touch on pain in 5-10 years old children. It was a randomized clinical trial. One hundred and twenty children، hospitalized in education al hospitals affiliated to Tehran University of Medical Sciences were randomly assigned to three groups of bubble blowing، touch and control. The first group was encouraged to play with bubbles before and during venipuncture; the second group received touch peripheral to injection area before and during venipuncture and the third group received routine care. Immediately after injection، pain intensity was assessed by Wong-Baker faces scale. The data were analyzed by Chi-square، ANOVA، and Shefeh tests using SPSS-PC (v. 11). The findings showed that the mean score of pain intensity in bubble making group، touch group، and control group was 5. 77، 5. 95 and 8. 12 respectively. ANOVA test results showed that there is a significant difference between the mean score of pain intensity in control group and touch and bubble making groups (P=0. 00). No significant difference was found between the pain intensity of bubble making and touch groups (P=0. 89). Distraction and touch are effective methods for reducing injection pain in children. These procedures are among easy to use and practical nursing interventions that help children to cope with this common painful experience.

The concept of pharmaceutical care has been used and discussed with multiple definitions in the literature related to health care sciences and especially in pharmacology and pharmacotherapy. However، the use of this concept is not common in the nursing literature and it has not currently been used. This study has been done to analysis the concept of pharmaceutical care in order to clarify areas of agreement of this concept in nursing and pharmacology disciplines and identifying its attributes، antecedents and consequences. Rodgers'' evolutionary method of concept analysis was used to clarify the meaning of Pharmaceutical care. Data bases of Sciencedirect، Springer and Google scholar were searched to retrieve the related literature. The main criteria for entry were، the literature published in English language in the disciplines of nursing and health care sciences. Literature search was limited to 1990-2011 with the keywords of «Pharmaceutical care» and «Pharmaceutical service» in the title of texts. The initial search resulted in 932 texts، 197 of them deemed relevant to our analysis. Then 40 texts (20 percent of those) were selected and reviewed. In this study، the attributes of pharmaceutical care were identified in two categories of specialized skills and communication skills. Specialized skills included five attributes including the identification of drug problems، resolving the drug problems، treatment and palliative care، monitoring short-term results of treatment and reviewing proportionality of prescription for each patient. The communication skills included four attributes of consultation with the patient، emotional commitment to the welfare of patients، collaboration with the health care team and attention to the patient''s medical condition. The antecedents included professional and organizational factors، and the consequences were health care، economic، informational and qualitative outcomes. The findings show that in spite of failure to use the concept of pharmaceutical care in nursing literature independently، it is a significant aspect of clinical practice and overall patient care.

Although Pregnancy is a normal and pleasant event in women''s life، but it often involves psychological and behavioral changes and can result in stress، particularly in those women whom their pregnancies is occurred after infertility treatment. Accordingly this study aims to determine the anxiety level of the women whose pregnancies have occurred using Assisted Reproduction Technologies (ARTs) and its relationship with infertility and obstetrics factors. In this cross sectional study، a total number of 100 women whose pregnancies have occurred using ARTs referring to three infertility centers of Tehran were recruited by convenience sampling. Anxiety was measured by Beck Anxiety Inventory (BAI) and data related to infertility and obstetrics factors were collected by a researcher made questionnaire and was analyzed using SPSS-PC (v. 14) by chi-square and fisher test. The mean age of the sample was 33. 7±6. 8 and the mean marriage duration، gestational age، infertility duration، and the number of ARTs treatment failures was 8. 7±5. 1، 20. 1±10. 8، 7. 3 ±5. 3 and 1. 9±1. 6 respectively. The findings revealed that 34% of the subjects were suffering from anxiety. There were significant relationships between anxiety levels and infertility duration (P=0. 03) and also a history of treatment failure (P=0. 02). No significant relationship was found between anxiety and obstetrics factors. Infertility duration and a history of treatment failure were the two factors that affected the anxiety level during this kind of pregnancy. Accordingly these women are required to be under special considerations from the beginning of infertility diagnosis and also before، during and after pregnancy.