Iranian Journal Of Nursing and Midwifery Research
Volume:17 Issue: 3, Mar-Apr 2012

The purpose of this study was to describe the first attempts and performance of health system in Iran in training specialist nurses in the field of diabetes- related care and education. This was a qualitative content analysis. Three diabetes management planners in the Ministry of Health and Medical Education, three provincial executive authorities of diabetes in the health system and ten nurses who worked as diabetes nurse educators (DNEs) participated in this study. Data obtained through semi-structured face-to-face interviews, a focus group, existing documents, field notes, and multiple observations. Data analysis was guided by the conventional approach of qualitative content analysis. Three major themes and six sub-themes were emerged through data analysis. Main themes were: (a) decentralization diabetes nurse educator training without any management (stop education due to transition training responsibility to provincial health authorities and lack of supervision of managers on training); (b) try to reform nursing education infrastructures (try to train qualified educators who were candidate for teaching to DNEs, try to reform undergraduate nursing curriculum); (c) failure of DNE curriculum (lack of consistency between content and timing with the curriculum objectives and lack of attention to learn evaluation process). The findings of this study reflected the failure and multiple challenges in educating nurses working in diabetes units. Despite the fact that important roles were defined for nurses in the action plan for preventing and controlling diabetes, any specific action was not done in preparing nurses for these roles.

Spiritual well-being (SWB) of patients with cardiovascular diseases particularly in those admitted in coronary care unit (CCU) is threatened due to disease crisis. Therefore, implementing spiritual care is necessary for them. This study aimed to determine the effect of spiritual care program on SWB of patients with cardiac ischemia admitted in CCU in Al-Zahra Hospital, Isfahan, Iran. In a single blind randomized clinical trial, 64 ischemic patients in CCU were randomly divided into test and control groups. Spiritual care program included supportive presence, rituals and using supportive systems for 3 days. Spiritual Well-being Questionnaire were completed before and after the intervention for the both groups. Mean scores of SWB had no significant difference between the two groups before the intervention (p = 0.84). Mean score of existence dimension (p < 0.001) and mean total score of SWB (p < 0.001) in the test group showed a significant difference comparing before and after the intervention; however, it was not significant in the control group (p = 0.17). Mean existence dimension (p = 0.01) and mean total score SWB (p = 0.01) had a significant difference between test and control groups after the intervention; however, there was no significant difference in mean score of religious dimension between the two groups after the intervention (p = 0.25). The spiritual care program promoted the SWB of ischemic patients in existence dimension and overall score, and nurses can use these programs to promote patients’ SWB.

Considering the school nursing standards, which is the most important and vital element of the school health team, can be a fundamental step toward solving the current and future problems of the school and society health. The present research was done with the goal of determining the current situation of the standard of the school health nursing process in elementary schools of Kerman, Iran. The present research is a quantitative, descriptive study and was done between the years 2009 and 2010 through conducting an opinion poll. In this study, first the international standards of school nursing were searched and extracted from informational sources. Then, a questionnaire was designed based on the standards of the school nursing process and its related indicators in 6 areas. This questionnaire had two parts. The first part had the respondents’ demographic information, answering was optional, and the second part of the poll was about each of the indicators. After preparing the questionnaire and determining its validity and reliability, it was distributed among the 120 samples (60 health trainers and 60 of Kerman’s elementary school staff), and their opinions were gathered and analyzed through statistical–descriptive analysis. The results of this research demonstrate that approximately all the above mentioned standard areas in the country were applied (98%). The rate of acquiring the standard of nursing process was high (90%) in some areas (Investigative area) and low (30%) in some other areas (diagnosis area). In total, the rate of acquiring the majority of indicators of nursing process standards has an average percentage. It is suggested to use schools health professionals to raise the indicators of the standard of the school nursing process (the indicators which had low or average acquiring rate), and to raise the performance quality.

Since weight management is affected by various factors, including social and behavioral ones, this study aimed to explore the peoples’ experience of barriers and facilitators of weight management. This qualitative content analysis was conducted as the initial step of TABASSOM Study. Participants, who tried to reduce their weight at least once, were selected by purposeful sampling method from aerobic fitness clubs, parks, and public offices in Isfahan in 2010. Data saturation was reached after indepth unstructured interviews with 11 participants. Data analysis was done by conventional content analysis method. The participants have intermittently followed weight loss program. Barriers such as physical problems, lack of motivation, lack of work and family support and lack of time have resulted in their failures and outages. The main facilitator to start or restart after stopping such programs for a while was positive psychologic effect.Discussion and Findings showed that many problems could prevent weight loss. It is important to identify obstacles that hinder weight management and regimen programs and to discuss them with people before planning for their weight management.

One important factor in growth, progress, and increase in work efficiency of employees of any enterprise is to make considerable effort. Supreme leader of the Islamic Republic of Iran also addressed the issue of need for more efforts. The goal of this study was to determine the association of perceived organizational justice and organizational expectations with efforts of nurses to provide a suitable model. The current study was a descriptive study. The study group consists of all nurses who worked in hospitals of Isfahan. Due to some limitations all nurses of the special unit, surgery wards and operating room were questioned. The data collection tools were the Organizational Justice Questionnaire, organizational expectations questionnaire, and double effort questionnaire. Content validity of the mentioned questionnaires was confirmed after considering the experts’ comments. The reliability of these questionnaires, using the Cronbach’s alpha, were 0.79, 0.83 and 0.92, respectively. The Pearson correlation and the structural equation model were used for the analysis of data. There was a significant correlation between the perceived organizational justice and the double effort of nurses during the surgery of patients. Correlation of the expectation from job, usefulness of job, and its attractiveness with double effort of nurses before the surgery was also statistically significant. Moreover, it was shown that the root of the mean square error of estimation (RMSEA) was 0.087, the fitted goodness index (GFI) was 0.953, the value of chi-square was 268.5, and the model was statistically significant (p < 0.001). Today Justice is an essential need for human life and its importance in organizations and social life of individuals is evident.

Oral care plays an inevitable role in health and well-being of patients in intensive care units (ICUs). Poor oral care causes colonization of respiratory pathogens and secondary respiratory infections. Ventilator-associated pneumonia occurs in patients on mechanical ventilation for more than 48 hours. It results in prolonged duration of mechanical ventilation, mortality and health expenses. The present study aimed to review the effects of an oral care practice on the incidence of ventilator-associated pneumonia in patients on mechanical ventilation admitted in ICUs. This was a clinical trial study conducted in the ICUs of selected hospitals in Isfahan during 2010. We randomly divided 54 patients into the intervention and control groups. Intubation was performed during the 48 hours before the study. The intervention group received an oral care practice along with brushing and the control group received routine oral care twice daily. The incidence of ventilator-associated pneumonia was diagnosed through clinical pulmonary infection score (CPIS). The two groups were compared in terms of underlying criteria (APACHE-II). The incidence of ventilator-associated pneumonia did not statistically differ between the intervention and control groups (37% vs. 48.1%; p = 0.41). The results of the present study showed that brushing and standard oral care practice had no effects on ventilator-associated pneumonia. Therefore, the incidence of such complication might be affected by many different factors.

Health-related professionals are at high risk of job burnout which will in turn lead to effects on health services provision. The present study was conducted to define job burnout and its association with personal characteristics among the midwives working in Isfahan, Iran. This descriptive correlational study was performed on 193 midwives working in health centers and hospitals in Isfahan. The participants were selected through cluster random sampling. The data was collected by a researcher-made personal characteristics questionnaire as well as Maslach Burnout Inventory. The data was analyzed by descriptive and inferential statistical tests in SPSS. In the present study, the highest frequencies of job burnout dimensions were for the low levels of emotional exhaustion (58%) and depersonalization (65.8%), and high levels of personal performance (58%). There was a significant inverse association between age and depersonalization (p = 0.02). However, no significant relations were found between job burnout dimensions and variables of marital status, number of children, level of education, and residential status. Although the results of this research showed a low prevalence of job burnout among midwives, the stressful nature of midwifery as a profession necessitates educational intervent.

Confrontation with the consequences of diabetes causes a crisis in physical, mental, and spiritual dimensions. Sometimes the spiritual crisis can be tremendous. Since spiritual health coordinates different aspects of human life, this study aimed to identify the spiritual health of patients with defects caused by diabetes. This was a qualitative-phenomenological and descriptive study and the participants were selected from rehabilitation centers in Isfahan and Valiasr Hospital in Zanjan. A purposive sample of 15 participants underwent deep interviews. Colaizzi’s method of analysis was used to analyze the data. outcome of this phase of the study was 173 codes and 2 groups that included hindering factors in spiritual health and the promotion of the relation with God. The concepts that patients had experienced as hindering factors of the treatment process were disappointment and hopelessness, guilt, feeling distant from God, quitting obligatory acts and knowing God as cruel. The concepts that patients had experienced as contributing factors to the healing process were resorting to Imams, God’s ordering the disease as a reward, fear of God’s punishment, believing in miracles, being closer to God, believing in the mercy of God, returning to religious practice, feeling of enjoying life and knowing that the disease is the atonement of sins. With regard to the importance of spiritual and religious care as one of the tasks of nurses, as the key members of health team, they should respect the patients’ beliefs and values in addition to considering their physical and mental conditions.

Various studies show an association between lack of social skills in adolescents and the future incidence of behavioral disorders. If girls, as future mothers, lack adequate health, awareness, self confidence and social skills, they may act as a source of many social problems. Therefore, the present study has tried to educate this group on one of the most essential social skills, refusal skill in high risk situation. This is a field quasi experimental study conducted on 145 female students in middle schools in Arak, Iran in 2010-2011. The schools were randomly selected. The subjects were selected through systematic random sampling from the schools’ log book. The data were collected by questionnaires containing personal and familial characteristics, three health belief model structures, and behavioral intention in high risk situations. The data were analyzed by descriptive statistical tests (frequency distribution, mean, SD) and inferential tests of repetitive variance analysis and T-test through SPSS. In the present study, repetitive variance analysis showed that education by use of a health belief model had a positive effect on refusal skills in high risk situations as well as perceived barriers (p = 0.007), self-efficacy(p = 0.015), behavioral intention (p = 0.048) after educational intervention in the study group, but not on perceived benefits (p = 0.180). The results showed that education significantly increased refusal skills in high risk situations in the study group through the health belief model. With regard to the results, it is essential to equip the students with preventive behaviors to guarantee their physical, emotional and social health.

None of the contraceptive methods are fully side-effect free. One of the side effects that commonly causes discontinuation is mood changes and depression. The present study aimed to compare the depression between contraceptive methods including low-dose estrogen (LD) combined pills, condom and intrauterine devices (IUD). In a cross-sectional study, 216 women were selected through systematic random sampling from 10 health care center sin Isfahan in 2011. Beck Depression Inventory II was used and individual productivity characteristics were asked. Validity and reliability of Beck depression inventory have been repeatedly confirmed in Iran. Content validity the productivity characteristics questionnaire was confirmed and its reliability was measured through Cronbach’s alpha correlation coefficient (calculated as 0.71). ANOVA, covariance analysis and logistic regression were used to analyze the data. Depression was observed in 47.8% of participants; however, there was no difference between mean score of depression in the users of three contraceptive methods. The findings of this study showed that depression is not correlated with family planning type and fear of depression should not be an obstacle to choose between these methods. Depression is a multifactor issue. This study showed that type of family planning method in itself cannot be the cause of depression and family planners and consultants should consider this.

Humans have been involved with the phenomena of pain and pain relief from the ancient times. Back pain is the most common pain. In fact, eight out of ten people experience it in their lifetime. However, individuals with specific jobs, including nurses, are faced with this problem more. Nursing is in the top ten careers suffering from the most severe musculoskeletal injuries. There are non-pharmacologic and pharmacologic treatments to relieve back pain. One of the non-medical treatments of pain is called reflexology which is a branch of complementary and alternative therapies. This research has been conducted to investigate the effect of reflexology on chronic low back pain intensity. This study was a double-blind clinical trial. The study population consisted of 50 female and male nurses suffering from chronic low back pain working in hospitals affiliated with Isfahan University of Medical Sciences. The participants were divided into two groups of reflexology and non-specific massage. A questionnaire was completed through interviews and a 40 minute sessions of interventions were performed three times a week for two weeks. Pain intensity was measured by Numerical Analogue Scale for pain before and after the intervention. Descriptive and inferential statistics, including independent t-test and chi-square test, were used to analyze the data. The results showed a significantly higher reduction in pain intensity scores in the reflexology group after the intervention as compared with the non-specific massage group. However, the non-specific massage was also significantly effective in reducing pain. Reflexology can be effective in reducing the severity of chronic back pain, i.e. it is able to reduce pain from moderate to mild. Thus, this technique is recommended to be performed by nurses as a complementary therapy in patient care.

Iran is one of the countries that has ratified the World Health Organization Framework Convention of Tobacco Control (WHO-FCTC), and has implemented a series of tobacco control interventions including the Comprehensive Tobacco Control Law. Enforcement of this legislation and assessment of its outcome requires a dedicated evaluation system. This study aimed to develop a generic model to evaluate the implementation of the Comprehensive Tobacco Control Law in Iran that was provided based on WHO-FCTC articles. Using a grounded theory approach, qualitative data were collected from 265 subjects in individual interviews and focus group discussions with policymakers who designed the legislation, key stakeholders, and members of the target community. In addition, field observations data in supermarkets/shops, restaurants, teahouses and coffee shops were collected. Data were analyzed in two stages through conceptual theoretical coding. Overall, 617 open codes were extracted from the data into tables; 72 level-3 codes were retained from the level-2 code series. Using a Model Met paradigm, the relationships between the components of each paradigm were depicted graphically. The evaluation model entailed three levels, namely: short-term results, process evaluation and long-term results. Central concept of the process of evaluation is that enforcing the law influences a variety of internal and environmental factors including legislative changes. These factors will be examined during the process evaluation and context evaluation. The current model can be applicable for providing FCTC evaluation tools across other jurisdictions.