Iranian Journal Of Nursing and Midwifery Research
Volume:18 Issue: 3, Ma-Jun 2013

Overweight and obesity is becoming an increasingly prevalent problem in both developed and developing world, and is one of the most serious public health challenges of the 21st century. Although various studies demonstrated pediatric obesity‑related factors, but, due to its ongoing hazardous effects, researchers aimed to assess obesity‑related factors in school‑aged children in Rasht, Iran. This was a case–control study which was performed in eight primary schools of Rasht. A cluster sampling method was used to select 320 students including 80 in case (BMI ≥85th percentile for age and gender) and 240 in control group (BMI = 5th-85th percentile for age and gender). Data were collected by a scale, a tape meter, and a form which consisted of obesity‑related factors, and were analyzed by Chi‑square, Mann–Whitney, and stepwise multivariate regression tests in SPSS 19. Findings showed that the mean and standard deviation of birth weight (g) in case and control groups were 3671 ± 5.64 and 190 ± 5.46, respectively (P = 0.000). 82.5% of case and 92.9% of control group had exclusive breastfeeding for 4-6 months (P = 0.024). Also, multivariate regression analysis indicated that birth weight, age, exclusive breastfeeding, and frequency of meals have significant effects on body mass index (BMI). It seems that more accurate interventions for primordial prevention are essential to reduce childhood obesity risk factors, including promotion of pre‑pregnancy and prenatal care to have neonates who are appropriate for gestational age and also improving exclusive breastfeeding in the first 6 months of life. In addition, identifying children at risk for adolescent obesity provides physicians and midwives with an opportunity for earlier intervention with the goal of limiting the progression of abnormal weight gain.

Coronary angiography is recognized as the gold test for diagnosis of coronary artery diseases. Based on the literature review, little is known about patients’ expectations about this procedure. Understanding the patient’s expectations is an important way to achieve patient‑centered care. The purpose of this study was to explore the expectations of Iranian patients undergoing coronary angiography. This descriptive exploratory qualitative study was carried out between 2011 and 2012 in three hospitals in Shiraz, Iran, with a purposive sample of 15 patients (7 men and 8 women, about 28-70 years of age). Data were collected using semi‑structured interviews to explore the patients’ expectations. Interview data were analyzed using conventional qualitative content analysis approach. The interviews revealed that the participants had four main categories of expectations about coronary angiography. The patient’s expectations were those from angiography, from the treatment team, and the need for preparation of angiography, education, and training. In general, the results of this study revealed a new insight into the expectations of patients undergoing coronary angiography. Patient education and preparation should include information addressing the expectations. Moreover, an appropriate care program based on the patients’ expectations can promote the quality of care and satisfaction of patients.

Oral contraceptive pills are among the most popular contraceptive methods, but the fear of cancer and cardiovascular disease overshadows its continuous use among women. This study aimed to define the association between consumption patterns of combined oral contraceptives among women with breast cancer. This is an analytical case–control study conducted on 175 women with breast cancer, referring to Seyed al Shohada Medical Center and private clinics in Isfahan to be treated and followed up in 2011, as well as 350 healthy women who were identical with the subjects in the study group regarding age and residential location. The data were collected using a researcher‑made questionnaire. Content validity and Cronbach’s alpha were employed to confirm validity and scientific reliability of the questionnaire, respectively. The data were analyzed by descriptive and analytical statistical methods through SPSS. The findings showed that there was a significant association between history of contraceptive pills’ consumption and incidence of breast cancer (P < 0.001). It was shown that the risk of developing breast cancer is increased by 2.27‑fold among those with pills’ consumption compared to those with no history of that. It was also shown that pills’ consumption for 36-72 months increased the risk of breast cancer by 2.18‑fold, the age of the first use being less than 20 years increased the risk by 3.28‑fold, and time since the last use of less than 25 years increased the risk by 2.63‑fold. There was no significant association between duration of use, age of the first and last use, and time since the first and last use in the study and control groups. The results showed that history of pills’ consumption is associated with incidence of breast cancer regardless of the consumption pattern. Use of oral contraceptives pills at any age and for any duration can increase the risk of breast cancer.

Following professional standards is the main concern of all managers in organizations. The functions of nurses are essential for both productivity and improving health organizations. In human resources management, supporting nursing profession is of ultimate importance. However, nurses’ experiences of perceived support, which are affected by various factors in workplace, have not been clearly explained yet. Thus, this study aimed to explain nurses’ experiences of perceived support and their contributing factors. This study is a qualitative research in which 12 nurses were selected through purposive sampling among nurses in university hospitals affiliated to University of Medical Sciences, Urmia, Iran, during 2011-2012. Data collection was conducted through deep interviews with semi‑structural questions. All interviews were first recorded and then transcribed. Finally, data were analyzed through conventional content analysis. The four main themes indicated that nurses experienced their workplace as non‑supportive. Themes such as poor organizational climate, low social dignity, poor work conditions, and managers’ ignorance to individual and professional values were considered as inhibitory factors to support. Nursing managers can promote nurses’ positive support perceptions through recognizing inhibitory factors and applying fair solutions and take benefits of their positive consequences including high efficacy, self‑esteem, and organizational commitment to promote the quality of care.

Coronary artery diseases are one of the most important issues in health and social problems. One of the amendable risk factors in development of these diseases is high cholesterol which can be modified through correction of lifestyle (diet change, playing sports, and usage of lipid‑lowering drugs). Patients’ compliance to therapeutic programs is the most important element to achieve this goal. This study aims to define the factors associated with compliance to medications among hyperlipidemic patients. This is a descriptive analytical study conducted on 82 hyperlipidemic patients. The data were collected by a questionnaire including two sections: The first section was about demographic characteristics and the second section contained a questionnaire extracted from Foley questionnaire (2005) to inquire medication compliance. The data were analyzed by descriptive statistics (mean), Pearson Spearman correlation coefficients, and independent t‑test. Based on the findings, it was evident that most of the hyperlipidemic individuals were compliant. There was a significant association between scores of medication compliance and age (P = 0.035), the number of family members (P = 0.033), the number of consumed drugs (P = 0.022), and education (P < 0.001). The results obtained in the present study were consistent with those of other studies reporting high compliance to medication among hyperlipidemic patients and possibly are one of the reasons for the low number of consumed drugs.Since compliance was lower among the individuals with increased age, lesser number of family members, and lesser education, these groups should be supported to promote their level of compliance to medication orders, and this important issue should be included in their educational programs.

Over the years, the concept technology has modified, especially from the viewpoint of the development of scientific knowledge as well as the philosophical and artistic aspects. However, the concept of technology in nursing are still poorly understood. Only small qualitative studies, especially in Iran, have investigated this phenomenon and they just are about information technology. The aim of this study is to gain a better understanding of the concept of technology in the view of Iranian nurses. This study was qualitative explorative study which was done with a purposeful sampling of 23 nurses (staffs, supervisors and chief nurse managers) working in Isfahan hospitals. Unstructured interviews were including 13 individual interviews and 2 focused‑group interviews. In addition to this, filed notes and memos were used in data collection. After this data transcribing was done and then conventional content analysis was used for data coding and classification. The results showed that there are various definitions for technology among nurses. In the view of nurses, technology means using new equipment, computers, information technology, etc). Data analysis revealed that nurses understand technology up to three main concepts: Change, Equipment and Knowledge. In deep overview on categories, we found that the most important concept about technology in nursing perspective is equipment. Therefore, it is necessary to develop deep understanding about the possible concepts technology among nurses. We suppose that technology concepts must be defined separately in all disciplines.

In recent years significant medical science advances have been made in the field midwifery and infant care. The premature, low birth weight and ill infants are admitted to the technologically advanced NICU for care and they often require long‑term stay. This study addresses parental experiences with the infant care in NICU, explores their concerns regarding nursing supports for parents and offers nurses’ perspectives on performing duties. A qualitative inductive content analysis method was applied in 2011 that included a purposely selected group of parents, nurses and physicians from neonatal unit at the Medical Science University of Isfahan. Participants were surveyed and interviewed according to the institutional ethics committee approval and signed informed consents. The content analysis identified two main categories: 1) the definition of stress, which consisted of misgivings, nervous pressure, imbalance, separation and 2) the parents’ reaction to stress, which revealed emotional, psychotic and behavioral reactions as subcategories. The medical team awareness of NICU parent experiences is essential to the quality of care. Recognizing the type of parents’ reaction to the whole process by the healthcare team seems essential to the optimum outcome.

Although nursing faculties may believe that they possess a core of knowledge about ethical interactions with students, they may unwittingly risk crossing an ethical boundary in the learning environment. The ethical dimension in education exists because the instructor has authority to contribute to or impede the students’ acquisition of knowledge. Therefore, this study aimed to determine the views of Iranian baccalaureate nursing and midwifery students regarding the occurrence rate of their faculties’ unethical behaviors. In this study, 115 subjects, including 61 nursing and 54 midwifery students, completed a questionnaire (response rate = 67.6%). The questionnaire consisted of demographic data and 27 short statements which described the faculties’ unethical behaviors. Reliability of instrument was confirmed (0.92) using Cronbach‑Alpha. Delaying in announcing the exam results (40%), lack of a positive learning environment (35.7%), failure to keep regularly scheduled office appointments (35.7%), and failure to update lecture notes when teaching a course (31.3%) were reported by the students as the main faculties’ unethical behaviors. Data analysis confirmed that there were no statistically significant differences between nursing and midwifery students’ responses (the two‑tailed t‑test was not significant at alpha 0.05 levels; P > 0.05). The study findings suggest that more emphasis should be put on faculties being accessible for consultation out of class time, announcing the exam results in a timely manner, and creating a positive learning environment.

This study aimed to determine the impact of an empowerment program on maternal stress. During May 2009–May 2010, this quasi‑experimental study was performed in the neonatal intensive care unit (NICU) of Shahid Akbarabadi, Rasoul‑e‑Akram, and Aliasghar Hospitals affiliated to Tehran University of Medical Sciences (Iran). The program consists of an educational CD along with written information and reinforcing activities for parents in the intervention group, and routine education was performed in the control group. We evaluated 140 mothers who were aged 18-37 years, had a gestational age of 28-37 weeks with singleton pregrancy, and with the birth weight of the newborn being less than 2500 g. The participants did not have chronic mental or physical illnesses. They were randomly assigned to two groups of intervention and control. A statistically significant difference was observed between mean (SD) stress scores of mothers before and after the intervention in the intervention group [123.00 (97.24) vs. 75.00 (7.16); P < 0.01)]. This study showed the importance of training mothers in reducing their stress and enabling them to appropriately communicate with and care for their premature newborn.

Studies indicate that becoming a mother is accompanied by prominent physical, social, and psychological changes which can affect not only mother’s psychological healthiness, but also all other aspects of her personal and family life. The purpose of this research was to explore the struggles experienced by Iranian first‑time mothers in adapting to their maternal role between 0 and 1 year after giving birth. A qualitative design was used in this study. Twenty‑one first‑time mothers with diverse ethnic backgrounds were recruited in their home or healthcare centers in Tehran and Ahwaz. Data collected through in‑depth interviews were analyzed by qualitative content analysis. The analysis produced four themes: “Unpreparedness,” “lack of control,” “incomplete maternal feelings,” and “unstable relations.” The main theme, “internal conflict,” integrates all other categories and encapsulates the major changes to which women are subjected, as well as the factors distressing this experience. Discrepancies between subjective expectations and postnatal experiences take an influential role in causing postpartum conflict and strain. The more accurate information mothers and families have about this transitory stage, the better they can get prepared to deal with it. This specifies the pivotal role of midwives, midwifery educators, and healthcare policy makers in incorporating these concepts into training programs and protocols of healthcare and support services in due time, form, and content that is in accordance with mothers’ mental and psychological needs.

The main professional goal of nurses is to provide and improve human health. Medication errors are among the most common health threatening mistakes that affect patient care. Such mistakes are considered as a global problem which increases mortality rates, length of hospital stay, and related costs. This study was conducted to evaluate the types and causes of nursing medication errors. This cross‑sectional study was conducted in 2009. A total number of 237 nurses were randomly selected from nurses working in Imam Khomeini Hospital (Tehran, Iran). They filled out a questionnaire including 10 items on demographic characteristics and 7 items about medication errors. Data were analyzed using descriptive and inferential statistics in SPSS for Windows 16.0. Medication errors had been made by 64.55% of the nurses. In addition, 31.37% of the participants reported medication errors on the verge of occurrence. The most common types of reported errors were wrong dosage and infusion rate. The most common causes were using abbreviations instead of full names of drugs and similar names of drugs. Therefore, the most important cause of medication errors was lack of pharmacological knowledge. There were no statistically significant relationships between medication errors and years of working experience, age, and working shifts. However, a significant relationship was found between errors in intravenous injections and gender. Likewise, errors in oral administration were significantly related with number of patients. Medication errors are a major problem in nursing. Since most cases of medication errors are not reported by nurses, nursing managers must demonstrate positive responses to nurses who report medication errors in order to improve patient safety.

Today anxiety, depression, and stress are among the fundamental problems, and nursing due to ongoing relationships with patients is one of the stressful jobs. The present study has been carried out to investigate the effect of fasting on emotional reactions among nurses in selected hospitals of Tehran. In a descriptive analytical study, 313 nurses working nurses of selected hospitals in Iran with the mean age of 37.82 ± 7.17 years were sampled with randomized cluster sampling method from two selected hospitals, and level of their emotional reactions was assessed by DASS21 questionnaire in two stages over 1-2 weeks before and after Ramadan. Then, using the statistical software SPSS15 and with Wilcoxon and paired t‑test, data were analyzed. The findings showed that depression and stress levels were significantly reduced after in comparison with before the holy month (P < 0.05). Despite the reduction of anxiety level in fasting caregivers after Ramadan, the difference was not significant. Fasting has been effective in diminishing stress and depression levels among nurses.

Despite current recommendations against routine use of episiotomy, its incidence is still high in Turkey. The study aimed to identify the prevalence of episiotomy in primiparas, related conditions, and effects of episiotomy on suture materials used, perineal pain, and wound healing 3 weeks postpartum. This study was designed as a prospective follow‑up study. Data were collected via a questionnaire form between March 2007 and February 2009 in Aydın Government Hospital, Turkey. Three hundred ninety‑six primiparas were included in the study by convenience sampling. It was determined that 56.3% of the women had episiotomies. The results of the study revealed that the probability of receiving an episiotomy was decreased in women with lack of legal marriage and unplanned pregnancies, and increased in women who had ineffective pushing efforts approximately four times, miscellaneous two times and baby’s head circumference 1.27 times. Moreover, the results of the study demonstrated that an episiotomy increased the number of the suture materials used by approximately five‑fold, as well as the prevalence of pain on the first postpartum day. On the third postpartum week evaluation, it was determined that the probability of problems with wound healing and experiencing pain was approximately two times higher among women who received episiotomies than those who did not receive episiotomies. The study revealed that episiotomies in primiparas increased the number of suture materials used and the probability of having perineal pain on the first postpartum day, as well as perineal pain and wound‑healing problems during the third postpartum week.

The most favorable method for cervical ripening is not fully agreed upon by practitioners; however, vaginal administration of isosorbide mononitrate (IMN) is considered a low‑risk method of labor induction for pregnant women at full term. Our study was designed to assess the effect of IMN on cervical ripening and labor induction among primiparous women in Iran. A randomized, double‑blind, placebo‑controlled trial was conducted on 90 primiparous women with Bishop score ≤ 5, term pregnancy, and no sign of labor. The women were allocated into two groups to receive either a 40 mg (2 × 20 mg) IMN tablet vaginally (n = 45) or placebo (n = 45) at 0 and 12 h. If uterine contractions were not present after 24 h, women were sent to the labor section for induction of labor. Bishop score, reason for induction, duration of active, second, and third phase of labor, and mode of delivery were assessed. There was a significant difference between the IMN group and the controls with respect to the Bishop score (4.92 vs. 4.03, P = 0.0.01), induction to active phase interval (387.6 vs. 520.4 min, P = 0.03), the length of induction (350 vs. 446 min, P = 0.03), and the drug administration to delivery interval (33.9 vs. 36.2 h, P = 0.03). The major side effect of IMN was headache, which responded to analgesia. IMN can be an effective alternative drug for cervical ripening and could decrease the labor interval. Further studies are necessary to fully address the benefits of IMN, especially in pregnancies of gestational age greater than 42 weeks.

Foot ulceration is one of the most common complications associated with diabetes that needs to be managed. In Iran, prevalence of diabetes foot ulcer is 3%. According to studies, evidence‑based nursing (EBN) is an effective alternative to facilitate clinical decision making in patient care and may lead to quality improvement in nursing practice. The aims of this study are to assess the effects of EBN education on the knowledge, attitude, and practice of nurses who take care of patient with diabetes foot ulcer. A quasi‑experimental study (based on IOWA model as a framework to improve nursing practice) was conducted using a before‑and‑after design. All of nurses (consisted of 19 baccalaureate nurses) who are working in an endocrinology ward were chosen and taught using EBN approach through different workshops. Before and after educational intervention, the data about nurses’ knowledge, attitude, and practice were gathered by questionnaire and then compared. The nurses’ performance in patient care was evaluated in 3 months by one checklist. The data were analyzed using descriptive and inferential statistics. There were statistically significant differences in knowledge, attitude, and practice of nurses before and after intervention (P = 0.001). The nurses’ performance in caring for patient with diabetes foot ulcer, based on clinical guideline, showed the improvement in clinical practice. Education of EBN can improve the nurse’s knowledge and attitude to EBN, and be used as a basis on which to influence the professional practice of nursing.