Iranian Journal Of Nursing and Midwifery Research
Volume:20 Issue: 3, Ma-Jun 2015

Despite the scientific and medical advances for management of complicated health issues, the current maternity care setting has increased risks for healthy women and their babies. The aim of this study was to conduct an overview of published systematic reviews on the interventions used most commonly for management of normal labor and delivery in the first stage of labor. The online databases through March 2013, limited to systematic reviews of clinical trials were searched. An updated search was performed in April 2014. Two reviewers independently assessed data inclusion, extraction, and quality of methodology. Twenty‑three reviews (16 Cochrane, 7 non‑Cochrane), relating to the most common care practices for management of normal labor and delivery in the first stage of labor, were included. Evidence does not support routine enemas, routine perineal shaving, continuous electronic fetal heart rate monitoring, routine early amniotomy, and restriction of fluids and food during labor. Evidence supports continuity of midwifery care and support, encouragement to non‑supine position, and freedom in movement throughout labor. There is insufficient evidence to support routine administration of intravenous fluids and antispasmodics during labor. More evidence is needed regarding delayed admission until active labor and use of partograph. Evidence‑based maternity care emphasizes on the practices that increase safety for mother and baby. If policymakers and healthcare providers wish to promote obstetric care quality successfully, it is important that they implement evidence‑based clinical practices in routine midwifery care.

Acute coronary syndrome is the most common disease in the world. Several studies suggest that hyperglycemia is associated with poor clinical outcomes in patients with coronary artery disease. The aim of this study was to investigate the impact of insulin infusion protocol and conventional therapy on the blood glucose level and outcomes in acute coronary syndrome patients with diabetes mellitus. We studied 64 patients (32 in each group) with acute coronary syndrome and acute myocardial infarction, who were admitted to the coronary care unit in a hospital in Isfahan, Iran in 2012. Inclusion criterion was blood sugar (BS) of more than 180 mg/dl on admission. Patients in the intervention group received insulin with East Jefferson insulin infusion protocol for at least 4 h, and in the control group, the subjects received subcutaneous insulin (conventional therapy) for at least for 48 h. Independent t‑test, Student’s t‑test, and Chi‑square test were used to analyze the data. Groups were matched for baseline characteristics. Blood glucose was significantly reduced in the two groups (P < 0.001), and the mean blood glucose level in the interaction group was significantly less than in the control group (P = 0.0002). Hypoglycemia was 31.2% and 25% in the intervention and control groups, respectively. The frequency of hypoglycemia did not differ significantly between the two groups (P = 0.75). Time to reach target insulin level differed between the two groups (4.75 h in the intervention group and 36.93 h in the control group; P < 0.001). Our research showed that use of insulin infusion protocol is better in maintaining glycemia control compared to subcutaneous sliding scale method. The protocol allows nurses to commence and maintain the infusion more effectively and safely compared to the traditional method.

Clinical guidelines are important instruments for increasing the quality of clinical practice in the treatment team. Compilation of clinical guidelines is important due to special condition of the neonates and the nurses facing critical conditions in the neonatal intensive care unit (NICU). With 98% of neonatal deaths occurring in NICUs in the hospitals, it is important to pay attention to this issue. This study aimed at compilation of the neonatal palliative care clinical guidelines in NICU. This study was conducted with multistage comparative strategies with localization in Isfahan in 2013. In the first step, the components of the neonatal palliative care clinical guidelines were determined by searching in different databases. In the second stage, the level of expert group’s consensus with each component of neonatal palliative care in the nominal group and focus group was investigated, and the clinical guideline was written based on that. In the third stage, the quality and applicability were determined with the positive viewpoints of medical experts, nurses, and members of the science board of five cities in Iran. Data were analyzed by descriptive statistics through SPSS. In the first stage, the draft of neonatal palliative care was designed based on neonates’, their parents’, and the related staff’s requirements. In the second stage, its rank and applicability were determined and after analyzing the responses, with agreement of the focus group, the clinical guideline was written. In the third stage, the means of indication scores obtained were 75%, 69%, 72%, 72%, and 68% by Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. The compilation of the guideline can play an effective role in provision of neonatal care in nursing.

Many maternal deaths caused are due to preventable causes during pregnancy and childbirth. Therefore, the detailed analysis of the root causes provides developing a plan and appropriate interventions to prevent these deaths occurring in the health system. This study aims to determine the causes of maternal mortality using root cause analysis (RCA) method. This research is a descriptive explorative study. The data were collected from the files in the maternal health center and the interviews conducted with relevant personnel. The causes of maternal mortality and related reasons were determined by experts’ team opinions and through a standard checklist of RCA. Causes consisted of the factors related to health services (human factors and structural factors), maternal family and social status, and maternal disease status. For each of these factors, analysis was performed to determine the root. In the end, interventional suggestions were developed to prevent the recurrence of similar deaths. Causes were classified into human factors, and structural factors in the area of planning and management and social status of mothers. The results showed that human factors were composed of lack of knowledge and skills in the medical team, unfamiliarity with their duties, lack of health care–based on protocols, etc. Structural factors included lack of follow‑up after discharge and inadequate supervision of inspectors on academic qualified doctors. Maternal social and family status factor included lack of referral the mothers’ to the health care center. Based on the RCA process, the most fundamental factor in creating these deaths was management errors at the level of universities and the Ministry of Health. These errors included inadequate supervision of medical education, failure to identify and introduce the instructions and guidelines related to the care of pregnant mothers by the health workers and experts, and lack of collective strategies to inform the public about the type and model of self‑care in health centers. Based on the obtained results, the solutions proposed for elimination of root causes of maternal death are organizing sequential training courses tailored for the staff taking care of pregnant women, sending guidelines related to maternal health care to all private and public institutions, and informing the community to receive health care services by health centers and mass media.

After the umbilical cord is cut, premature neonates face numerous problems including hypothermia. With regard to serious complications of hypothermia and incapability of conventional methods in preservation of neonates’ temperature after admission, the researcher decided to conduct a study on the effects of two polyethylene covers in prevention of hypothermia among premature neonates. This clinical trial was conducted on 96 neonates aged 28–32 weeks that randomly allocated, by drawing of lots, to three 32‑subject groups as follows: Intervention group 1 (a plastic bag cover and a cotton hat), intervention group 2 (a plastic bag cover and a plastic hat), and a control group receiving routine care. Data were analyzed by descriptive and inferential statistics through SPSS V.14. Mean axillary temperatures in intervention groups 1 and 2 were different after admission and 1 and 2 h later, but this difference was not significant and the mean axillary temperature increased with time. Mean axillary temperature in the control group showed no significant difference at these time points and it did not increase with time. The mean temperatures in preterm infants were significantly higher in the intervention groups after admission and 1 and 2 h after birth, compared to the control group. Mean axillary temperature in intervention group 2 was significantly higher than in intervention group 1. Usage of a plastic bag cover and a plastic hat (with no risk of hyperthermia) is more effective in preventing hypothermia among neonates aged 28–32 weeks, compared to usage of a plastic bag cover and a cotton hat.

Eating disorder is one of the most common health problems with clinical and psychological consequences, which can affect body image in cancer patients. Similar studies in this area for checking the status of this disorder and its relevance with body image in patients with cancer are limited. Therefore, this study was designed with the aim of determination of eating disorders in patients with cancer and their relevance with body image. The research was a cross‑correlation study. It was carried out in Sayed‑Al‑Shohada Hospital affiliated to the Isfahan University of Medical Sciences in 2013. Two hundred and ten patients with cancer were selected and were asked tocomplete the demographic and disease characteristics questionnaire, the Multidimensional Body‑Self Relations Questionnaire (MBSRQ), and eating disorders questionnaire. SPSS statistical software, version 14 was used for statistical analysis’‑Test, analysis of variance (ANOVA), and Pearson correlation coefficient were used for analyzing the obtained data. The mean values of age, body mass index (BMI), and duration of illness were 48.2 ± 13.20 years, 24.6 ± 4.6kg/m2, and 25.64 ± 21.24months, respectively. Most patients were married (87%), without university education (96%), unemployed (67%), and with incomes below their requirement (52%). Most patients were diagnosed with breast cancer (36.5%). They received chemotherapy as the main treatment (56.2%). In addition, mean ± SD of eating disorders and body image were 12.84 ± 4.7 and184.40 ± 43.68, respectively. Also, 49.7% of patients with cancer had an eating disorder. Among these, 29% had experiences of anorexia and 20.7% had bulimia. There was a significant negative correlation between the score of body image and eating disorders (r = −0.47, P = 0.01). Findings of this study showed that most patients with cancer had experienced symptoms of eating disorders. This may lead to a negative impact on the body image in these patients and may be the cause of further psychological and physical changes in these patients. The findings of this study can assist the healthcare team to pay more attention to eating disorders and body image in patients with cancer and also in considering the relationship of these issues in their evaluations.

Migraine is a primary headache disorder that affects the neurovascular system. Recent studies have shown that consumption of some fatty acids such as omega‑3 fatty acids improves migraine symptoms. The aim of the present study is to assess the association between usual intake of fatty acids such as eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and saturated fatty acids (SFA) with the frequency of migraine attacks. 105 migraine patients with age ranging from 15 to 50 years participated in this cross‑sectional study. Usual dietary consumption was assessed by using a semi‑quantitative food frequency questionnaire (FFQ). Moreover, frequency of migraine attacks during 1 month period was determined in all participants. Data had been analyzed using independent sample t‑test and linear regression test with adjustment of confounding variables. In this study, we found that lower intake of EPA (β = −335.07, P = 0.006) and DHA (β = −142.51, P = 0.001) was associated with higher frequency of migraine attacks. In addition, we observed similar relationship either in men or women. No significant association was found between dietary intake of SFA and the frequency of migraine attacks (β = −0.032, P = 0.85). Frequency of migraine attacks was negatively associated with dietary intake of omega‑3 polyunsaturated fatty acids. No significant relationship was found between SFA intake and migraine frequency. Further studies are required to shed light on our findings.

Identifying and using the strengths of patients, in practice, is a new territory. Today, the need to educate nurses and psychiatric patients about positive psychology in practice and the importance of understanding and focusing on strengths is clear. However, little is known about the strengths the psychiatric patients use and experience. Thus, this study has been designed and conducted in order to understand how people with psychiatric disorders demonstrate their strengths. In the present study, 13 semi‑structured, qualitative interviews with patients and 2 focus groups with nurses were carried out. In addition, a qualitative content analysis was used to identify significant strengths. Based on the results, the four main strengths consisted of: Finding a meaning in daily living, work as enduring strength, entertaining activities, and positive relationship. Patients also reported that health care providers rarely focused on patients’ strengths, and experts confirmed these findings. Our findings indicate that patients’ own strengths are a pivotal factor in getting through their illness from their perspective. Despite the enduring legacy of pessimism regarding psychiatric patients, these people have a repertoire of strengths. Nurses should, therefore, have a greater focus on eliciting and nourishing psychiatric patients’ strengths in their care. It is suggested that the theoretical and practical aspects of patients’ strengths be incorporated in nursing school curricula.

Selection and acceptance of appropriate sexual behavior and sexual function are made difficult by low sexual self‑efficacy in the postpartum period. The general purpose of this research is to define the effects of an 8‑week pelvic floor muscle exercise program on sexual self‑efficacy in primiparous women after childbirth. This clinical trial was performed on 79 primiparous women who referred to health care centers, Mashhad, Iran in 2013, 8 weeks after delivery, to receive health care services. They were selected by easy sampling. The samples were randomly assigned to either intervention or control group. The intervention group was trained in Kegel exercises for 8 weeks. Both groups were evaluated at 4 and 8 weeks. Data collection tools included: Demographic information, sexual self‑efficacy, and Brink scale. Data were analyzed using repeated measures, Friedman test, t‑test, and Mann–Whitney test. The results showed significant increase in pelvic floor muscle strength in the intervention group at 4 and 8 weeks after exercises (P < 0.0001), but no significant difference was observed in the control group (P = 0.368). There was a significant increase in sexual self‑efficacy in the intervention (P < 0.0001) and control groups (P = 0.001) at 4 and 8 weeks after the start of the study. Comparison of the two groups showed a significant difference in sexual self‑efficacy after they performed these exercises (P = 0.001). The findings showed that 8‑week pelvic muscle exercises increase the sexual self‑efficacy in women after delivery.

Ventilator-associated pneumonia (VAP) is a common side effect in patients with an endotracheal tube. This study aimed to evaluate the effect of an upper respiratory care program on the incidence of VAP in mechanically ventilated patients. In this clinical trial, 62 patients with endotracheal tube were selected and randomly allocated to intervention or control group. In the intervention group, an upper respiratory care program was performed and in the control group, routine care was done. Modified Clinical Pulmonary Infection Questionnaire was completed before, and on the third, fourth, and fifth day after intervention. Data were analyzed by repeated measure analysis of variance (ANOVA), chi-square, and independent t-test through SPSS 13. The results of this study showed that until the fourth day, the incidence of VAP was similar in both intervention and control groups (P > 0.05), but on the fifth day, the incidence of VAP in the intervention group was significantly lower than in the control group (P < 0.05). The results of this study showed that in patients with an endotracheal tube, an upper respiratory care program may reduce the incidence of VAP. Therefore, in order to prevent VAP, nurses are recommended to perform this upper respiratory care program.

Cancer is a broad group (over 270 types) of diseases. This disease, like other chronic diseases, occurs in all ages and ethnic groups, and is considered as a major health problem. Stress is one of the most important psychological factors influencing the occurrence of physical diseases, and can lead to severe anxiety, depression, and negative effects on health. It can also make individuals vulnerable to physical diseases, and in the long term, leads to death. This study was conducted to determine the effect of inoculation training on stress, anxiety, and depression in cancer patients. This study was conducted in 2013 as a clinical trial with convenient random sampling of patients from the chemotherapy clinic of Seyed Al‑Shohada hospital of Isfahan. Forty patients with cancer who were eligible for the study were randomly assigned to either case or control group. The case and control groups had the same treatment plans, and the only difference was stress inoculation training administered in the case group, which was composed of eight 90‑min sessions over 8 weeks. Data were collected using Depression, Anxiety, Stress Scales 42 (DASS‑42) questionnaire and demographic questionnaire, and analyzed by analysis of covariance (ANCOVA) and t‑test in SPSS. The results showed that there was a significant difference between case and control groups in terms of stress, anxiety, and depression (P < 0.001). Stress inoculation training reduced stress, anxiety, and depression in cancer patients. Stress inoculation training significantly reduced stress, anxiety, and depression. Therefore, teaching this skill and the strategies of coping with stress is recommended for these patients, in addition to medicational treatment.

Phlebitis is the most common complication associated with peripheral intravenous infusion of amiodarone. The purpose of this study is to determine the effects of sesame oil on the prevention of amiodarone‑induced phlebitis. This is a double‑blind randomized controlled trial. Thirty‑six patients hospitalized in a coronary care unit were randomly allocated into two groups using a convenience sampling method. Following peripheral intravenous cannulation, five drops of pure sesame oil were applied to the skin within a 10 cm radius of the infusion site prior to the administration of amiodarone in the intervention group. Sesame oil was rubbed on the skin at the infusion site every 6 h in the 24‑h period of amiodarone infusion. In the control group, liquid paraffin, used as a placebo, was rubbed on the skin at the infusion site of amiodarone. Both groups were monitored for the development of phlebitis and its degree within the 24‑h period of amiodarone infusion as well as 6 h after its administration. The incidence of phlebitis was confirmed and recorded by an assessor who was blind to the two groups. Data were analyzed using Statistical Package for Social Science (SPSS) version 18, and descriptive and inferential statistics such as Chi‑square test, Kaplan–Meier, Hazard ratio, independent t‑test, and Fisher’s exact test. There was a statistically significant difference between the two groups in their catheter survival after 30 h and 10 min (P < 0.001). Over 60% of the patients (61.1%) in the intervention group did not show any sign of phlebitis, while 16.7% and 22.2% of the patients manifested signs of grade 2 and 3 phlebitis, respectively. In the control group, 22.2% of the patients showed no signs of phlebitis, while 5.6%, 27.8%, and 44.4% of the patients exhibited signs of grade 2, 3, and 4 phlebitis, respectively. The statistical analysis showed significant differences in the degree of phlebitis (P = 0.006) and the onset of phlebitis development (P < 0.001) between the two groups. It is recommended to apply sesame oil topically to the infusion site of amiodarone so as to reduce the rate of the development of amiodarone‑related phlebitis.

One of the most critical periods of the life of a person is adolescence. During this period, individuals face many problems such as low self‑esteem. Self‑esteem can be influenced by many factors such as school, friends, and inner personality, but it seems that the family has a crucial role in shaping self‑esteem. Therefore, the present study aimed to determine the relationship between family functioning and self‑esteem in female high school students in Isfahan, Iran. This descriptive correlational study was performed with multi‑stage random sampling method on 237 female high school students who met the inclusion criteria of the study. The data collection tools included Bloom’s Family Functioning Scale and Pop’s self‑esteem questionnaire. The data obtained from the questionnaires were analyzed through SPSS software. The results showed that the majority of the samples examined had moderate level self‑esteem (48.5%) and family function (56.5%). There was a significant correlation between the dimensions of family functioning and areas of self‑esteem (except for lack of independence, and public, academic, and physical self‑esteem). In addition, the correlation between family aspirations and self‑esteem (r = 0.636, P < 0.01) was higher than other variables. Moreover, across the dimensions of family functioning, a significant negative correlation was found between the lack of independence and the family self‑esteem subscale. The results of the study showed that adolescents’ self‑esteem is highly correlated with their family’s performance. Therefore, to enhance the self‑esteem of adolescents, family‑centered empowerment programs should be planned and implemented by health service providers, especially nurses, in order to improve and enhance family functioning.

Nursing continuing education with development of knowledge, skill, and attitude results in improvement of nursing activity, and thus improves the health care in the society. If the education is not planned and implement properly, it affects the patient care. This study was designed to explore the challenges of nursing continuing education in Isfahan University of Medical Sciences hospitals. The research was conducted from April 2012 to February 2013 in Isfahan, Iran. The sampling was begun with purposeful method and continued with snowball method. Thirty‑nine participants were selected among the nurses of Alzahra, Kashani, and Noor hospitals, nursing and midwifery faculty, continuing education center, and the vice‑chancellery for treatment. The participants were both learners and planners of continuing education program. In this descriptive explorative qualitative research, we interviewed 39 participants in five focus group and five individual interviews, until data saturation was achieved. We used semi‑structured interviews and field notes for data gathering, and members checking, triangulation (data and method), peer debriefing, and peer review to increase the strength of data. Data were analyzed with thematic analysis method that was proposed by Broun and Clarke in 2006. Data analysis produced 175 initial codes, 8 subthemes, and 5 main themes. The main themes included: Learners related factors, teachers related factors, educational process related factors, inadequate facilities, and defective evaluation. According to the results, we need to revise the educational process in nursing continuing education. To achieve this goal, we need a team for needs assessment, planning, and evaluation. In addition, we must pay attention to educators’ and learners’ issues.

Patient education is among the lowest met need of patients in Iran; therefore, expansion of that role can result in greater professional accountability. This study aimed to explain the practical science of the process, structure, and outcomes of a nurse‑led action research project to expand the nurses’ role in patient education in Iran. This study was part of a participatory action research. Daily communications and monthly joint meetings were held from January 2012 to February 2014 for planning and management. These were based on the research protocol, and the conceptual framework included the Mobilizing for Action through Planning and Partnerships process by means of Leadership for Change skills. Data were produced and gathered through participant observations. Administrative data included project records, official documents, artifacts, news, and reports, which were analyzed through qualitative content analysis. A participatory project was established with three groups of participants organized from both academic and clinical fields. These consisted of a “core research support team,” “two steering committees,” and community representatives of clients and professionals as “feedback groups.” A seven‑stage process, named the “Nurse Educators: Al‑Zahra Role Expansion Action Research” (NEAREAR) process, resulted from the project, in which strategic issues were gradually developed and implemented through 32 action plans and quality improvement cycles of action research. Audits and supervision evaluations showed meaningful changes in capacity building components. A nurse‑led ad hoc structure with academic–clinical partnerships and strategic management process was suggested as a possible practical model for expanding nurses’ educational role in similar contexts. Implications and practical science introduced in this action research could also be applicable for top managers and health system policy makers in a wider range of practice.

Client satisfaction is an important indicator for assessment of the quality of care provided. Detecting patients dissatisfaction and trying to find the most effective and costly services is the basic way for improvement of service quality. The purpose of this study was to determine the satisfaction level of women in the maternity care centers (hospitals) of Lorestan University of Medical Sciences, Iran. In this descriptive cross‑sectional study, the satisfaction level of 200 patients who received care during childbirth in province hospitals was assessed using a researcher‑made questionnaire. Women in maternity care units completed the questionnaires. The mean maternity care satisfaction score was 66.6 ± 3.5. The lowest satisfaction level was related to getting to know the delivery room (64%) and vaginal examination (66%). The highest satisfaction score was related to confidentiality of the information (86%) and trusting the midwife (84%). Regarding the environmental factors, the lowest satisfaction was related to respecting silence in the pain room (69.5%) and the highest was related to cleanliness and hygiene of the delivery room (84%). Our results suggest the relative satisfaction of women receiving care in the health centers of Lorestan province; but this level of satisfaction does not mean that the delivery of care in this province is perfect. By reviewing the policies and the existing care programs regarding promoting the quality of services, managers can increase clients’ satisfaction.

During health care in the neonatal intensive care unit (NICU), infants undergo extremely painful procedures, which may cause problems, if not controlled, such as changes in the pattern of respiratory rate, heart rate, and blood oxygen saturation. The present study aimed to find the effect of melody on the physiological responses of neonates’ heel stick pain. This quasi‑experimental study was conducted in Alzahra Hospital (Isfahan, Iran) for 5 months. Fifty infants were selected through convenient sampling method and were randomly assigned in equal numbers to two groups (n = 25). In the melody group (intervention), a selected melody was played for the infants at a distance of 1 m from them, with a sound intensity of 65 dB, from 3 minutes before, during, and after the heel stick procedure, respectively, and their physiological responses were observed with a monitoring system and recorded at the afore‑mentioned time periods. Physiological responses were also recorded in the control group (no intervention) 3 min before, during, and after the heel stick procedure, respectively. Means of respiratory and pulse rates in the melody and control groups showed a significant difference at different time points. But the mean blood oxygen saturation in the melody group showed no significant difference at different time points, although the difference was significant in the control group. The results showed that melody could maintain more balance in some physiological responses of infants, such as the respiratory rate and pulse rate during the Guthrie test. Therefore, melody is recommended to be used to prevent the destructive effects of pain in infants during painful procedures.

Mothers rely on nurses for help and advice on how to feed their babies. Without help, any mothers see breastfeeding as a goal they cannot reach for themselves. So, the nurse plays a significant role in helping the mother to begin breastfeeding and to take pleasure in it; at one fell swoop, the mother provides her infant with optimum nutrition. However, nursing could be hampered when natal teeth, sometimes called fetal teeth, are present in the mouth of a baby at birth. Teeth erupted in the infant’s mount during the first month of life are termed as neonatal teeth. The normal eruption of the primary teeth typically begins at 6 months of age. Presence of these natal teeth is an uncommon ondition, seen in 1 in 2000–3000 newborns.[1]Various superstitions and folklore are associated with natal teeth, ranging from claims that the affected children were exceptionally favored by fate to the belief that they were doomed among races.[2]……