Journal of Hayat

Research development in Tehran Nursing and Midwifery School, 2004: an action research report

A.R Nikbakht Nasrabadi

Introduction: Continuous professional development is an essential component within many health care 'Learning Organizations'. This paper describes an initiation to develop a professional practice development framework for faculties in Tehran Nursing and Midwifery School.

Materials and Methods: The project was undertaken within an action research methodology with four phases .The goal of the project was to improve research, provide competition, reinforce data management, identify priority of needs in nursing and midwifery, and in so doing, enhance knowledge of the development of health information resources. A multi-method approach to data collection was undertaken to capture the change process from different stakeholders' perceptions. Triangulation of the data was undertaken. Despite organizational constraints, leadership and peer support enabled the co-researchers to identify and initiate high quality research initiatives. The change process for the co-researchers included: enlightening personal journey, exploring the research-practice gap, enhancing personal and professional knowledge, evolving cultural change and collaborative working.

Results: Descriptive analysis and evaluation method showed that the project was done effectively.

Conclusion: A more flexible time-scale and long term funding are required to enable continuity for trust-wide projects undertaken in dynamic academic settings

Study of general health of traumatic nursing team members of Bam one year after earthquake

F Sistanehei

Introduction: It is necessary to understand that psychological reactions after a natural disaster are as complex as disaster itself. Following a catastrophic earthquake like Bam’s, such reactions can be seen in nursing team members as well.

Materials and Methods: This study is a descriptive cross sectional analytic research, conducted with cooperation of Japanese Nursing Association to identify somatic and psychological problems of nursing team members of Bam. A total of 92 members of nursing team affiliated to healthcare centers of Bam were studied. Data collection tools were 2 questionnaires first for evaluating demographic characteristics and general health and second- questionnaire of Goldberg and Williams- for evaluation of four domains of psychosomatic problems, anxiety and insomnia, psychosocial functioning and severe depression. Each domain contained seven questions, each scored from 0 to 3 based on Likert score. Complete score of general health was 0-84. Scores were classified in four groups: 0-20 as optimal, 21-4 as approximately optimal, 41-6 as approximately suboptimal and 61 and higher as suboptimal.

Results: One year after the earthquake, evaluation of general health of nursing team members showed 30.3% of subjects had optimal psychosomatic status, 34.8% had moderate problems of anxiety and insomnia, 40.2% had approximately optimal psychosocial functioning and 44.2% of subjects were not severely depressed. Overall, 38.4% of nursing team members had approximately optimal general health.

Conclusion: This study showed that following a catastrophic earthquake, most of the victims suffer from several psychological and somatic reactions. In addition to on time rescue procedures, other important allaying factors are cultural and religious values and believing in God.

Incidence of anemia in pregnancy and its relationship with maternal characteristics and pregnancy outcome

F Davaritanha

Introduction: Anemia is a common finding among pregnant women, and it could cause a number of complications for both mother and fetus.

Materials and Methods: In this case - control study, 302 pregnant women among patients referred to prenatal clinic of Mirza Kochak Khan Hospital were randomly chosen and were divided into anemic and normal groups based on their hemoglobin (Hb) level. Patients with Hb<11g/dl during the first or third trimester as well as those with Hb<10.5g/dl in the second trimester were considered anemic. Anemic patients were treated and pregnancy outcomes of two groups, including birth weight of the newborns, prematurity, stillbirth and abortion, were compared.

Results: Overall prevalence of anemia during pregnancy was 8.6%. The prevalence of anemia in the first, second, and third trimesters of pregnancy were 10.3%, 3.5% and 12.7%, respectively. The frequency of anemia had a positive correlation with maternal age, gravidity and parity however it was less frequent in patients taking iron supplements. There was no significant difference in pregnancy outcome of normal and treated anemic woman. Growth retardation was more frequent in treated anemic patients but only in women who were diagnosed in third trimester.

Discussion: The prevalence of anemia among pregnant women is noticeable, and with the iron deficiency as the most common cause, we recommend administration of iron supplements for prevention of anemia and its maternal and fetal consequences. Treatment of anemia in early stages of pregnancy results in normal pregnancy outcome, a finding emphasizing the importance of treatment.

A phenomenological analysis of post operative pain experiences in three subcultures in Iran

A Nikbakht Nasrabadi

Introduction: Pain is a phenomenon with both personal and cultural meanings. As cultural diversity increases around the world, caregivers are more and more likely to care for clients from backgrounds different from their own. Culture affects the assessment and management of pain. The aim of this study was to explore the meaning of pain experiences in 3 subcultures in Iran.

Materials and Methods: A phenomenological approach was used in order to explore the meanings of post operative pain experiences in participants. Data were gathered through series of semi structured interviews as well as goal-oriented observation and collected written narratives. Benner's interpretive method was used for data analysis.

Results: From analysis of viewpoints of 15 patients from Khorram-Abad, 13 patients from Tehran and 8 patients from Gorgan, 4 themes emerged. Considering postoperative pain insignificant compared to primary pain, need for protection, increase in spirituality and insensitivity of healthcare providers were the emerged themes.

Conclusion: While pain is a subjective and personal phenomenon and reaction to pain is influenced by cultural and personal values, in this study no difference was found in the pain experiences in 3 under-study subcultures. It seems that Iranian-Islamic culture acts as a conceptual umbrella to encompass the whole experiences and influences all subcultures.

Investigating causes of self-burning in married women

F Amirmoradi

Introduction: Self-burning is a cruel method of suicide and prevention is the most effective way to decrease its morbidity and mortality.

Material and Methods: This investigation is a descriptive prospective study performed at Shahid Motahari Burn Center, Tehran, Iran from December 2001 to December 2002. Inclusion criteria included being female, married, having no history of medical and mental disorders and admission of self-burning. Data were collected by a questionnaire and interviews and were analyzed with descriptive statistics methods and chi-square test.

Results: A total of 35 cases entered our study. The mean age of patients was 24.573.94 years and 48.6% of cases were in the 21-25 year age group, 80% had primary school education, 97.1% were housekeeper and 68.8% had low economical status. There were statistically significant differences in all of these variables. In 42.9% self-burning had happened at 12-18 hour period and in 45.7% it had occurred at yard. Kerosene had been used by 91.4% of the women as the burning agent 94.3% of the women had experienced husband’s violence (verbal and physical), 60% of the women stated that their husbands were guilty in their action and 91.4% of the women didn’t know any supportive sources in the society. The mortality rate was 100%.

Conclusion: This research showed that family violence and marital problems are the most important causes of self-burning in the married women. Because of close relationship to families, community health nurses can prevent self-burning in married women by detecting and eliminating these risk factors.

The effect of self - care educational program on decreasing the problems and improving the quality of life of dialysis patients

Sh Baraz

Introduction: In patients who have a chronic disease such as end stage renal disease for which cure is not a realistic goal, maximizing functioning and well-being should be a primary objective of care. However, functioning status in the dialysis patients is often lower than normal.

Materials and Methods: This study is aiming to determine the effect of self–care educational programs on decreasing problems and improving quality of life of dialysis patients. This study was a quasi-experimental research in one group (pretest-posttest) accomplished in the educational hospitals of Iran and Tehran medical sciences universities from 2003 to 2004. A total of 32 patients were chosen on the basis of a non-randomized sampling. Each patient was assessed in two sessions before starting the dialysis treatment by questionnaires about educational requirements and quality of life and a checklist of common problems in dialysis patients. In order to validate the results, the laboratory variables were analyzed as a two months average prior to the education. The authors designed an educational program on the basis of existing problems and then determined the characteristics of each person under study and the required education was presented in two sessions. After the educational period was ended, the laboratory variables (average two months) and quality of life two months after education were analyzed and also the checklist were studied in two stages with a time interval of two weeks (third and fifth weeks).

Results: There was a significant decrease in serum urea, uric acid, serum creatinine, K, weight gain, systolic blood pressure, edema, skin itching and local vascular problems. Also, there was a significant improvement in the patients’ quality of life.

Conclusion: Self-care educational programs have a positive influence on decreasing the problems and improving the quality of life of dialysis patients.

Effect of magnesium sulfate on bleeding time in pregnancy

Z Khakbazan

Introduction: According to some studies, pharmacological concentrations of Mg2+ have anti-thrombotic effects and interfere with platelet aggregation in vitro and in vivo.

Materials and Methods: The study group consisted of 50 pregnant women who required magnesium sulfate for mild pre-eclampsia or preterm labor. In all patients, a platelet count, magnesium level, bleeding time and mean arterial pressure were obtained before and 2 hours after magnesium sulfate infusion. Magnesium sulfate was started with a 6 gr intravenous bolus, followed by 2 gr/hr infusion. Bleeding time was measured by Duke method. Data were analyzed with Mann Whitney U and Wilcoxon rank tests.

Results: Thirty one patients (62%) received magnesium sulfate for preterm labor and 19 (38%) for mild pre-eclampsia. Analysis of the entire study group revealed a rise in the magnesium level (p<0.0001), a lowering of the mean arterial pressure (p<0.0001) and no significant difference of the bleeding time and platelet count. Comparison of platelet count, magnesium level and bleeding time before and 2 hours after magnesium sulfate infusion revealed no significant difference in two groups.

Conclusion: According to this study, magnesium sulfate with usual dosage has no effect on bleeding time in pregnancy.

Internal evaluation in Faculty of Nursing and Midwifery, Tehran University of Medical Sciences

F Farzianpour

Introduction: Evaluation is a systematic process for collecting, analyzing and interpretation of the obtained information for the purpose of investigating how much the objectives in mind can be achieved. Education in an academic educational system means bringing about proper and increasing changes that affect the outcome of this system, that is affecting the students, and the aim of such evaluation was promotion of the quality of an education process.

Materials and Methods: In this study faculty of nursing and midwifery, Tehran University of Medical Sciences, benefiting from opinion poll of university lectures, student and graduates have evaluated their system of educational in the year 2004 and their aim was to remodel and adjust educational system with the society’s needs and promotion of the quality of such education’s. The employed method was cross sectional and descriptive and analytical on the basis of 10 procedural steps and with in 8 sections dealing with evaluated factors. Such as faculty board members, management and organizational capability, students, manpower and logistic affairs, educational environments research work centers, health and therapeutic sections, educational equipment, research equipment, laboratory and diagnosis centers, educational courses and programs, teaching and learning process as well as satisfaction expressed by students.

Results: the results of the research showed that general average of 8 investigating sections, based on SWOTs model were respectively 80.4% (nursing department), 81.5% (Midwifery department) and 82.1% (Ph.D nursing) that may well be interpreted as a desirable research work.

Conclusion: Educational evaluation is the best indicator showing how much we should go to achieve certain aims, analyzes quality of the activity if such a system and by which we achieve logical and routine results.

The effect of family counseling programs on prevention of psychological abuse of elderly women

M Heravi Karimoi

Introduction: Attention to psychological abuse of old women as a vulnerable group and its complications are important issues. We performed this study to determine the effect of family counseling program on prevention of psychological abuse of elderly women.

Methods and Materials: This is a semi-experimental study. We selected 30 old women referring to clinics of an educational hospital in Tehran by simple randomization. Data collecting instruments included demographic sheets about old person and family members and a questionnaire about psychological abuse, which were completed by interview. An observational checklist about behavioral symptoms was completed at 3 interview sessions by family and old person at home. Then 6 counseling sessions were established. Duration of every session was 1:30 up to 2 hours. After two months and in the last three sessions, final evaluation was conducted by again completing data collecting instruments.

Results: study results showed that 90% of abusers were woman and family dysfunction was the reason of abuse in 43.3% of cases. Mean score of psychological abuse showed a significant decrease after counseling, using dependent t-test and Wilcoxon test (p<0.001). Also, mean score of behavioral symptoms of abuse showed a statistically significant decrease after counseling, using dependent t-test and Wilcoxon (p<0.001). Pearson correlation coefficient (r=0.90) showed that there was a significant correlation between psychological abuse and behavioral symptoms.

Conclusion: Regarding positive effect of family counselling programs on reduction of psychological abuse of old women, it is suggested that effect of family counseling programs in reduction of other types of abuse be determined.

Job satisfaction of midwives

T Mirmolaei

Introduction: Job satisfaction of midwives, as key members of healthcare system, has special importance in the quality of midwifery care to the vulnerable groups of the society i.e. mothers and children.

Materials and Methods: This is a survey and cross sectional study. Sampling size was 251 midwives, which were chosen through cluster sampling. Data were gathered by questionnaire in one stage and were analyzed by SPSS software, using descriptive and analytic (2, Pearson correlation) statistical methods. Results:

Results of this research demonstrated that satisfaction level of midwives in two aspects of job position (62.9%) and relationship with colleagues (48.2%) was moderate. It was low in the aspects of salary and benefits (92.8%), job security (69.7%), managerial policies and work condition (64.9%), supervisory (48.6%) and relationship with personal life (49.8%). There was a significant relationship and correlation between job satisfaction and all of its aspects, strongest with the aspect of managerial policies (r=0.87) and weakest with the relationship with colleagues (r=0.547). There was no significant relationship between job satisfaction and demographic characteristics such as age, academic degree, marital status, the number of children and monthly salary but there was a significant relationship between job satisfaction and the condition of house ownership, the years of job experience, the condition of employment, the place of work, work shift and whether they liked midwifery when they chose it (p<0.05).

Conclusion: Half of midwives (49.4%) had moderate job satisfaction, 49% had low and only 1.6% had high job satisfaction. Considering the results of this research, it can be concluded that the authorities must take efficient measures to omit the most important causes of low job satisfaction through increasing salaries and benefits, promoting job security, improving work condition, reformation of managerial and supervisory systems and using midwives’ professional ability in areas of their skill’s.

Graphic analysis of labor progression

F Rahimikian

Pregnancy and delivery are special events in women’s and their family’s life. Although pregnancy is a natural phenomenon and not a disease, sometimes it can be associated with several dangers to the mother and her fetus. Maternal death is a global finding and its five most important causes are bleeding, infection, hypertension, prolonged labor and abortion in unsanitary condition. Early diagnosis of abnormal labor progression and prevention of prolonged labor can reduce the risk of postpartum bleeding and infection. The chart of labor called “Partograph” has been introduced and applied since 1970 to help diagnosis of the abnormal labor and cephalopelvic disproportion. Partograph is an early alerting system which can prevent probable difficulties in different stages of labor through recording of all of the observations and examinations on one chart, so that mother can be referred as soon as possible to higher levels of health services.