Journal of Hayat

Clinical Judgment in Nursing: a Concept Analysis using Rodgers’ Evolutionary Method

Fatemeh Alhani

Background & Aim: Nurses’ clinical judgment is an evolving complex concept. In order to understand the concept, clarification is needed. This study aimed to conduct the concept analysis of clinical judgment in nursing .

Methods & Materials: Based on the Rodgers’s evolutionary method, evolving concept of clinical judgment in nursing was analyzed. Literature was retrieved from scientific databases during 1980 to 2013. Based on the inclusion criteria, 42 articles, three books and one dissertation were analyzed using thematic analysis method .

Results: The results showed that clinical judgment in nursing was a complicated process with attributes including intention, observation, data collection and information process, interpretation, prioritization and inference. Antecedents included knowledge, experience, evidences, clinical reasoning, intuition, critical thinking and consequences included nursing diagnosis and clinical decision making .

Conclusion: Clinical judgment in nursing is a critical thinking process, situational based and beyond observation and assessment. This concept analysis could distinct the transposition concept of clinical judgment and other related concepts. The results of this study would help to develop theories and clinical judgment measurement instruments in practice, research and educational settings .

Effect of a Multidimensional Fall Prevention Program on Incidence of Falling and Quality of Life among Elderly

Mehdi Jafari Oori

Background & Aim: Falling is common among elderly due to changes in sensory–motor function. Falling causes physical, emotional and financial problems and decreases the quality of life in elderly. Since the causes of falling are multifactorial, multi-dimensional approaches should be considered to prevent it. This study aimed to investigate the effect of a multidimensional fall prevention program on the incidence of falling and quality of life among old people living in nursing homes.

Methods & Materials: This before-after quasi-experimental study was conducted on 60 old people living in nursing homes who met the inclusion criteria. Multidimensional fall prevention program was focused on: 1- exercise (stretching, balance, and strength) 2-training classes for caregivers and elderly and 3-environmental modification. Data were collected before and six months after the intervention using demographic and illness form, fall frequency form and the LEIPAD questionnaire. Collected data were analyzed using the paired t-test, one-way ANOVA, Mann-Whitney and Wilcoxon tests in the SPSS-16 .

Results: Before and six months after the intervention, the mean frequencies of falling were 2.00 (±0.70) and 0.20 (±0.55), respectively. The mean scores of quality of life before and six months after the intervention w ere 56.48 (±10.45) and 77.43 (±10.45), respectively. Results indicated that there were statistically significant difference between the study participants before and six months after the intervention regarding falling frequency (P<0.001) and quality of life score (P<0.001).

Conclusion: The multi-dimensional fall prevention program decreased the fall frequency and increased quality of life of participants. Health care providers, particularly nurses can use the prevention program to diminish falling incidence among elderly and improve their quality of life.

Hope and Fear in Living with HIV/AIDS: a Phenomenological Study

Ali Mohammadpour

Background & Aim: The HIV infection is a serious health problem with major effects on various aspects of life. It is essential to understand the lived experiences of patients living with HIV/AIDS. The present study was conducted to investigate affected patients' lived experiences .

Methods & Materials: This qualitative study was carried out using an interpretative, phenomenological approach. Nineteen patients with HIV/AIDS were selected using purposive sampling method. Field notes, in-depth and semi-structured interviews were used to collect data. The interviews were transcribed verbatim and were analyzed using the hermeneutic approach developed by Diekelmann (1989) .

Results: From 19 participants, 57.9% were males. Mean age was 39 years 42.1% were single 47.4% had CD4 counts less than 200 cells/mm3. The main emerged themes were as follows: 1) death way 2) halo of worries 3) hope to cure. Based on the final step of the Diekelmann approach, "being in state of hope and fear" was emerged as a constitutive pattern in patients living with HIV/AIDS .

Conclusion: Patients with HIV/AIDS experienced fears, doubts, worries, hopes and many emotional challenges in different aspects of their lives. Caregivers should understand and comprehend the emotional states of the patients. Health care providers should design effective interventions to help individuals to cope with HIV/AIDS .

Effect of Problem-Solving Skills on Depression Scores in Nursing and Midwifery Students

Somayeh Ghavipanjeh

Background & Aim: Depression is common among nursing and midwifery students. Problem-solving is a short-term intervention that can be used to treat psychological problems. This study was carried out to evaluate the effect of problem-solving skills training on depression scores among nursing and midwifery students .

Methods & Materials: This was a clinical trial. Nursing and Midwifery st udents (n=900) studying at Tabriz and Urmia universities were recruited in the study during 2 010-2011. The Beck Depression Scale was administered in both schools. Ninety two students who achieved a score above 10 in the Beck Depression Scale were selected. One school was randomly allocated to the intervention group and the other one was allocated to the control group. Students in the intervention group received six sessions of problem-solving skills training within three weeks. T he questionnaire was completed by the participants in both schools after the intervention. Data were analyzed using the independent t-test .

Results: After the intervention, the Beck Depression Inventory score in the intervention group decreased from 18.60 to 13.41 (P<0.01). There were no differences in the control group before and after the intervention (P<0.01) .

Conclusion: The problem-solving skills training program reduced depression scores. Providing information and using the problem-solving skills training are recommended .

Role of Relaxation in Pregnancy Health in Quran

Nikzad Iesazadeh

Background & Aim: One of the key factors affecting the physical and mental health of fetus is peace. According to Quran, this factor is a fundamental Principle in different fields of Islamic Ethics and law and it also affects all orders and Prohibitions. That’s because of conditions that are ordained during Pregnancy Period and of course it affects the benefits and losses of the Person in next Periods of growth. This study assessed the fundamental role of peace during pregnancy and fetal life from the perspective of the holy Quran and its priority to other functions of marriage .

Methods & Materials: This study is a retrospective review which was performed by searching library sources and 15 relevant sources were found. The concept of peace in holy Quran can be followed by keywords such as, Assurance / Etminan (Raad/28), tranquility/ Sakineh ( Fath/24), inhabitancy / Sakana (Tobeh/103), Security / Amniyat (Thein/3), Permanency / Sobat( Forghan/47). In addition, Keywords such as, Health, Pregnancy, and Sprit were studied too .

Results: Meanwhile, the topic of marriage and finding a family (including matrimony, spousal time, pregnancy and reproduction) is a composition of religious orders and prohibitions. According to some studies based on the Quran's verses and his successor’s anecdote considerable results such as reproduction, correct sexual satisfactory, moral and psychological peace was achieved. Relaxation in pregnancy phase is very important and vital process for the embryonic formation particularly in view of his/her future corporeal and spiritual life. Such standpoint is firmly emphasized by Islamic orders due to healthy generation among the human being .

Conclusion: Aquiring spiritual relaxation and developing it according to psychological guidelines and strategies of the holy Quran is necessary to achieve a peaceful and satisfactory condition during pregnancy and birth of a healthy and righteous child .

Effect of Infant Massage by Mothers on Maternal Attachment Behavior in Infants Hospitalized in Neonatal Care Units

Ziba Mosayebi

Background & Aim: Several studies have indicated that hospitalizing infants causes disruption on mother-infant attachment. The aim of this study was to assess the effect of infant massage by mothers on maternal attachment behavior in infants hospitalized in the neonatal care units .

Methods & Materials: In this clinical trial, 42 mothers and their neonates were recruited and randomly allocated to the intervention and control groups. Mothers in the intervention group received training by means of educational movies about practical exercises on how to massage the infants. The trained mothers used massage techniques on their infants for five days. The process lasted 15 minutes. The attachment of the mothers on their infants was assessed before and on the day 5 after the massage. Data were collected using the scale of mother-to-infant attachment. Data were analyzed using the Chi-squared test, Fisher’s exact test and the t-test in the SPSS-19 .

Results: There were no differences between the two groups in terms of demographic variables and the mean of maternal attachment at baseline (P>0.05). Five days after the massage, there were statistically significant differences between the two groups in the mean maternal attachment (P<0.001) .

Conclusion: According to the role of massage in attachment behavior, this traditional care is recommended to be used in neonatal units .

Effect of Acupressure on Amount of Gastric Emptying in Mechanically Ventilated Patients Hospitalized in Intensive Care Units

Nasrin Hanifi

Background & Aim: The major problem with mechanically ventilated patients receiving enteral nutrition hospitalized in the intensive care units is delayed gastric emptying. Acupressure can increase gastric motility. This study aimed to determine the effect of acupressure on the amount of gastric emptying in mechanically ventilated patients hospitalized in the intensive care units .

Methods & Materials: In this clinical trial, 78 mechanically ventilated patients were recruited using convenience sampling method and were randomly divided into two control and experimental groups. Acupressure was applied on the Neiguan point for four days in the experimental group. The control group patients received no intervention. Gastric residual volume was measured in the admission time and before the gavages. The mean gastric residual volume of the admission time and the 1-4 days after the admission were compared in the two groups. Data were analyzed using the independent t-test, Chi-squared test, covariance analysis and repeated measured tests in the SPSS-16.

Results: The results revealed that there were no differences between the two groups in the admission time and the first day (P>0.05). There were statistically significant differences between the two groups in the admission time and 2-4 days after the admission (P<0.05). The difference of mean scores of gastric residual volume were significantly different between the two groups during the four days of post intervention constantly (Repeated measured ANOVA P=0.011) .

Conclusion: The acupressure increased the gastric emptying in mechanically ventilated patients hospitalized in the intensive care units. Since the acupressure wristband was an easy to use, non-expensive, available procedure, it can be used to improve gastric emptying and prevent delayed gastric emptying complications .

Psychometric Properties of Premenstrual Symptoms Screening Tool among Female Students of Semnan University

Siavash Talepasand

Background & Aim: The aim of present study was to assess psychometric properties of premenstrual symptoms screening tool (PSST) to provide a fast and appropriate screening tool for women who suffer from severe PMS/PMDD and their clinicians .

Methods & Materials: It was a cross-sectional study. The study included 404 female students studying at Semnan University who were randomly selected using stratified method. In order to assess psychometric properties, we used the exploratory factor analysis, convergent validity (evaluated by symptom checklist-90-Revised), criterion-related validity (calculated by comparing psychiatrist diagnosis and PSST). Sensitivity and specificity coefficients of optimal cutoff points were calculated by the ROC Curve and construct validity was evaluated by the PSST ability to separate PMS and PMDD groups from healthy group. Reliability was evaluated using the cronbach’s alpha and test-retest method .

Results: The p rinciple component analysis revealed that the PSST consists of four factors: interest reduction, interference in functions, physical and neurotic symptoms, and eating and sleep patterns. As an evidence of convergent validity, PSST scores showed significant correlations with the SCL-90-R’s dimensions. Agreement coefficient between psychiatrists and the PSST diagnosis was 0.314 for the PMS and 0.80 for the PMDD. This tool separated the PMS and PMDD groups from healthy group well. Optimal Cutoff point for separating females suffering from PMDD was 2.22. The sensitivity and specificity coefficients were 0.9 and 0.77, respectively. The cronbach’s alpha was 0.91 and the test-retest reliability was 0.56 for the total tool .

Conclusion: The translated version of the premenstrual symptoms screening tool can be used as a valid tool for Iranian females. This instrument can be useful for rapid screening and identifying women who suffer from severe PMS/PMDD, especially in clinical settings .