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This study is a descriptive -analytical research which is designed to evaluate clinical skills of Nurses in coronary care units in affiliated hospitals of Tehran medical sciences University.The specific objectives of this research are as follows: Determining clinical skills of nurses in coronary care unit in the fields of patient assessment, intrepretation of Electrocardiogram, and ABG test administration, Iv therapy, educating the clients , caring the patients under cardiac catheterization and resuscitation ofcardio-pulmonary disorders. The population involved 50 nurses who were working in the coronary care units. The sample and population were the same. The researcher collected the data during a period of 3 months and observed the subjects minimum two full working shifts.The results indicated that nursing skills of the majority of the subjects towards the patientassessment was at weak level, one half of them had high level skill ofEKG interpretation(+90%), Meanwhile 2/3 of the subjects (68%) had a very weak skill (0-20%) in the field of ABGtest interpretation. One half of them had a medium skill for administration ofthe IV drugtherapy and all of them were at very weak levelforpatienteducation skills. More than one halfof these nurses had a good skill about nursing care of the patients under cardiaccatheterization. Finally, the last objective (Cardiac resuscitation skill) was not analysed due to afew cases.

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Background & Aim: Patient education, one of the most important nurses responsibilities, depend on their motivation therefore, this study was performed and the purpose of the study was for determining the nurses motivating factors related to the patients education .

Methods & Materials: A descriptive cross sectional research was carried out among the nurses in the hospitals affiliated to Tehran University of medical science. Sample population was 214 nurses selected by stratified & cluster sampling. Data was collected by questioner through self reporting. The data were analyzed by SPSS computer software. Descriptive statistic and 2 Test, Fisher Exact Test, Exact Test Mont Carlo were used.

Results: Data of motivating factors categorized in 3 levels, high, moderate, low with Lickrate scale showed that in nurses’ opinion salary and payment (48%), facilities (49.5%), supervision (57.5%), have average effect on their motivation related to the patient education. Job security (68%), respect & appreciation (76%), career development (74%), work-interest (81.5%), knowledge (85.5%), professional responsibilities (90%) have much effect on their motivation related to the patient education. Statistical test showed a meaningful relation between demographic variables and motivating factors.

Conclusion: According to the findings, Job security, respect & appreciation, career development, work-interest, knowledge, professional responsibility have much effect on the motivation for patient education.

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Background & Aim: Nurses have the major role at care continuity and health promotion. They frequently affect total productivity in a organization. However, the nurses believe that due to several barriers they have not desire productivity, therefore the health care have been left at level of quality. The aim of this research are assessing nurses&apos view about productivity and role of human resource on it.

Methods & Materials: This study has been done based on grounded theory method. Open interviews has been used for gathering of data. Sampling was purposive in beginning study but so that study was proceeding and categories were completed, it changes to theoretic sampling. Constant comparative analysis was method of data analyses.

Results: Essential themes emerged from the data in human resource category. These are: systemic calculating number of staff, accurate staff select and use criteria for them, provide adequate staff from various categories in total year&aposs day, accept patient when as coordinate to in charge nurse and well communication. These make necessary groundwork for productivity. Then accidents that emerged from inappropriate quantity and quality of human resource will be decreased. These enhance nursing productivity the biggest group of health care services. Model of Productivity and human resource effects on it’s, from nurses&apos view, has concluded of this research.

Conclusion: In nurses&apos view that participates in this research, human resource can affect on productivity process and improve it, then it lead to develop quality care- health care vision and goal.

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Background & Aim: Performance appraisal is one of the most important duties for nursing managers. This will improve the quality of nursing care, and it needs suitable approaches and effective strategies in nursing services. The aim of this study is to determine the impact of performance appraisal using management by objective approach on nursing care quality.

Methods & Materials: This was a quasi-experimental and single-blind study that was carried out in two surgical units of an affiliated hospital of Tehran University of Medical Sciences. 80 patients were selected using a randomized sampling. The quality of nursing care were controlled in both experiment and control units before and after the performance appraisal procedure. The procedure was programmed on the basis of management by objective approach for six months in the experiment unit. In the intervention unit, nursing performance appraisal was done three times and in every time head nurse and supervisors participated in giving feedbacks and recommendations for the nurses. At the end of the intervention, quality of nursing care was assessed in both groups blindly. The results were compared and statistically analyzed.

Results: Significant difference was found between quality of nursing care in the experiment and control units (P<0.001). Quality of nursing care was significantly different before and after intervention in the experiment unit (P=0.009).

Conclusion: Performance appraisal using management by objective approach could increase the quality of nursing care. As a result, using nursing performance appraisal plans according to the basis of MBO could be an effective evaluation way to access the quality of nursing care.

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Background & Aim: Privacy is one of basic rights of the patients. Privacy becomes important for the adolescents when they hospitalize in an unfamiliar environment. This study aimed to compare the perceptions of inpatient adolescents with nurses on the observance of privacy and its importance.

Methods & Materials: In this cross-sectional study, 175 nurses and a convenience sample of 180 inpatient adolescents who had met the inclusion criteria were recruited to the study. Data was gathered using a questionnaire. Man-whitney u and kruskal-wallis statistical tests were used to analyze the data.

Results: The results showed that there was significant differences between nurses&apos and inpatient adolescents` perceptions on the observance of privacy and its importance (man-whitney u, P<0.001). The most important priority regarding the privacy from nurses&apos point of view was "covering the unnecessary parts of the body while caring" whilst it was "providing a pleasant decorated environment, telephone, toilet and bath in room, and hospitalization in a room with peers" from the adolescents&apos point of view. The most observed case about privacy from the nurses&apos point of view was "taking immediate action to help the teenagers if necessary" whilst, from the adolescents view, it was "calling them with their favorite names".

Conclusion: The mean perceptions of nurses were higher than the adolescences toward observance of privacy and its importance. The results can guide nurses to improve quality of care for this group.

 

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Background & Objective: Privacy is a basic humanity principle. Protecting patients&apos privacy is a necessity in health care organizations and along with the patients&apos satisfaction, is one of the main indicators of quality of care. The objective of this study was to assess patients&apos privacy protecting by medical staff and its relation to patients&apos satisfaction.

Methods & Materials: This is a cross-sectional survey in which 360 inpatients were recruited using convenience sampling method from an emergency department. Data were collected using a questionnaire and were analyzed using statistical tests in the SPSS.

Results: According to the results, about one half of the patients reported poor privacy protecting and one other half (49.4%) reported that their privacy was protected "relatively good" to "good". A strong correlation was found between level of privacy protected and the patients&apos satisfaction in various dimensions. There was significant correlation between some of demographic variables with privacy protecting and patients&apos satisfaction.

Conclusion: In our study, protecting patients&apos privacy and also patients&apos satisfaction was not generally appropriate. More attempts of clinicians are required to improve the quality of care to promote patients&apos privacy as well as patients&apos satisfaction.

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Background & Objective: Conflict occurs more frequently in health care organizations than the other settings due to complexity, frequent interaction between personnel, variations in specialties, roles, and hierarchy. Although conflict is not harmful and destructive in its nature and some degrees of conflict can help to improve health care services, high levels of conflict or its continuity may be harmful. Therefore, it is necessary to manage and control conflict. This study was carried out to assess the relationship between components of the conflict control model.

Methods & Materials: In this cross-sectional study, we developed a questionnaire that probed the relationships between components of conflict control model. A total of 290 nurses were recruited to the study using multi-stage sampling procedure from general educational hospitals in Tehran. Data were gathered using a questionnaire. Content validity of the questionnaire was examined by the expert panel. The internal consistency of the questionnaire was 0.81. Data were analyzed in the SPSS using descriptive statistics and spearman statistical test.

Results: The range of age was 22-53 (34.5±8.2). The majority of the respondents (88.6%) were female, 57.6% were married and 84.8% were staff nurses. From the majority of nurses&apos perspective, the meaning of conflict was discoordination, disagreement and disparity. However, some of the nurses meant it as violence, and difficult issues. About 41.4% of the respondents used negotiation, when they faced up to conflict. Other strategies were aggression, disagreement, avoidance, forgiveness, ignorance, and imposing own ideas to the others. From the respondents&apos point of view, factors that might cause or control the conflict were "mutual understanding and interaction" (32.4%), personality of nurses and their individual characteristics (26.6%), and conditions of the job (21.7%). Interaction was recognized to be the core strategy in conflict control model. Interaction had also significant associations with the five main variables in this study.

Conclusion: Lack of appropriate and efficient communication was an important factor in occurrence of conflict from the nurses&apos point of view. It is essential to improve nurses&apos and managers&apos communication channels by helping personnel to use effective communication skills. This measurement can be helpful for staff in understanding each other and reducing misconceptions. In addition, recognizing additional factors and variables that increases the occurrence of conflict can help to modify effective approaches.

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Background & Objective: Invasive procedures are severe stressors for
in-patient children. The stress result in sleep disorder, reduced concentration, and increased pain. Nowadays, pharmacologic and nonpharmacologic interventions are used to control stress. We aimed to assess the effect of massage on children&aposs anxiety level before intensive procedures.

Methods & Materials: In this clinical trial, 70 children aged 7-11 were recruited from a children hospital. The participants were randomly allocated to the intervention and control groups. The intervention group received massage therapy in the Yeen tang point and palms for five minutes. The control group received the usual care. Anxiety was measured using OSBD-R. Data were analyzed using Mann-Wittny and Willcoxon statistical tests.

Results: The anxiety level was not significantly different between two groups before the intervention (Control group: 3.24±0.48 Intervention group: 3.24±0.56) (P=0.472). Following the massage, the anxiety level decreased significantly in the intervention group (Intervention group: 1.57±0.54 Control group: 3.37±0.46) (P<0.001).

Conclusion: Massage in the Yeen tang point and palms can reduce the anxiety level in hospitalized children prior to invasive procedures. It is recommended to use this massage technique in pediatric wards to reduce anxiety level.

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Background & Objective: Due to physical and mental complications, stroke causes disability in self-care and adherence to rehabilitation in patients. The purpose of this study was to assess the adherence to rehabilitation regimen in family caregivers of patients with stroke.

Methods & Materials: In this cross-sectional study, 180 family caregivers of patients with stroke were recruited to the study using convenience sampling method. The participants were asked to complete demographic sheet and the Adherence-of-Therapeutic-Regime Questionnaires during two months of stroke. Data were statistically analyzed using descriptive and inferential tests in the SPSS-16.

Results: Findings indicated that only about 10% of caregivers were in good levels of adherence to the rehabilitation regimen and about 25% of them were weak. The weaknesses of the adherence were related to rehabilitation of motion, cognitive and emotional deficiencies, and also prevention of respiratory and skin disorders.

Conclusion: According to the study, a small number of family caregivers were in appropriate level for adherence to the rehabilitation regimen. The nurses should be able to empower the family caregivers to decrease physical and psychological disorders related to stroke in patients.

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Background & Aim: Premature infants undergo painful and stressful procedures during care and treatment. Nurses can help to reduce short- and long-term effects of pain caused by diagnostic and therapeutic procedures using various methods including music therapy. The aim of this study was to assess the effect of music therapy on physiological pain responses of premature infants during and after blood sampling.

Methods & Materials: This was an experimental study with crossover design conducted on 20 premature infants hospitalized in the intensive care unit of a hospital affiliated to the Tehran University of Medical Sciences for a five months period in 2010-11. Infants were randomly allocated in two groups of experiment and/or control. Each infant was considered as its own control. We assessed the physiological pain responses caused by blood sampling such as heart rate and oxygen saturation level. Infants in the experiment group listened to the Transitions music five minutes before until 10 minutes after the blood sampling. The responses were recorded and reviewed ten minutes before until ten minutes after the blood sampling in both groups and physiological changes were detected. Data were analyzed using ANOVA and Chi-square tests in the SAS and SPSS.

Results: Results showed significant difference in heart rate between the experiment and control groups during needle exit (P=0.022). There was also significant difference in heart rate between experiment and control group in the first 5 minutes of blood sampling (P=0.005).

Conclusion: Results showed that music therapy could reduce some physiological responses of pain during and after blood sampling. Music therapy can be used as a beneficial intervention following painful procedures such as blood sampling in the NICU.

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  Background & Aim: Governing organizational culture in hospitals can affect patients’ safety through establishment of behavioral norms among nurses. This study aimed to determine the relationship between nurses’ perception of organizational culture and their performance about patients’ safety .

  Methods & Materials: In this cross sectional, descriptive-correlation study, we used stratified sampling method to recruit 250 nurses working in general wards and emergency departments of general hospitals in Babol, 2013. Data were collected through questionnaires and were analyzed using the descriptive and inferential statistic tests including the Pearson test, ANOVA test and T-test in the SPSS . 

  Results: Nurses' perception of organizational culture was "fairly desirable" (54.5%). Performance of the nurses in the field of patients' safety was "desirable" (88%). The Pearson test showed that there was a positive and statistically significant correlation between nurses’ perception of organizational culture and their performance in the field of patients’ safety (P<0.01) .

  Conclusion: It seems that improving organizational culture in hospitals can enhance nurses’ performance in the field of patients' safety .

  

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  Background & Aim: Mothers often feel anxious about giving care to their premature babies. This maternal stress is associated with negative attitudes and behaviors towards babies. The aim of this study was to assess the effect of Kangaroo mother care on stress among mothers with premature babies .

  Methods & Materials: This quasi-experimental study was carried out on 46 pairs of mothers and their premature babies hospitalized in the ICUs of Shahid Sadooghi and Tamin Ejtemaee hospitals. The participants were selected using convenience sampling method and were assigned into two intervention and control groups. In the intervention group, the Kangaroo mother care was provided to the babies after breastfeeding for about 30 minutes once a day for four weeks. Maternal stress was measured using the Parental Stress Scale before and immediately after the intervention. Data were analyzed using the Chi-squared test, t-test, and Mann-Whitney test . 

  Results: The mean of stress score in mothers of the intervention and control groups were 102.0 ± 17.02 and 174.52 ± 18.25, respectively (P<0.001). The stress score was significantly different before and after the intervention among mothers of the intervention group (P<0.001) .

  Conclusion: The Kangaroo mother care decreased stress score among mothers who had premature babies. The Kangaroo mother care is strongly recommended to be used by mothers with premature babies .

  

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  Background & Aim: Implantable Cardioverter Defibrillator is the most effective treatment for cardiac dysrhythmias. Having such life-saving device is the unique experience with important changes in the patient’ life. Understanding of these experiences can lead to success in treatment and follow- up.This study aimed to understand the experiences of patients with Implantable Cardioverter Defibrillator .

  Methods & Materials: A qualitative study using interpretative phenomenological approach was used. Thirteen participants were selected purposefully from heart clinics of Imam Khomeini hospital (Tehran). Each semi-structured interview was conducted in the period 30 to 45 minutes. Data analysis was performed using the six steps of van Manen . 

  Results: The main theme of ‘Start Living Again’ was extracted from patients with implantable defibrillator.This theme consist of ‘a sense of security’, ‘living with angel’, ‘attachment to the device’ and ‘attempt to maintain power’ .

  Conclusion: The participants with an Implantable Cardioverter Defibrillator have a life again with a sense of security and peace of mind. They try to keep this life-saving device.Therefore, health care providers, especially nurses can help this patients and their families by providing appropriate self care education .

  

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  Background & Aim: With regard to the i ncreasing trends of information and complexities of health organizations , using of a dvanced tools and computers is necessary . Hospital staff is key members to develop health information systems, because they play not only a major role in the management of system, but also in the development, implementation and evaluation of the system. Since the evaluation of information systems is not possible without analyzing of the experiences and users ' views, thus the aim of this study was to explore nurses' experiences of the hospital information systems .

  Methods & Materials: In this qualitative study, we investigated the nurses' experiences of the application of hospital information systems for the rich and deep understanding of the phenomenon . The c onventional content analysis was used to collect and analyze the data . Face- to-face and semi- structured interviews were conducted with participants to achieve full saturated information. Saturation was achieved with 18 interviews . 

  Results: The emerging themes were gradual system evolution, , audit and responsibility, security, effectiveness and accessibility .

  Conclusion: Nurses' experiences were positive with the applying of the Health Information Systems. The negative experiences of the nurses were related with the application of the system and redundant work, not the system itself. Regarding to participants need, it is recommended that the system should be extended to other duties such as reporting so that more effective use of the system in order to improve the quality.

  

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  Background & Aim: H ospital emergency departments in Iran are prone to crisis for different reasons. Understanding nurses’ perspectives about these crises help in crisis management. The purpose of this study was to explain the nature, causes and consequences of crisis in emergency departments from nurses’ points of views .

  Methods & Materials: This was a qualitative study with content analysis approach. Data were collected using semi-structured interviews with 12 nurses working in emergency departments of general and trauma hospital. Participants were selected through purposive sampling method. Interviews lasted between 45 minutes to an hour. The data were recorded and transcribed. The accuracy and consistency of data were confirmed. Interviews were conducted until no new data were emerged. Data were analyzed using qualitative content analysis with conventional approach . 

  Results: Five themes were emerged through data analysis including: 1) unexpected imbalance 2) events 3) defect in service provider factors 4) positive consequences and 5) negative consequences .

  Conclusion: The results of this study revealed that every factor that can affect balance and daily tasks can make a crisis in emergency departments. Causes of the crisis can be divided into internal or external factors. Several measures should be planned to decrease the crisis in emergency departments from high rank decision making in the ministry of health and medical education to planning appropriate programs in hospitals .

  

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  Caring is the most central concept in nursing. This concept distinguishes nursing from other health professions. However, according to some experts’ opinions, caring is not an only-nursing concept it is defined as the heart of all health professions. Caring is entered in the philosophy, vision and mission of several health organizations (1) and is introduced as the essence of nursing and the fourth complementary concepts of nursing Meta paradigm (2). Caring, as a central concept in nursing, has led to developing various caring theories. The most popular ones involve the cultural care theory of Leninger and the human care theory of Watson that were presented in the 1970s. In addition, the theory of Roach was developed in the 1980s. Another theory was presented by Boykin and Schoenhofer in the 1990s. These theories can be compared in some aspects including origin, domain, and definition of caring, description of nursing and other key components (3).

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Background & Aim: Although the number of kidney donors is increasing in the country, few relatives decide to donate. Decision making on kidney donation to a relative faces many challenges, while how to make this decision is still ambiguous. The aim of the present study was to explore the way of decision making about kidney donation to a relative.
Methods & Materials: The present study was a qualitative study conducted in 2015. The thematic analysis approach was used to analyze the data. In this study, 16 relative donors from the kidney transplant centers of all the teaching hospitals affiliated to Tehran University of Medical Sciences (Imam Khomaini, Shariati, Sina) were selected through purposive sampling. Then, 16 face-to-face, in-depth, semi-structured interviews were conducted. Data were analyzed using the thematic analysis approach proposed by Clark & Braun (2006).
Results: Data analysis led to the identification of two themes “being resolute in decision making” and “mulling over the decision”. The first theme was comprised of three subthemes including donation with a heartfelt desire, consistency in decision making, discretion in decision making, and the second theme was consisted of two subthemes including unsteady in decision making and bargaining in decision making.
Conclusion: Decision making on kidney donation to a relative faces a variety of challenges influenced by the donor’s family background, the supportive role of family members, kinship ties and a sense of love for relatives. By providing knowledge and awareness to donors to address ambiguities and subjective questions, they can have an important role in developing the culture of relative’s kidney donation.
 

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Background & Aim: Urinary incontinence is a common disorder in women. Pelvic floor muscle exercise is one of the effective treatment methods. Self-efficacy is considered an effective and strong predictor of willingness to perform and continue these exercises. In Iran, there is no appropriate tool for assessing self-efficacy. So this study was performed to determine the psychometric properties of the Broome scale in women with urinary incontinence.
Methods & Materials: A psychometric study of the Broome scale was conducted on women with urinary incontinence who referred to health centers affiliated to Tehran University of medical sciences in 2015.In this study, following processes were implemented: translation, back translation, face validity, content validity using CVR and CVI, reliability using Cronbach’s α coefficient, and construct validity using explanatory factor analysis.
Results: The face validity was confirmed through the modification of ambiguous items based on the patients’ views. Content validity (CVR= 0.8 and CVI= 0.8 to 0.9) and reliability (Cronbach’s α= 0.96) were also confirmed. Explanatory factor analysis showed two factors with eigen value more than 1 including pelvic floor exercise self-efficacy in usual and special situations. These factors explained 82.08 percent of the total variance.
Conclusion: The reliability and validity of the Broome scale were confirmed for using by Iranian women with urinary incontinence, and this scale can be used to measure these women's self-efficacy in performing pelvic floor exercises.
 

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Background & Aim: Concerns over limited equipment and resources particularly in the intensive care units have raised the issues of medical futility, futile treatment, and futile care. Considering that there is no consensus in the definition of the concept of futile care, this study aimed to explore the concept of futile care, especially in terms of clarifying it with the concept of futile treatment.
Methods & Materials: This is a qualitative study conducted using the conventional content analysis approach. In this study, 22 nurses, eight medical specialists, four medical ethics specialists, and one sharia specialist, were purposively recruited with the consideration of maximum variation. Data were collected using individual, in-depth, semi-structured interviews.
Results: The main theme of the study was “care is never futile: care as goal”. This theme is consisted of four main categories including: 1. care as an indispensable service; 2. care as an ongoing process focused on human existence; 3. care as a sacred and essential process in Islam; 4. the necessity for differentiating between care and cure: futile treatment instead of futile care.
Conclusion: Although, in some cases, and depending on the circumstances, medical interventions may be futile, care is never futile. According to the findings of this study, the terms medical futility and futile care cannot be used interchangeably because interchangeable use of these terms can devalue the nature of care. Thus, it is necessary to use the term of “futile treatment” instead of “futile care”.
 

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Background & Aim: Nursing care is an essential part of health care services. Missed nursing care is a new concept referring to any aspect of care, that is omitted or delayed. The present study aimed to assess missed nursing care and its related factors from the viewpoints of nurses working in the hospitals affiliated to Kerman University of Medical Sciences in 2017.
Methods & Materials: In this descriptive, cross-sectional study, 300 nurses participated. Two questionnaires on missed nursing care, and its related factors were used for data collection. Data were analyzed through the SPSS software version 20 using descriptive indices.
Results: The mean score of missed nursing care was 32.28±7.41, which was lower than the median (range) of the questionnaire. The highest mean score of missed nursing care and its related factor, respectively were “attending the interprofessional patient care conferences” and “the volume of activities related to patients’ admission and discharge”.
Conclusion: The level of missed nursing care was lower than the median in the present study, which can be lowered by proper management. In addition, by decreasing nurses’ workload, missed nursing care related factors can be reduced.