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The objectives of this analytical-descriptive study were determinig the incidence of nosocomial pneumonia as a result of aspiration among the hospitalized patients in the intensive care units of Tehran university of medical sciences in 1999.For collecting data, the applied instruments consisted of: Glucose oxidase tape, thermometers, blood tests, chest radiography, culture from endotracheal secretions and checklists.The samples, consisting 80 patients, were assigned into 2 groups according to the day starting gavage: the first group included 50 patients from the first day connecting to ventilator and second group included 30 patients from the second day connecting to ventilator.Following nearly 5 months of sampling incidence of nosocomial pneumonia resulting from aspiration estimated to 31.2%with an interval estimation of 21%<<41 %. Moreover, incidence of nosocomial pneumonia lacking aspiration estimated to 18.7% with an interval estimation of 1 l%<<27%.The results indicated that remaining the nosogastric tube and early gavaging of the patients under ventilation can be effective risk factors in the incidence of nosocomial pneumonia. Furthermore, the most pulmonary infiltration was happened in the upper lobe of the right pulmonary. Therefore, it could be supposed that the patients during aspiration had been mainly slept on their back.

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Unintended pregnancy is a world wide problem that affects women, their families, and society. From a total of 175 million pregnancies per year 75 million of them are unintended. This cross-sectional study was undertaken to determine prevalence of unintended pregnancies and pertinent factors and suggests an appropriate solution. A sample of 400 women who were seeking pregnancy tests in laboratories of hospitals affiliated of Tehran University of Medical Sciences, at the obstetric and gynecologic ward, and who had positive tests were selected by the Poisson random sampling method. Women who were found to have diseases such as hydatidiform mole were excluded. A questionnaire was used to collect data. Pregnancy intention was measured using NSFG 2001 questionnaire. Descriptive and analytic tests (chi-square, Fisher exact, t-test) were used to analyze the data. Prevalence of unintended pregnancy was 47.5%, of whom 36.3% hadn’t used contraception methods. Fear of side effects (66.7%) was the most prevalent reason of not using contraception. The main reason for unintended pregnancy was economical problems (42.6%). 63.7% of women with unintended pregnancy had used one of contraceptive method but 86.8% of users had used that method in an incorrect way. Also the results indicated that the age of women, educational status, number of children, husband’s age and education were associated with contraceptive use. The results indicated that prevalence of unintended pregnancy is high and the contraceptive methods weren't used or were used incorrectly by most of them (91.6%). This may show the necessity of training women about contraceptive methods and side effects of unintended pregnancy. Due to the important role of health care providers they should be trained to give such consultation to women.

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Introduction: Satisfaction from marital relation is a fundamental factor in stability and maintenance of marital bond. Sexual satisfaction is one of the effective factors in spouse relation satisfaction.

Materials and Methods: This research is a correlation study. A sample of 400 women referring to health care centers in Arak city was selected randomly in 2003. The information collecting tools were questionnaires. To analyze the data, the descriptive statistical, frequency distribution charts, the mean and central tendency as well as inferential statistics (2 test and Kruskal Wallis) have been applied.

Results: According to the results, there was a meaningful relationship between having orgasm and sexual relation satisfaction, nonsexual relation satisfaction with spouse and marital relation satisfaction. Also, there was a meaningful statistical relationship between orgasm experience and variables of age, spouse s age, education, spouse s education, duration of marriage, number of children, and family s income.

Conclusion: There is a relationship between women s orgasm experience and the amount of satisfaction from marital relation. Hence, it was suggested that the health planners and the officials in charge pay more attention to women s sexual problems and a sexual counseling clinic be established in health care centers.

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Introduction: Obesity is a problem to individual’s health and determintion of its causative factors is essential for prevention of obesity and maintenance of health.
Materials and Methods: This research is a case-control analytic study (prospective) which has been conducted in kindergartens and pre-elementary schools affiliated to health organization in Qazvin city. After a preliminary study on twenty 5-6 year-old children, 35 obese (case) and 70 normal (control) children were chosen. The kindergartens and pre-elementary schools were selected based on random cluster case-picking method. The tools were a questionnaire, tape meter and spring scale. The obesity was defined as a weight/ height ratio more that two standard deviation above average for sex. The statistical tests were 2, t test and Mann-Whitney test.
Results: The findings showed that the individual characteristics of the child, except weight birth and playing hours, were congruous in case and control groups. Also there was no significant difference between milk-feeding patterns in case and control groups, 77.1% and 85.7% dominant feeding on mother's milk, 20% and 8.6% feeding on formula and 2.9% and 5.7% feeding jointly on mothers milk and formula, respectively. In case of length of each feeding pattern group, no meaningful difference in two groups was found. Therefore all the survey hypotheses were rejected.
Conclusion: According to the research findings, no meaningful relationship between feeding patterns in infancy and obesity in 5-6 year-old children was found and hence probably other factors are playing a role in predisposing to obesity. It is recommended that more extensive researches being carried out in this field.

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Introduction: It has been estimated that 335 million elderly, about 13 percent of general population, live in developing countries. It has been predicted that in 2040, this percentage will rise to 20 percent. Psychophysical complains are common in elderly and investigation of quality of life (QOL) in these samples of population is very important.

Materials and Methods: This research is a descriptive analytical study carried out to investigate the QOL of elderly residents of Zahedan city. In this study a short form questionnaire (SE 36) of QOL was used. Estimated required number of the samples was 200 that were selected with random cluster sampling.

Results: Average age of studied population was 72.3 years and their mean number of children was 6.7. Mean scores of the general health perception, physical activity, physical role function, bodily pain, social function, emotional role function, vitality and mental health were 38.6, 42.7, 36.8, 37.8, 43.9, 45,46.7 and 42.7, respectively.

Conclusion: Since currently there are no sound data for elderly QOL in Iran, considering mean QOL score of 50 and standard deviation of 10, all observed QOL scores (in eight dimensions) were low. These findings show importance of attention to QOL in elderly clients.

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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.

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Background & Aim: Multiple sclerosis (MS) is characterized by a broad spectrum of physical and psychological impairments. Fatigue is a common and disabling symptom for individuals with MS 75%-90% of individuals with MS reported problems with fatigue. They describe fatigue as a frustrating and overwhelming symptom that can be disabling.

Methods & Materials: Assessing the usage and efficiencies of fatigue reducing strategies in patients referred to multiple sclerosis association of IRAN. This is a cross-sectional survey study of 100 patients who were selected randomly. The method of collecting data was by asking and answering and the research tool was a questionnaire. The questionnaire was prepared in four parts. Part one included the disease and demographic questions. Part two included Fatigue Severity Scale (FSS). Part tree included Fatigue Reducing Strategies and part four included Fatigue Relief Scale. The data were collected in one stage, and analyzed with SPSS software. To analyze the data, descriptive and inferential statistical methods (fisher exact test, chi square test, correlation coefficient, meant, standard deviation) have been used.

Results: The Findings of this study represented that the majority of subjects (63%) were suffering of severe fatigue symptom. The most frequently used strategies to relive fatigue were lie down (51%), watching TV (30%), frequent rest (28%) and sitting without doing any thing (28%). But the most effective strategies were sleeping (8.17), daily nap (8.4), take a shower with lukewarm water (7.25), avoiding heat (7.16), exercising (7.14), praying (7.0) and socialization (7.0). Results also showed that fatigue have been affected by some variables such as education level, having child, number of children, job status, daily working hours, dwelling place and time of bed-ridden. Findings also suggested that all strategies will be useful when the highest level of fatigue has been experienced (p=0.532, r=-0.063).

Conclusion: The most common strategies were not necessarily the most effective ones. Most frequently used strategies were included sleeping, napping, warm water bathing, heat avoidance, and exercising. However more physically active strategies such as exercise and socializing were more effective strategies. The patients should be suggested that to try variety of strategies such as walking and exercising besides sleeping and resting to relive the fatigue. Patients should be instructed to monitor the intensity of their fatigue and also be encouraged to maintain that level of activity which is in balance with efficient rest period.

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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: 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 & Objective: Job satisfaction is the person&aposs attitude toward his/her work. Increasing nurses&apos job satisfaction result in better quality of nursing care and reduces the number of nurses who leave their job. Conditions of different wards of hospitals can affect nurses&apos job satisfaction. The aim of this study is to compare nurses&apos job satisfaction in oncology and delivery wards.

Methods & Materials: This is a cross-sectional comparative study. A total of 144 nurses (94 nurses in oncology and 50 nurses in delivery wards) of Tehran University of Medical Sciences hospitals participated in the study. Data were collected using a questionnaire. Data were analyzed using descriptive and inferential statistical test (chi-square).

Results: Comparison of the global job satisfaction among oncology and delivery nurses, indicated that there was no statistical significant relationship between them from working in a specific ward point of view (P=0.637). Also there was no significant relationship between intrinsic job satisfaction and working in a specific ward (P=0.966). There was statistical significant relationship between extrinsic job satisfaction and working in specific ward (P=0.039).

Conclusion: Considering that extrinsic job satisfaction of oncology nurses were low, reconsideration about specific conditions of oncology wards and taking efficient measures in improving nurses&apos extrinsic job satisfaction (especially oncology nurses) is essential.

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Background & Aim: High frequency of traumatic and non-traumatic brain injuries in one hand and improvement of the health care condition to restore patient&aposs life in the other hand has increased the frequency of comatose patients in ICU. These patients often experience physical, cognitive, behavior or sensory defects, and the sensory input reduction in intensive care units expose them to cognition disorders. It seems that using sensory stimulation programs may be effective in preventing from sensory deprivation and facilitating recovery process.

Methods & Materials: In this quasi-experimental study, 30 comatose patients who were hospitalized in ICU in Shariati and Sina hospitals were sought to be studied. The subjects were selected randomly using matching that was placed in case and control group. In the intervention group, patients received an auditory stimulation for 2 weeks, 6 days of a week, 2 times a day. The auditory stimulator was a recorded tape (5-10 minutes) of a familiar voice for 30 minutes. The Glasgow Coma Scale (GCS) was used for measuring the level of consciousness (LOC). LOC was measured before and after each intervention 4 times a day. The control group LOC was measured in a similar manner to the case group. At the same time, homodynamic symptoms (blood pressure, pulse rate, and mean arterial pressure) were measured. Non-parametric test was used for analyzing data. The data was analyzed through SPSS V.11.5 computer software.

Results: The findings indicated that there was a significant difference in LOC of the intervention group at the first day and after fourteen days of the intervention (P<0.001), but not in the control group (P=0.769). Although 2 groups were similar in LOC of the first day (P=0.605) but there were a significant difference between their LOC at the fourteenth day (P=0.001).

Conclusion: The results showed that the auditory stimulations with familiar voice were effective in increasing LOC in the comatose patients. It is suggested that nurses expose comatose patients with auditory stimulations using a recorded tape of familiar voice in ICU.

 

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Background & Aim: Adverse childbirth experiences as a trauma can evoke fear and post-traumatic stress disorder in some women. This study was conducted to investigate the effect of counseling on post traumatic stress disorder after a traumatic childbirth.

Methods & Materials: This research was a clinical trial which was conducted at Kamaly hospital in Karaj. Samples (300 women) who had experienced a traumatic childbirth were selected by a convenient sampling method and were randomized into an intervention (n=150) and a control (n=150) group. The intervention group received face-to-face counseling within 72 hours of birth for forty to sixty minutes in a session. The control group just received usual care after childbirth. The data collection tool was questionnaire, which was completed via interview. The measuring variables were demographic characteristic, reproductive history, maternity social support, and post-traumatic stress disorder. Data were analyzed using descriptive statistics and inferential tests (Chi-square, Fisher&aposs exact test, and generalized Fisher&aposs exact test) by SPSS v.13 software.

Results: After 4-6 weeks of follow-up there was no significant difference regarding post-traumatic stress disorder between two groups (P=0.295). At 3-month of follow-up, the intervention group reported less post-traumatic stress disorder comparing with the control group (P=0.001).

Conclusion: A midwife-led counseling plan is effective in reducing post-traumatic stress disorder during a long term.

 

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Background & Aim: Diabetes education does not assure adherence to diabetic regimen. The aim of this study was to investigate the effect of nurse-led telephone follow ups (Tele-Nursing) program on adherence to diabetic diet among type 2 diabetic patients.

Methods & Materials: This was a quasi experimental study. Sixty patients who were registered at Iranian Diabetes Society were selected using convenience sampling method. Data gathering instruments included a data sheet to record glycosylated hemoglobin and a questionnaire. Data were gathered at baseline and 12 weeks after the intervention. First, all participants attended in a three-day self-care education and dietary consultation program at Iranian Diabetes Society. Then, they were randomly assigned to the experiment and control groups. Telephone follow ups were applied in experiment group for 3 months, twice a week for the first month and then weekly for the second and third months. Data were analyzed using SPSS version 13.

Results: Results showed that there were significant statistical differences between control and experiment groups in adherence to diabetic diet (P=0.035). There were significant differences in glycosylated hemoglobin between control and experiment groups after the intervention (P<0.000).

Conclusion: According to the results of the study, it is concluded that the nurse-led telephone follow ups can improve HbA_1c and diet adherence in type 2 diabetic patients.

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Background & Aim: It is important to measure the anxiety level in patients who undergo heart surgery and find out ways to relief it. This study aimed to determine the effect of cardiac rehabilitation program's first phase on the level of anxiety among patients hospitalized for coronary arteries bypass surgery.

Methods & Materials: In this randomized clinical trial, sixty patients were selected using block sampling and randomly allocated into experimental and control groups. Data were gathered using a questionnaire including the spiel burger's standardized questionnaire. The level of anxiety was measured in both groups. Then, the first phase of cardiac rehabilitation program (including physical exercise, and daily living activities) was carried out in the experimental group. Finally, patients in the experimental group discussed their experiences of surgery. Control group Patients received usual care. The level of anxiety was measured in both groups the day before surgery and at the time of discharge. Data were analyzed using t-test, chi-square, and Friedman tests in SPSS.

Results: Findings showed that the level of anxiety had no significant differences between two groups at the time of admission. After implementing the rehabilitation program, the level of anxiety decreased significantly (P<0.001) in the experimental group. Significant differences were observed in the level of anxiety between two groups after intervention (P=0.015) and at the time of discharge (P=0.038).

Conclusion: This procedure should be used in surgery patients

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Background & Aim: Patient monitoring in cardiac intensive care unit (CICU) is considered to be non-invasive and safe, but it can cause unintentional catastrophic consequences due to the alarm fatigue. The aim of the study was to determine the status of monitoring system alarms and nurses’ alarm fatigue.
Methods & Materials: This descriptive, cross-sectional study was carried out in cardiac intensive care units of a hospital in Fars province from January to March 2019. The alarm status of 24 monitoring devices was observed for 100 hours in 100 patients under the physiological monitoring. Patients under monitoring were included in the study using a continuous and convenience sampling. Also, 62 nurses working in five CICUs of this hospital completed the alarm fatigue questionnaire (through census). The data obtained from the observation and the questionnaires were analyzed by the SPSS software version 16 using descriptive statistics.
Results: The auditory alarms of monitoring devices were turned off and only visual alarms could be recorded. In the visual alarms recorded during 100 hours, 131 alarms (53.47%) were technical, followed by the false, nuisance, and ultimately real or actual alarms with rates of 40 (16.33%), 38 (15.51%) and 36 (14.69%), respectively. The mean (and standard deviation) score of alarm fatigue among nurses was 21.04 (7.52), and the alarm fatigue score for %50 of nurses was higher than the average score.
Conclusion: Turning off the auditory alarms can lead to serious risks to patients. Also, a high proportion of technical, nuisance, and false alarms can cause alarm fatigue in nurses. Adopting solutions in accordance with standard guidelines and checking physiological monitoring devices in hospitals are necessary in order to reduce false, nuisance, and technical alarms. Failure to pay attention to these issues leads to the alarm fatigue among nurses, which itself results in numerous consequences such as compromising the patients’ safety.
 

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Background & Aim: Anxiety is one of the most important mental problems in patients who are candidate for coronary angiography, which can have negative physiological and psychological consequences and ultimately lead to the increased hospital stay, increased patient need for analgesics, increased costs and increased incidence of angiographic complications. Therefore, the aim of this study was to determine the effect of aromatherapy on anxiety in patients undergoing coronary angiography.
Methods & Materials: In this randomized clinical trial, 80 patients undergoing coronary angiography referred to the post-cath. ward of Shahid Mohammadi hospital in Bandar Abbas in 2018 were selected and allocated into two groups of intervention and control through the random numbers table. In the intervention group, the eye pads impregnated with 0.2 ml of peppermint oil were used, and in the control group, the pads impregnated with 0.2 ml of placebo were placed on their chest for 20 minutes. Patient’s anxiety levels were recorded before and after the intervention. A demographic characteristics questionnaire and the Spielberger standard questionnaire were used for the data collection. The   data were analyzed by the SPSS software version 24 using the descriptive and inferential statistical methods in accordance with the objectives of the study.
Results: The results of data analysis showed that aromatherapy reduced the anxiety of patients in the intervention group, which was significantly different from the control group (P=0.006). Paired t-test also showed that in the intervention group, the mean score of anxiety after the intervention was significantly lower than that of before the intervention (P<0.001), however this difference was not significant in the control group (P=0.90).
Conclusion: Based on the findings of the study, we can conclude that aromatherapy with the inhalation of peppermint aroma has been effective in reducing anxiety in patients undergoing coronary angiography. It is recommended that nurses use aromatherapy as a non-pharmacological approach to reduce the patients' anxiety.
Clinical trial registry: IRCT20190225042844N1
 

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Background & Aim: Stress and anxiety are one of the major problems in patients undergoing semi-invasive and invasive procedures such as endoscopy. Different methods to reduce anxiety do not have the same effects. The aim of this study is to compare the effect of thought distraction by music therapy and the presence of caregiver on anxiety level of patients undergoing endoscopy.
Methods & Materials: In this randomized clinical trial, 105 patients referred to endoscopy ward of Shahid Mohammadi hospital and Persian Gulf Bandar Abbas hospital in 2018 were selected by the convenience sampling method and assigned into three groups of music therapy, presence of caregiver and control using the random allocation (35 in each group). The demographic information form and the Spielberger anxiety questionnaire (STAL) were completed before and after the intervention. In the music therapy group, patients received natural sounds through headphones. In the caregiver’s presence group, endoscopy was performed with the presence of caregiver, and the control group only received routine pre-endoscopic care. Data were analyzed using descriptive and inferential statistics through the SPSS software version 24 at a significance level of 0.05.
Results: The result of analysis of variance showed that there was no significant difference in the anxiety mean score between the three groups before the intervention (P=0.77), but a significant difference was observed after the intervention (P<0.005). The decrease in scores in the music therapy group was significant (P=0.044), but in the caregiver’s presence group (P=0.571) and the control group (P=0.663), no significant change was observed before and after endoscopy.
Conclusion: The results of this study showed that distraction with music therapy is an effective way to help patients undergoing endoscopy, and the use of this method can help the procedure to be performed better and enhance patient satisfaction.
Clinical trial registry: IRCT20190715044215N1