---

The present study is a descriptive one made for the purpose of quality assessment of family planning counseling in health and treatment centers affiliated to Tehran University of Medical Sciences in year 2000. 410 client of the Family Planning Social Services who had attended 25 health and treatment centers affiliated to Tehran University of Medical Sciences were participated in this research study. A checklist was completed through the observation of family planning counseling sessions. The finding and results of this study showed that personnel&aposs behaviour and the quality of family planning counseling for the majority of samples in the first section have been suitable. In the section of the history taking from clients helping them to select suitable method and to determine next appointment, data for the majority of samples in this study have been in an average level. In the section of need understanding of clients introductory methods providing information the audiovisual training equipments used during family planning counseling, explanation of way of utilizing the selected method, and finally the environment for family planning counseling have not been suitable for majority of the samples. The findings of this study can be beneficial for public health planning in order to improve the quality of the family planning services.

---

Introduction: Caring is the essence of nursing and medication process is an important part of nursing related interventions in the health care systems. Medical and/or nursing errors can lead to severe problems for both patients and nursing system. The purpose of this study was to investigate the ethical practice in medication process among nurses working in selected hospitals related to Tehran University of Medical Sciences.          

Materials and Method: This study is a descriptive–analytic research. Samples of the study were 305 nurses employed in adult units of selected hospitals. The research data gathering tools were a checklist and a questionnaire. Questionnaire included questions about demographic data and errors in medication process. Checklist included 17 questions related to expected behaviors regarded medication process. The researcher first completed the questionnaire and then the checklist was completed on two separate occasions at least 15 days apart. The data were analyzed using descriptive and analytic statistics such as Chi square, Fisher exact test and Pearson correlation coefficients.

Results: The majority of subjects were 26-35 years old, female and single. About half of nurses (49.6%) had undesirable performance in process of medication. Ethical practice had a significant correlation with type of ward (p=0.005), the mean number of occupied beds in a week (p=0.000), number of co-workers in the shift (p=0.001), educating (p=0.037), satisfaction with place of work (p=0.0043) and technical possibilities in the ward (p=0.029).

Conclusion: According to the results, the majority of nurses had an undesirable performance in medication process. It is suggested that managers, program planners and nursing teachers pay more attention to ethical practice in medication process in order to enhance performance of nurses in this field.

---

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.

---

Background & Aim: Surgery is a stressful experience. Fear of postoperative pain causes anxiety. The purpose of this study was to investigate the effect of patient education about pain control on patients&apos anxiety before abdominal surgery.
Methods & Materials: In this quasi-experimental study, 89 patients who were planned to undergo elective abdominal surgery in an educational hospital were recruited to the study. Informed consents were obtained. The participants were randomly allocated in two control (n=45) and experimental (n=44) groups. The questionnaire included demographic information, clinical characteristics, and the Spielberger&aposs State Trait Anxiety Inventory (STAI). Patients in the experimental group received education about pain control one day before surgery. The education method was oral explanation for 20-30 minutes. The control group received no intervention. Data were analyzed through descriptive and inferential statistics (chi-square, t-test, Fisher&aposs exact test, Wilcoxon signed ranks and Mann-whitney&aposs tests) in the SPSS.
Results: Findings indicated that there was a significant difference in anxiety level between the experiment and control groups before surgery (P<0.001). There was also a significant difference between anxiety level in the surgery day (P<0.001) between the two study groups. The anxiety level was significantly decreased in the experiment group.
Conclusion: Based on our findings, patient education about pain control led to reduce preoperative anxiety in patients undergoing abdominal surgery. Patient education is a non-medical simple intervention that is recommended for using in surgery wards.

 

---

Background & Aim: Premenstrual syndrome (PMS) is a common psychosomatic disorder that affects 30-50% of women in reproductive ages. The purpose of this study was to determine the effect of a counseling program on premenstrual syndrome related symptoms.
Methods & Materials: This study was a randomized clinical trial in which the effect of a 3-sessioned counseling program on the PMS symptoms were assessed in 123 adolescent with PMS. The program included information providing, life style alteration, and providing stress management skills on symptoms of PMS. The participants were randomly allocated to intervention (n=67) and control (n=61) groups. Participants completed the demographic questionnaire, the PMS symptoms&apos daily record scale, and the symptom checklist 90-revised (SCL-90-R). Data were analyzed using the SPSS-11.5.
Results: The comparison of baseline data showed no significant difference between two groups regarding demographic characteristic and the PMS related symptoms. There were significant differences in the mean of total PMS severity, somatic symptoms (P<0.001), anxiety, interpersonal sensitivity, and hostility (P<0.05) between two intervention and control groups. There was not any significant difference in depression between intervention and control groups (P=0.11).
Conclusion: Group counseling resulted in a significant reduction in severity of total PMS, somatic symptoms, anxiety, interpersonal sensitivity and hostility in intervention group compared to the control group. There was no statistically significant difference in depression between two groups.

 

---

Background & Objective: Professional socialization is defined as the process of acquiring knowledge and skills and internalizing values, attitudes, and norms to develop professional identity. This process occurs primarily during formal education programs and continues during orientation to hospital settings. The aim of this study was to clarify professional socialization concept and to identify its attributes, antecedents and consequences in nursing context.

Methods & Materials: Rodgers&apos evolutionary method of concept analysis was used to facilitate clarification of professional socialization concept in nursing. The search, performed on scientific databases using the keywords: &apossocialization&apos, &aposprofessional socialization&apos and &aposnursing&apos, resulted in findings of a sample of 446 papers covering the period 1995 to 2009 represented the disciplines of nursing and related sciences. After applying inclusion and exclusion criteria, a total of 47 articles and four books were included in the final analysis. The process was audited by two independent experts to ensure neutrality and credibility of the study and to reduce the potentials for bias.

Results: The result of the analysis showed that professional socialization is a complex process consisting of four critical attributes: learning, being interactive, developing, and being adaptive. Comprehensive educational programs, competent role models, and provision of adequate field experiences were antecedents for these attributes. The widespread and diverse consequences of professional socialization depend on personal, situational, and organizational factors. Thus, while occurrence of socialization process generates benefits, its nonoccurrence entails severe consequences.

Conclusion: Professional socialization process is a complex, diverse, dynamic, ongoing, inevitable, and unpredictable process. This process can have both positive and negative consequences on professional development. However, negative consequences are more prominently documented in the literature. Thus, successful socialization requires establishing facilities in education and practice. The purpose of this revolutionary concept analysis was to focus on significance and how-to-apply ways of the concept in nursing. These findings not only are added to the body of knowledge, but also serve as an important impetus for further theory development and research in nursing.

---

Background & Objective: Preterm labor is a major risk factor of mortality and morbidity in newborns and fetuses. Low birth weight is also a risk factor for mortality and various neonatal diseases. This study aimed to determine the association between the CRP levels in first trimester of pregnancy with low birth weight and preterm labor.

Methods & Materials: In this prospective cohort study, we measured serum CRP levels in 400 pregnant women up to 20 weeks of gestation. All participants were followed up to delivery. Preterm labor was defined as delivery before 37 weeks of gestation. Low birth weight was defined as weight less than 2500 g at birth. Statistical analysis was done using Chi-square, Logistic regression, and ROC curve. P-values less than 0.05 were considered to be significant.

Results: After controlling for the effects of age above 35 years, mothers&apos occupations, history of preterm labor, socio-economic status, history of abortion, primiparity, and passive smoking, logistic regression analysis showed statistically significant relationship between the CRP and preterm labor (P-value=0.000, OR=1.24, %95 CI=1.11-1.38). However, there were no significant relationships between the CRP levels with other factors. Using Roc curve, we determined CRP cut-off point level for preterm labor. With 81% sensitivity, and 64% specificity, CRP cut-off point was 3.45 mg/l. After controlling for the effects of low socio-economic status, history of LBW, history of abortion, gravidity, primiparity, and passive smoking, logistic regression analysis showed statistically significant association between the CRP levels and LBW (OR=1.31, CI %95=1.08-1.59, P=0.005). However, there were no significant relationships between CRP levels with other factors. CRP cut-off point level for LBW was determined using Roc curve. With 87.5% sensitivity, and 74% specificity, CRP cut-off point was 4.75 mg/l.

Conclusion: It seems that the inflammatory marker, CRP, can be used to identify women who are at high risk for preterm labor and LBW. However, larger studies are needed to establish this relationship definitively

---

Background & Aim: Cigarette smoking is a common risky behavior among teenagers. Theories and models of health education aim to design effective educational programs. This study has been conducted to assess the effect of a health education program designed based on the health belief model on preventive smoking behaviors among female teenagers.

Methods & Materials: In this quasi-experimental study, 176 female teenagers from the Educational Cultural Centers of 17 zones of Tehran Municipality were randomly allocated to two equal experiment and control groups (88 girls in each group). The designed educational program was presented to the experiment group through three lecture and question/answer 45 minute sessions. Data were collected using a questionnaire before and eight weeks after the intervention. Data were analyzed using the SPSS-16.

Results: There was no significant difference between the two groups in the characteristics of the participants before the intervention. Comparison of the two experiment and control groups after education showed that the mean score of all studied constructs of the health belief model (i.e., susceptibility, severity, benefits and barriers, cues to action), as well as the preventive behaviors were increased significantly.

Conclusion: The results of this study showed that the program seems to be helpful in promoting the smoking preventive behavior among teenagers.

---

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.

---

Background & Aim: Oral care and using mouthwash help to prevent stomatitis. The aim of this study was to investigate the effect of two mouth wash protocols on prevention of head and neck radiotherapy induced-stomatitis.

Methods & Materials: In this single blind clinical trial, 120 individual were recruited. The experiment group (N=40) gurgled with 3cc of Matrices mouthwash and the control group used water mouth wash. The participants were assessed using the WHO grading scale. Data were analyzed using the Fisher exact test and Mann-Whitney U test as appropriate.

Results: There was not significant differences between the experimental and control groups regarding stomatitis intensity in the first day (P=0.371). Tere were significant differences between the two groups regarding stomatitis intensity in days 7 and 14 (P<0.001).

Conclusion: Oral stomatitis is a common condition in patients with head and neck radiotherapy. It makes painful ulcers, dehydration, malnutrition, and potentially life-threatening infection. Matrica mouth wash could prevent and treat induced-radiotherapy ulcer stomatitis.

---

Background & Aim: Multiple structural factors preside over burn units influence nurses&apos quality of care and their activities. The complexity and multy-dimensional nature of nursing care in these units, creates many challenges. Understanding the perspectives of people&aposs involved is recommended. This study, with a theory-to-research approach, was conducted to assess the frequency of confronting intra and extra organizational factors preside over burn units, the intensity of its related pressure, and correlations among these variables from nurses&apos perspectives.

Methods & Materials: In this cross-sectional, correlational study, 98 nurses working in the Shahid Mottahari burn center were recruited by census. Data was collected using the intra and extra organizational factors instrument, provided based on the previous grounded theory study of the researchers. Intra-organizational factors questionnaire consisted of 58 Likert type statements in eight subscales and two dimensions of frequency (α=0.94) and intensity (α=0.96). Extra-organizational factors questionnaire consisted of eight Likert type statements (α=0.74). Data were analyzed using the SPSS version 14.

Results: The results revealed that the frequency of nurses&apos confrontation with factors related to environment and patients as well as its intensity were more than other factors. Moreover, the intensity of the whole factors was more than its frequency. All the extra- organizational factors were significantly correlated with all intra-organizational factors except for the "absence of employment permission" (P<0.05).

Conclusion: This study explained the importance of intra-organizational factors of a burn center in inducing stress on nurses. In addition to verification of some relationships in the previous mid-range theory, the results of this study also modified some of its aspects. Therefore it added to the existing body of knowledge about organizational factors and job stress in burn units. Moreover, it produced some evidences to use in nursing administration and service, and finally it resulted in some directions to control stress in nurses&apos job.

---

Background & Aim: Endotracheal suctioning (ETS) is a common invasive nursing procedure. Hemodynamic parameters changes during and after the procedure. If appropriate strategies do not be applied during the ETS, hemodynamic changes can be significant and life threatening in critically ill patients. The purpose of this study was to assess the effect of education of endotracheal suctioning on patients&apos hemodynamic parameters.

Methods & Materials: This was a non-equivalent quasi-experimental study conducted in two critical care units in Hazarat Rasool hospital. All nurses working in these two units participated in the study in a period of two weeks. Systolic blood pressure, diastolic blood pressure and mean blood pressure of all patients who needed suctioning were measured before and after the endotracheal suctioning. We analyzed the data using the SPSS.

Results: At baseline, the systolic, diastolic and mean arterial blood pressures increased significantly (P=0.02) in the first and third minutes post-suctioning. In post-education phase, diastolic and mean arterial blood pressure increased significantly (P<0.001) in the first minute post-suctioning. In the third minute post-suctioning, systolic, diastolic and mean arterial blood pressure decreased (P=0.43).

Conclusion: The study findings showed significant changes in hemodynamic parameters after post-endotracheal suctioning. In this study, conducting endotracheal suctioning education improved the outcomes of hemodynamic parameters in patients. Educational programs can improve nursing care outcomes by preventing and minimizing hemodynamic changes during and after the suctioning in critically ill patients.

---

Background & Aim: Shoulder pain is a consequence of hemiplegia among patients with stroke. It makes patient to be dependent to others in their daily living activities. This study aimed to determine the effect of the slow stroke back massage (SSBM) on shoulder pain and hand function among patients with stroke.

Methods & Materials: In this semi-experimental study, 34 patients were recruited among from 70 patients who reffered to rehabilitation center in 2010, according to the inclusion criteria. Participants were randomly allocated into two groups of control and experiment. In the intervention group, the SSBM was implemented for 10 minutes through seven consecutive sessions. Shoulder pain and hand function were measured using the visual pain scale (Visual Analog Scale), and the researcher-made "affected hand function in ADL" instrument, respectively. The measurement was done before and 24 hours after the last session of the intervention. Data were analyzed using descriptive and inferential statistical tests (independent t-test and paired t-test).

Results: At baseline, the mean scores of shoulder pain were 8.4 in both experimental and control groups (P=0.999). After the intervention, the mean scores of shoulder pain were 1.13 and 8.40 in experimental and control groups, respectively (P<0.001). At baseline, the mean scores of hand function were 7.46 and 8.93 in the experimental and control groups, respectively (P=0.752). After the intervention, the mean scores of hand function reached 9.13 and 8.6 in the experimental and control groups, respectively (P=0.918).

Conclusion: According to the results of the study, applying the SSBM as a treatment procedure and care plan by health care providers can be considered as an effective intervention to prevent or reduce shoulder pain and consequently to improve motor function of affected hand in patients with hemiplegia after stroke.

---

Background & Aim: Quality of nursing care is a major issue in nursing management. In the last year of nursing studies (internships) in Iran, nursing students are going to independently carry out responsibilities of graduated nurses. Patients&apos satisfaction is a main indicator for nursing care quality. This study was to determine the correlation between the quality of caring behaviors among internship students with the patients&apos satisfaction with nursing care quality.

Methods & Materials: In this cross-sectional study, 200 patients were selected using convenience sampling method from the hospitals affiliated to the Tehran University of Medical Sciences. Data were gathered using two questionnaires including: 1) quality of the caring behaviors and 2) patient satisfaction with nursing care quality questionnaire (PSNCQQ). Data were analyzed using statistical tests in the SPSS-13.

Results: Regarding quality of caring behaviors, the subscale scores of the knowledge and skills were good and patient education was low. The relationship between the nurses and patients, and nursing morality were in average level. Regarding the patient satisfaction, the highest level of satisfaction was related to nursing knowledge and skills and the lowest level was related to the patient education. Significant correlation was found between the total quality of the caring behaviors with the patients&apos satisfaction and their subscales (P<0.001).

Conclusion: Based on the findings, patients are more satisfied with the caring behaviors of the students who focus on the communication with patients, nursing ethics, and especially patient education during the care.

---

Background & Aim: Lack of knowledge about coronary angiography may cause anxiety and stress in patients. Implementing appropriate educational methods can be effective in decreasing the level of anxiety among these patients. This study aimed to compare the effects of face-to-face with group education on anxiety and knowledge of patients undergoing coronary angiography.

Methods & Materials: This quasi-experimental study was conducted in Shaheed Rajaie Cardiovascular Center affiliated to Tehran University of Medical Sciences in 2012. Through consecutive sampling method, 84 hospitalized patients who were candidate for coronary angiography were selected and allocated into two educational groups. Data were collected using a demographic data sheet, the knowledge assessment questionnaire, and the Spielberg state-trait anxiety inventory. Patients in both groups received same educational content. The patients&apos knowledge and anxiety were assessed before and after the intervention. Data were analyzed using descriptive statistics and independent t-test and paired t-test.

Results: The finding showed that both face-to-face education and group education were effective in enhancing the knowledge of the patients. However, group education was more effective than the face-to-face education in reducing the patients&apos anxiety (P=0.049).

Conclusion: Health professionals, particularly nurses, can use group education as an effective and appropriate strategy to improve patients&apos knowledge and to reduce the anxiety among patients undergoing coronary angiography.

---

Background & Aim: Pain is an unpleasant experience related to potential or actual tissue damage. Distraction is an effective technique to control pain. This study aimed to examine the effect of pressing a small soft ball during intravenous catheter insertion on pain related behavioral responses of children.

Methods & Materials: A randomized clinical trial study was conducted in surgical ward of the Qods hospital in Qazvin, Iran in 2010. Sixty children aged 4-6 were selected through a simple randomized sampling method. The children were allocated into two equal intervention and control groups. Data were collected using the FLACC scale. In the intervention group, children were asked to press a soft ball during IV catheter insertion. The researcher marked the FLACC during the procedure. In the control group, no distraction was made during the IV catheter placement. The data were analyzed using descriptive statistics, independent-sample t-test, Chi square at P<0.05.

Results: There was no significant difference between the two groups in terms of demographic variables including gender, birth order, race, age and type of disease. In the intervention group, none of the children experienced severe pain during IV catheter insertion and 63.3% of the children had moderate pain. In the control group, 50.0% of children had moderate pain and 23.3% of them experienced severe pain during IV catheter insertion. There was a significant difference in perceived pain between the children of two groups (P<0.001).

Conclusion: Distraction is an effective, non-expensive, and easy-to-access technique to control and reduce pain in children during IV catheter placement. This study showed that distraction through pressing a soft ball was effective in reducing the behavioral responses of pain in children who underwent IV catheter placement.

---

Background & Aim: Implementation of the motivational program by nurse managers can improve nurses&apos performance and behaviour, provide better care for patients, and promote patients&apos satisfaction. This study aimed to determine the effect of implementation of the motivational program designed using "Expectancy Theory" by head nurses on patients&apos satisfaction.

Methods & Materials: This was a quasi-experimental study conducted in medical and surgical units of two hospitals in Zanajn in 2011. Data were gathered using a patient satisfaction questionnaire. The reliability of the questionnaire was confirmed (α=0.72). Fourty participants were selected and allocated in two study groups. The groups were matched for some variables before the intervention. The motivational program was implemented in the intervention group for five months. The program had two designing and implementation phases including: 1) determining nurse managers&apos expectancies from nurses, assessing nurses&apos attitudes about valuable rewards, founding reward management committee and management improvement committee, and providing evaluation checklists for nurses&apos performance 2) implementing standards of nursing care and patient education by nurses, monthly evaluation of nurses by head nurses and collaborative members of the reward management committee, determining level of rewards based on the results of nurses&apos performance evaluation, and giving reward to nurses at the end of each month in a reward ceremony. Data were analyzed using the Paired t-test, Independent t-test, Mann-Whitney, and Chi-squared in the SPSS v.16.

Results: There were no significant differences between the two groups at baseline dealing with the demographic variables. The results showed that patients satisfaction was significantly higher in the intervention group after the intervention (P<0.05).

Conclusion: This motivational program designed based on the "expectancy theory" has clear steps to be implemented among nurses and can be used as a practical guide by nurse managers to improve patients&apos satisfaction.

---

Background & Aim: Increase in cancer prevalence results in feeling fear of being diagnosed with cancer among individuals. Understanding concerns of patients diagnosed with cancer helps health care professionals to provide appropriate caring plans. This study aimed to understand main concerns of patients who confront cancer diagnosis.

Methods & Materials: This was a qualitative study with content analysis approach. Fifteen patients with cancer were selected from a specialized hospital, an oncology clinic, and Emdad Center of Cancer patients in Sari using a purposeful sampling method during May 2011 to June 2012. The sample size was completed regarding data saturation. Data were collected using interviews, observations and recording field notes. All interviews were tape-recorded and transcribed verbatim. Data were analyzed using descriptive content analysis and the Granhim and Landmann method.

Results: Three categories including 485 primary codes were emerged. The derived codes were as follows: 1) sever personal and family disturbance 2) imagination of despair and 3) unclear imagination of future. The main code included in all derived codes was life threatening nature of cancer.

Conclusion: The findings showed that life threatening nature of cancer is a source of fear that makes the disease frightening. Clinical staff and nurses should pay more attention to concerns of patients with cancer and design their care plan accordingly.

---

Background & Aim: Fatigue is a premature symptom in patients suffering from chronic obstructive pulmonary disease. This study aimed to determine effect of the home-based pulmonary rehabilitation on fatigue among patients with COPD.

Methods & Materials: In this clinical trial, 36 patients were recruited among from 100 patients with COPD according to inclusion criteria in Masih Daneshvari hospital in 2010. Participants were allocated into two control and intervention groups using random block sampling. In the intervention group, the pulmonary rehabilitation program was implemented during three educational sessions in three consecutive days. Fatigue was measured using the Fatigue Severity Scale (FSS) before and seven weeks after discharge. Data were analyzed using descriptive and inferential statistical tests (Independent and paired t-test, chi-square and covariance analysis).

Results: At baseline, the mean scores of fatigue were 47.11 and 47.50 in the experimental and control groups, respectively (P=0.902). After the intervention, the mean scores of fatigue reached 21.94 and 54.64 in the experimental and control groups, respectively (P<0.001).

Conclusion: According to results of the study, home-based pulmonary rehabilitation nursing could decrease fatigue in patients with COPD.

 

---

  Background & Aim: Children with cerebral palsy need permanent care and attention in various stages of growth and development. The parents experience problems in taking care of these children and making them independent. This study was conducted to explore these experiences.

  Methods & Materials : This qualitative study was conducted in 2011-2012 using content analysis. Purposeful sampling was used to recruit 19 parents of children with cerebral palsy referred to rehabilitation centers in Tehran. The data were gathered using in-depth and semi-structured interviews and were analyzed inductively.

  Results: Data analysis results revealed three original categories including "life with hardness" ، "being in ambiguity" ، and "need to be supported" ، and several subcategories including "physical strain" ، "psycho-emotional strain" ، financial burden" ، "restriction in social activities" "facing with anonymous" ، "lack of having an advisor" ، "need to get help from professionals and specialists" ، "need to have emotional- spiritual support" ، and "need to have help in caring the child".

  Conclusion : Parents in permanent care of children with cerebral palsy face with new and various situations consistently and experience difficulty and bewilderment because of insufficient family and social support. Further studies are needed to explore the support process of caregiver parents of these children.