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Introduction: It is necessary to give the essential educations to the patients and their families during hospitalization and after discharge. We conducted this study with objective of determining educational needs of patients undergoing CABG and their families at discharge and one month later.   

Materials and Methods: This research is a survey study. 60 patients and 60 members of their family who were selected by simple randomization. Data were collected by questionnaire. The questionnaire was prepared in two parts questions about disease and demographic characteristics and specific educational needs about wound care, activity and rest, drugs, nutrition and other needs of patients and their family. The data were collected in two stages: at discharge and one month later and analyzed with SPSS software. Descriptive and inferential statistical methods (t test,  test and variance analysis) were used to analyze the data. Results: At discharge, most of the patients and their families had respectively moderate and high levels of educational needs. Both groups had moderate educational needs about rest and activity, drugs use (general educational needs), nutrition and other needs. Patients have low but their families have high educational needs about drugs use (special educational needs). At one month after discharge, most of the patients and their families had moderate educational needs in all of the mentioned categories. The t statistical test didn’t show significant correlation between educational needs at discharge and one month later in patients and families. The  test showed significant differences between educational needs of the patients and their families (p=0.036) at discharge but didn’t show such a difference one month after discharge (p= 0.558).

Results: showed a significant relationship between educational needs and level of education.

Conclusion: Since most educational needs of the patients and their families concern the uses of drugs and wound care, and also most patients were unable to count their pulse, we suggest nurses pay more attention to these problems and give the essential training to the patients and their families.

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Introduction: There are different methods of teacher evaluation .The aim of this study was to investigate process of teacher evaluation in selected Iranian Medical of Sciences Universities.
Materials and Methods: In this descriptive-analytic study, we investigate the existing documents and performed serial semi-structured interviews with evaluation staff in the universities. The implementation of the whole process of staff evaluation at universities were also observed. The data were analyzed considering both qualitative and quantitative approaches. The descriptive analytic method as well as content analysis was applied for data analysis.
Results: Review of the teachers by students was the dominant method for teacher evaluation in the selected universities. This method have some important advantages and disadvantages which are discussed in this article according to the findings.
Conclusion: According to the results of this study, it is highly recommended to use a combination of different methods for evaluation of the university teachers as well as decision making purposes.

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Introduction: Phenomenological investigation of nursing profession and nurses&apos perspectives in Iran in comparison to a caring-oriented nursing system (Sweden) is the main purpose of this study.

Materials and Methods: Interpretive phenomenology was used to conduct this study. Data gathering methods included observation and semi-structured interviews with 1) Iranian nurses, 2) Swedish nurses, 3) Iranian nurses who graduated from nursing in Iran but work as nurse in Sweden and 4) Iranian nurses who work as nurse in Sweden and studied nursing there. Content Analysis was used for data analysis.

Results: Except humanitarian approach to nursing in a small group of Iranian nurses, the difficulties experienced due to work conditions and environmental factors have lead them to a state of burnout. Although caring is a primacy in nursing, enough attention is not being paid to it in nursing education programs.

Conclusion: Burnout as a main theme which emerged in this study affects all aspects of nursing profession in Iran. The nature of nursing profession, its routine tasks and poor public image as well as sociocultural factors have influenced nursing negatively.

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Introduction: Patients&apos rights have been center of attention in recent decades because of patients&apos vulnerability and worldwide sensitivity to human rights.

 Materials and Method: The current study is a qualitative, phenomenological research which has been carried out in Emam Khomeini Hospital during 2004-2005. The aim of this research was to identify the meaning of patient&aposs rights from the view point of patients and/or their companions. To achieve this, 16 semi-structured interviews were conducted with 12 informants. They were asked to explain their experience regarding the patient&aposs rights. All interviews were recorded. Data analyzing was simultaneously carried out using thematic analysis method.

Results: The emerging themes included expectation for equality and justice in receiving health care services, human respect and privacy need to be informed regarding their diagnosis and having essential facilities in the hospital.

Conclusion: It appears that whether the participants are aware of patients&apos bill of rights or not, they are able to define some rights for themselves. Attention to theses rights can help policy makers to design unique patients&apos bill of rights according to Iranian sociocultural and economic situation.

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Introduction: Surgery is a stressful event and patients undergoing surgery experience anxiety. Any effort to reduce anxiety of surgical patients should be of priority in nursing care of preoperative patients. The purpose of this study was to compare the effect of Benson relaxation technique and Zekr (rosary) on anxiety level of patients awaiting abdominal surgery.

Materials and Methods: This research is a quasi-experimental study carried out on patients who were admitted for abdominal surgery in a affiliated hospital to Tehran University of Medical Sciences in the year 2004. A total of 70 patients were chosen and divided randomly into two groups. We used Benson’s relaxation technique in first and Zekr in the second group. The patients were assessed on the day before surgery and on the day of surgery by a questionnaire that included demographic information and Spielberger anxiety tool. Vital signs were also recorded. The data were analyzed by SPSS computer software. The differences between pre and post intervention values were analyzed using paired t test, and between groups using independent t test and 2.

Results: Although there was a significant difference between mean anxiety level before and after intervention in both Zekr (p<0.006) and relaxation group (p<0.02), there was no significant difference between two techniques in reduction of preoperative anxiety (p>0.05). There was also a significant reduction in systolic blood pressure and pulse rate in both groups (p<0.05).

Conclusion: It seems that Zekr is as effective as Benson’s relaxation technique in reducing anxiety level of patients and both can be used to reduce anxiety level of patients awaiting abdominal surgery.

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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.

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

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

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

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

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

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

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

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

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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: Nursing professionalization is a developmental experience that evolves throughout professional nurses’ careers. Nursing systems that prepare nurses include experiences that are important in the early development of nursing identity. This phenomenenon is also foundational to the assumption of various nursing roles.

Methods & Materials: A phenomenological approach was used in order to explore the meanings of professionalization experiences among participants. Data were gathered through series of semi structured interviews. Benner's interpretive method was used for data analysis.

Results: From 17 famale and male beginner nurses who worked in different educational and private hospitals in Tehran points of view 5 main themes and 4 subthemes emerged which encompasses the whole experiences of participants’ professioalization experiences. These themes included sufficient knowledge, well practical experiences and autonomy in practice to provide a comprehensive care.

Conclusion: Faculty understanding of beginning nurses' definitions and experiences of nursing professionalization can provide insights that can be used to develop educational experiences that support and enhance students’ professional nursing identity and ultimately affect their future practice. Faculty can also use knowledge of nurses’ definitions of professionalization to enrich student learning.

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Background & Aim: Nowadays, mechanical ventilators are being used for some patients in ICUs due to various physiological and clinical causes. Keeping endotracheal tube clean and open is necessary in order to improve the patient&aposs oxygenation. This study aimed to investigate the effects of open and closed system endotracheal suctioning on vital signs of patients in ICU.

Methods & Materials: In this quasi-experimental study, 40 patients from Shariaty Hospital&aposs ICU were selected using convenience sampling method. Data was collected using a record sheet. The sheet consisted of demographic characteristics and vital signs including blood pressure, mean arterial blood pressure, heart rate, respiratory rate, and arterial blood oxygen saturation percentage. Endotracheal suctioning was done randomly in 90 minute intervals once using closed method and once using open method. All patients were hyper oxygenated by Ambo bag for 2 minutes before and after the procedures. The patients&apos vital signs were checked and recorded using SIEMENS 680 2xi monitor before, and 2 minutes and 5 minutes after the procedures. Data were analyzed using SPSS software.

Results: Systolic and diastolic blood pressures, and heart rate showed higher increase 2 and 5 minutes after the open method compared to close method (P<0.001). Arterial blood oxygen saturation percentage reduced in the open method more than in the closed one 2 and 5 minutes after the procedure (P<0.001). No significant difference was seen in the patients&apos respiratory rate in two methods (P>0.05).

Conclusion: Closed endotracheal suction system results in lower disturbances in the vital signs than the open system. Therefore, for better results, the closed endotracheal suctioning is suggested.

 

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Background & Aim: Anxiety is one of the emotional conditions among patients scheduled for surgery that can result in increasing postoperative pain, increasing analgesic and anesthetic requirements and prolonging hospital stay. The aim of this study was to assess the effectiveness of acupressure (acupuncture without needle) in reducing patients&apos anxiety before abdominal surgeries.

Methods & Materials: In this randomized, blinded, sham controlled trial, 70 patients who were scheduled to undergo abdominal surgery in Tehran University of Medical Sciences&apos hospitals were selected using convenience sampling method. The patients were randomized to an acupressure group (n=35) or a placebo group (n=35), receiving acupressure either at the right points (Yintang and Shen men) in acupressure group or at sham points in the placebo group for 10 min. Anxiety was recorded on a Visual Analog Scale (0-10). Vital signs were measured before and after pressure application in both groups.

Results: The anxiety was decreased in both groups following pressure application for 10 min (P<0.001). The amount of anxiety was significantly different between the groups (P<0.001). The heart rate, respiratory rate, and diastole/systole pressure (P<0.001) were decreased in the case group. Only heart rate (P=0.016) and respiratory rate (P=0.007) were decreased in the placebo group. Changes in respiratory rate and systole pressure following pressure application were statistically significant between two groups.

Conclusion: Acupressure at the right points can decrease anxiety before abdominal surgeries but it has no clinical effect on vital signs.

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Background & Aim: HIV/AIDS is a well-recognized global problem in the world, including Iran. It is necessary to comprehend and understand lived experience of HIV positive patients. The present study was designed and conducted to better understand the perspectives and experiences of HIV positive patients about the role of the spirituality and religious beliefs in their lives with HIV/AIDS.

Methods & Materials: This qualitative study was conducted using an interpretative phenomenological approach. In-depth, audio-taped and semi-structured interviews with 19 participants were conducted to collect data. Data were transcript. Observations were also recorded in comprehensive field notes. A hermeneutic approach was used to analyze the data, according to the method developed by Diekelmann.

Results: According to the findings, participants aged between 21 and 56 years of old at the time of contamination to the HIV. Almost half (47.4%) of the participants had CD4 counts under 200 cells/mm3. Analyzes of the data revealed three main themes: (a) Redefining religious values and communicating with God (b) Compensation and (c) Individual development. The themes included some sub-themes.

Conclusion: Experiencing difficult conditions in HIV positive individuals provide them with an opportunity to return to religious values, redefine themselves and give meaning to their lives, rather than fear or disappointment. Communicating with other HIV positive patients and religious experts are suggested as additional appropriate strategies.

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Background & Aim: Postoperative nausea is a common problem after general anesthesia, especially in ambulatory surgery. In ocular surgeries including strabismus surgery, intraocular pressure increase may lead to eye damage. Drug therapy has various side effects. The purpose of this study was to evaluate acupressure on nausea in patients undergoing strabismus surgery.

Methods & Materials: In this double-blinded clinical trial, 60 patients undergoing strabismus surgery were allocated into intervention and control groups. In the intervention group, a sea-band was placed on the P6 point of patients&apos wrists 30 minutes before induction of anesthesia. In the control group, the sea-band was placed in the opposite position of the patients&apos wrists. Data were collected during six hours after surgery in the recovery room. Data were analyzed using Chi square, t-test, and Mann-Whitney tests.

Results: There were no differences in demographic and surgical characteristics between the two groups at baseline. The intensity of nausea in the recovery room (P=0.002) and six hours after surgery (P<0.001) were significantly less in the intervention group than the control group.

Conclusion: Based on the findings of this study, acupressure decreases post operative nausea. Acupressure is a simple, noninvasive and cost- effective intervention which can be applied by nurses to prevent post operative nausea.

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  Background & Aim: Coronary artery bypass graft is a critical intervention for patients with coronary artery disease. This surgery is associated with significant changes and unique experiences in lives of patients. This study was conducted to understand the experiences of patients with coronary artery bypass graft.

  Methods & Materials: This qualitative study was conducted using an interpretive phenomenological approach. Eleven patients were selected from outpatient cardiology clinics of Tehran Heart Center using purposive sampling method. Data were gathered through semi-structured in-depth interviews lasting 55-70 minutes. The van Manen six steps analysis was used to analyze the data . 

  Results: During the data analysis, the main themes of e xperiences of living with coronary artery bypass and rebirth were extracted. These themes contained living with healthy heart, feeling back to the young and attempts for health maintenance .

  Conclusion: According to the study, participants were inclined to maintain the new lifestyle, dietary changes and also adhere to medications prescription. Nurses can help patients with properly designed educational program based on experiences of the patients.

  

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

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

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

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

  

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Background & Aim: White lie is one of the inevitable challenges that creates an ethical dilemma during the patient care process. White lie remains an abstract concept in caring process. The aim of this study was to analyze the concept of white lie in the caring process using a hybrid model.
Methods & Materials: A hybrid model of concept analysis including three phases was used in this study. In the theoretical phase, different databases including PubMed, CINAHL, Scopus, Science Direct, Google scholar, SID and Magiran were searched for finding relevant articles published in 1980-2018. The keywords were truth, white lie, care and deception (in Persian and English). In the fieldwork phase, semi-structured in depth interviews were conducted with nurses. In next step, by combining the two previous stages, the final analysis was performed.
Results: In the theoretical phase, the attributes of the concept were determined, including “harmlessness”, “without personal motivation” and “use in compulsion situations”. In the fieldwork phase, three main categories such as “the sweetness of the bitter truth”, “harmless sentences to prevent harm” and “temporary relief to balance the situation” were identified from the data analysis. By merging the concepts extracted from the theoretical and fieldwork phases, “white lie in the patient care process” was defined as “an ethical decision without personal motivation, which is chosen in unstable situations to prevent predictable harms to the patient in facing the bitter truth”.
Conclusion: Although a definition of white lie was developed based on the above three phases, the further development of this concept requires a deeper look at the Iranian-Islamic culture. Therefore, further research is recommended in other medical centers in the country.
 

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Background & Aim: Pregnancy is a very important period that is sometimes associated with various complications such as diabetes and poor sleep quality. Therefore, early identification of possible risk factors can play an important role in the health of pregnant women. The purpose of this study was to investigate the relationship of gestational anxiety with sleep quality and gestational diabetes in pregnant women.
Methods & Materials: The present study was a descriptive-analytical study. In this study, 359 pregnant women referred to health centers in Baneh during 24-28 weeks of pregnancy were included through the convenience sampling method. Data collection tools were the demographic information questionnaire, the Petersburg sleep quality questionnaire, the short form of pregnancy-related anxiety questionnaire (PRAQ-17), and gestational diabetes screening result recorded in each patient's health record.
Results: The results revealed that 12.3% of pregnant women were anxious, of which 78.8% suffered from poor sleep quality and 10% had gestational diabetes. Statistical analysis showed that there was no statistically significant relationship between gestational anxiety and poor sleep quality, and gestational diabetes (P>0.05).
Conclusion: It seems that gestational anxiety is not related to sleep disorders and gestational diabetes. However, further research and prospective cohort studies are needed in this regard.