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

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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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This was an analytical-descriptive study on determination of relationship between physiological variables of the neonates when admitted to the neonatal intensive care unit and mortality rate amony transferred neonates to a specialized center of Esfahan university of medical sciences.In this research, seventy neonates who were transferred to this center were randomly according to Poasan model selected.On the time of admitting neonates to this center, their VS, BS and ABG were immediately checked and the results recordered. The neonates were followed until they were discharged or expired. For data analysis, the descriptive statistical methods and Spearman correlational coefficient were used.The results indicated that 31.4% of the transferred neonates expired. The relationship between mortality rate and birth weight was meaningful. Furthermore, there was a significant relationship in physiological variables of the neonates when admitted to the neonatal intensive care unit(P<0.01).These results can be applied in nursing services management, nursing education and national programming in order to establish special teams for neonatal transferring.

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One of man's fundamental needs is communication. Nurses within their specialty sense this need in their relationship with their patients, even though in some cases with physical impediments e.g. the placing of bypass tubes, this relationship is endangered. This study is a quasi experimental research, whose main aim is to compare the effects of two types of communication methods on anxiety and satisfaction in patients after cardiac and bypass surgery having intubation, warded at chosen hospitals affiliated to the Tehran University of Medical Sciences. According to the specific criteria, 90 patients were randomly selected by divided into two groups (experimental and control). The researchers met all patients the day before the surgery explained the reason and use of the picture chart for the experimental group and the routine communication methods for the control group. Therefore on the day of surgery communication was established with both groups with their own particular method. Data collection was done through a questionnaire consisting of: 1) demographic specification and clinical history, 2) Spielburger's questionnaire for obvious anxiety and 3) visual analogue scale (10cm) for patient satisfaction evaluation which is undertaken the day after surgery and after extubation. The results of the χ² test and the Fisher's exact test showed significant statistical differences between the two groups concerning the level of the patient's anxiety and satisfaction. The use of the picture chart for the experimental group, decreased patient's anxiety resulting from speech disability and increased their satisfaction with their communication with nurses as compared to the control group. Considering the beneficial results from using picture charts in establishing communication with patients, nurses with the help of devices, must try to create better relationships with intubated patients in the post-surgery period and provide them with more desirable services.

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Post-surgery pain is usually controlled by PRN drugs administered by nurses. According to the decision-making theories, this clinical decision-making depends on three factors: nurse-related factors child-related factors and hospital-related factors. This study deals with the first and second factors mentioned. This descriptive-analytic study aims at determining the perspective of nurses on factors which affect their decisions to administer the analgesic PRN to children after surgery in several chosen hospitals of Tehran. The study used a standardized questionnaire to collect data from 57 nurses in pediatric surgery wards. The questionnaire consisted of three parts: 1) nurses demographic data 2) 20 clinical scenario for nurses to make a decision for prescribing either analgesic medication, non-analgesic medication or no medication where necessary and 3) 12 factors which affect clinical decision-making in using analgesics.(in prioritizing among the above mentioned). The results show that factors such as age, nursing experience, pediatric nursing experience and motherhood were significantly related to choosing to use analgesics. Education and personal experience of extreme pain was also related to the type of analgesic chosen. Concerning the specifics of the children there was a significant difference between the choice to use analgesics and the type of analgesic used according to the various ages of the children. There was also a significant relationship between the type of surgery and the time of surgery and with the choice to use analgesics and the type of analgesics used, such that medication and analgesics were administered more frequently for complicated surgeries and in first 24 hours after surgery. Type of surgery, severity of pain, time of surgery and uneasy behaviors were selected respectively as the most effective in the administration of PRN analgesic drugs. Nurse and child related factors strongly influence nurses in making decisions to administer PRN analgesics postoperatively.

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Fear is an undesirable feeling which most of the time results in physiological changes and can affect on the cardiovascular function of the patient. This research is a cross-sectional descriptive study that describes the congruency opinions between 91 patients /nurses about the reasons for patients’ fear related to coronary angiography in two affiliated hospitals of Tehran University of Medical Sciences. The tools which were used included: questionnaire for study and recognition of patient and nurses demographic characteristics, a check list containing thirty probable reasons for patients’ fear which were filled out by patients and nurses, and a scale for analysis of the reasons for fear which were filled out by patients, descriptive statistics indicators, sign test, and t-test were applied in order to analyze the data, by SPSS software. The results showed that patients’ and nurses’ ideas about the reasons for fear before angiography are similar in two cases and only in one case after the operation. Among the thirty probable reasons which were mentioned for patients’ fear, seventeen cases caused less fear after angiography and two cases caused more fear after that. In the comparison between the intensity of fear caused by other reasons no insignificant result was observed. The comparison of intensity of fear showed that the intensity of patients’ fear after angiography is less than before (p= 0.005). According to these cases it may be concluded that because of the different reasons for patients’ fear concerning angiography, nurses need to pay more attention to patients’ fear. It is also suggested that an assessment tool be used in order to assess issues relating to patients, level of care and training related to coronary angiography.

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This research is a descriptive-analytical study conducted with the aim of examining and comparing adjusted behaviors of children (brothers and sisters) suffering from a chronic disease, referred to treatment centers with the siblings of the healthy children of the same age, in Tehran. The research sample was a group of 300 children along with a pair of parents. They were divided into groups of 150 siblings suffering from a chronic disease and 150 siblings who were healthy. For sample-taking of the children suffering from chronic disease parents of the children referring to hospitals or hospitalized in wards, who had the required qualifications were also studied through simple random selection. In order to select healthy children and their parents, the parents of the children referring to specified treatment centers for receiving medication and clinical treatment were selected as the control group, through the simple random sampling method. The basis of research comprised of a questionnaire comprising of two parts. The 1st part consisted of demographic particulars and the 2nd part constituted the form of questions put to the child's parents, whose form was prepared on the basis of the standardized child behavior checklist in accordance with Achen Bach's parents’ report. The form consisted of two parts: one concerning social merit (6 questions on activities, social relations and studying performance of the child) while the other related to behavioral problems of the child (102 questions in relation to social problems, anti-social behavior, aggressive behavior, difficulty in concentration, physical complaints, anxiety, depression, isolation disorder in thinking, sexual problems and miscellaneous matters). The results in relation to the research objectives point out that there is by p<0.001 and p< 0.005 and in a sensible manner, the behavioral problems of the siblings suffering from a chronic disease as compared with healthy siblings are more and their social merit is less.

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Introduction: In hypertensive patients M position (sitting, right arm at the level of heart and both plantar surface of foots on the floor) is the standard position for measurment of blood pressure since it reveals the “true” pressure. Materials and

Methods: It is a quaziexperimental study that compares effect of different positions of limbs on blood pressure of hypertensive patients. The sample size was consisted of 100 hypertensive patients. A questionnaire and a check list for systolic and diastolic blood pressure of the patients in different positions were used. One researcher collected all of the data. At first demographic data, weight and hight were recorded. After 5 minutes in sitting position in 3 different comparing positions, M (sitting, right arm at the level of heart and both plantar surface of foots on the floor), A (sitting, right arm hanging beside the body and both plantar surface of foots on the floor) and B (sitting, right arm hanging beside the body and right foot on the left knee), blood pressure was measured and recorded. The study methods included interview and physiologic measurement. The paired t-test for related measure was applied in order to analyse the data.

Results: The results showed that the difference of mean systolic and diastolic blood pressure in “A & M”, “B & M” and “B & A” positions was significant (paired t test, p<0.0001) and the mean of systolic and diastolic blood pressure in “A” position was more than “M” position, “B” position was more than “M” position and “B” position was more than “A” position.

Conclusion: According to the findings of this study, “B” position has the greatest effect and “M” position has the lowest effect on increasing the systolic and diastolic blood pressure. This research indicated that attention to the limbs position during the measurement of blood pressure is very important.

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Introduction: To reduce the morbidity and mortality of cardiovascular diseases, patients are emphasized on following the exact prescription order of their antihypertensive and other cardio vascular medications.

Materials and Methods: The purpose of this study was to identify factors related to medication compliance in patients with coronary heart disease. A descriptive analytical study was designed and a total of 150 patients with coronary heart disease were chosen with convenience sampling among patients in one of the cardiovascular clinics affiliated to Tehran University of Medical Sciences. The instrument included a questionnaire for the demographic data, side effects of the drugs, physical condition, level of cognition and self-reporting of the patients about medication non-compliance A questionnaire which was about attitude evaluation A data evaluation form to calculate the rate of medication compliance Biophysiologic measurments and finally, available documents. The data were collected in two consecutive steps: at the first appointment, the questionnaires were filled. At the second appointment (1 month later) medication compliance rates which was based on counting of pills, were calculated.

Results: The data were analyzed with descriptive statistics, chi-square test, Fisher’ exact test and Tchoprof coefficient. Only 28% of the patients had met the drug regimens appropriately but 56% of them had a poor record. There was a meaningful relationship between the self – reporting of the patients and counting of the pills (p value<0.005). In addition, some factors such as age, education, occupation, teaching and its sources, duration of acquiring the cardiac disease, number of hospitalization and level of cognition of patients under investigation were assessed as effective elements to use the pills properly.

Conclusion: No meaningful relationship was found between sex, marital status, parenthood status, living arrangement, health insurance situation, health personnel availability, positive family history of cardiac disease, co-existence of another disease, difficulty in providing of the drugs, side effects of the drugs, physical condition and attitude and medication compliance. In conclusion, by providing some educational programs about drug regimens, based on the level of cognition, experiences, capabilities, and also the living style of the patients, medication compliance can be improved.

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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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The concept of privacy, which is used in many disciplines, is a basic human need and also is recognized as an important concept in nursing. The concept of privacy has been described in various dimensions including physical, psychological, social and informational privacy. In this article we review these dimensions. Most of the studies related to the privacy have been carried out in the area of physical privacy. One of the basic areas of privacy in hospitals is related to data protection and the prevention of information inaccuracies. Major factors that threaten the privacy include intrusion upon the seclusion or physical boundaries and unnecessary physical touch. In order to decrease these problems, health worker need to find a new approach of working with patients. Review of the literature showed that only a few studies about the privacy of patients have been carried out. To encourage research in this field, accurate instruments should be developed in order to measure different aspects of the privacy, an aim that is difficult to achieve because of the complex nature of the concept. It is also important that necessity of observing patients’ privacy systematically be thought to medical students

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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: Evaluation is a systematic process for collecting, analyzing and interpretation of the obtained information for the purpose of investigating how much the objectives in mind can be achieved. Education in an academic educational system means bringing about proper and increasing changes that affect the outcome of this system, that is affecting the students, and the aim of such evaluation was promotion of the quality of an education process.

Materials and Methods: In this study faculty of nursing and midwifery, Tehran University of Medical Sciences, benefiting from opinion poll of university lectures, student and graduates have evaluated their system of educational in the year 2004 and their aim was to remodel and adjust educational system with the society’s needs and promotion of the quality of such education’s. The employed method was cross sectional and descriptive and analytical on the basis of 10 procedural steps and with in 8 sections dealing with evaluated factors. Such as faculty board members, management and organizational capability, students, manpower and logistic affairs, educational environments research work centers, health and therapeutic sections, educational equipment, research equipment, laboratory and diagnosis centers, educational courses and programs, teaching and learning process as well as satisfaction expressed by students.

Results: the results of the research showed that general average of 8 investigating sections, based on SWOTs model were respectively 80.4% (nursing department), 81.5% (Midwifery department) and 82.1% (Ph.D nursing) that may well be interpreted as a desirable research work.                        

Conclusion: Educational evaluation is the best indicator showing how much we should go to achieve certain aims, analyzes quality of the activity if such a system and by which we achieve logical and routine results.

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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: The main aim of performance appraisal is aid to staff development and increasing job motivation. Outcomes of performance appraisal consider as a determining indicators of the amount of success in achieving the mentioned aims. The aim of this study is to determine the employed nurses’ views regarding the performance appraisal&aposs outcomes and its relation with job motivation in medical-surgical wards of affiliated hospitals of Tehran University of Medical Sciences.

Methods & Materials: This investigation is a descriptive correlational study. The sample size was 120 of employed nurses in medical-surgical units in Tehran University of Medical Science that was selected by cluster sampling. The data was collected by questionnaire. Descriptive statistics, t-test and Pearson’s correlation coefficient were used for analysis.

Results: Perception of the most samples was almost positive (65%) about performance appraisal’s outcomes. They believed that the rate of the job motivation in surveyed units was low. There was a statistical significance relationship between performance improvement as one of the outcomes of the performance appraisal and job motivation (p<0.05).

Conclusion: Aiding to nurses performance improvement with using of performance appraisal was the only factor that was correlate with the job motivation in comparison with the other expectances of performance appraisal.

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

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

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

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

  

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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 .