Background & Aim: Premature infants are the most admitted group to NICUs. Stabilization of cardio pulmonary parameters is a main goal in NICUs. Mechanical ventilation and endothracheal suctioning are the most common and effective procedures to stabilize cardio pulmonary parameters. The aim of present study was to compare the effects of two endothracheal suctioning methods (open and closed) on physiological stability in premature infants under mechanical ventilation .

  Methods & Materials: In this clinical trial, 90 preterm infants (GA: 27-34 weeks) hospitalized in the NICUs of Alzahra and Taleghani hospitals were selected and randomly assigned to two groups. In one group, infants were suctioned using open suctioning method and in the other group, infants were suctioned using closed suctioning method. The physiologic parameters (O2 sat, HR, mean BP variation) and stability (recovery time of HR, BP) were compared between the groups. Data were analyzed using descriptive and inferential statistical methods such as x², independent t-test and mixed model in the SPSS-21 . 

  Results: There was significant statistical difference between the two groups on mean BP (P=0.016). Recovery time of the BP and HR was shorter in the closed suctioning group. Physiologic stability was better in the closed suctioning group (P<0.05) .

  Conclusion: Variation of the mean BP and recovery time was more in the open suctioning group compared with the closed suctioning group. Considering better physiologic effects of closed suctioning, it is recommended to assess the combined effect of closed suctioning with weight on physiologic parameters of premature infants .

  Background & Aim: The present study aimed to investigate the spiritual health among nursing and midwifery students at Kerman University of Medical Sciences in 2012 .

  Methods & Materials: This was a cross-sectional study in which all 222 nursing and midwifery students studying at Kerman University of Medical Sciences were recruited to study. Data were gathered using t he Palutzian & Ellison questionnaire of spiritual well-being. The obtained data were then analyzed in the SPSS-20 using parametric statistical tests such as independent t-test and Anova . 

  Results: Results showed that spiritual well-being of nursing and midwifery students was in the good range. Except gender, no statistically significant relationships were observed between the mean of spiritual well-being and parameters such as age, marital status, academic year, and field of study .

  Conclusion: According to the findings , spiritual health among nursing and midwifery students was moderate. It is necessary to promote spirituality among nursing and midwifery students .

  Background & Aim: The quality of clinical services is a major concern for healthcare systems throughout the world. Clinical Governance, a relatively new approach to improve quality of healthcare systems, plays a fundamental role in the establishment of primary healthcare strategies to provide high quality services. Moreover, regarding the importance of organizational culture as a powerful lever to improve organizational behavior, success of organizations in implementing strategies largely depends on the support receiving from organization. Accordingly the aim of this study was to examine the correlation between organizational culture with establishment of clinical governance in public hospitals in Rasht .

  Methods & Materials: A cross-sectional correlation study with structural equation modeling was used. All 152 nurses working in managerial positions participated in the study. Data were collected using Denison Organizational Culture questionnaire, and research-made questionnaire on clinical governance. Validity and reliability of questionnaire were confirmed. Data were analyzed using the Pearson correlation coefficient test and confirmatory factor analysis in the SPSS and LISREL . 

  Results: There was a significant positive relationship between clinical governance and all components of organizational culture (P< 120.01' type="#_x0000_t75"> ). Factor analysis showed the impactof organizational culture on successful establishment of clinical governance .

  Conclusion: Improvement of organizational culture leads to sustainable establishment of clinical governance through which quality of healthcare services improves. Managers of hospitals should pay attention to instituting appropriate organizational culture in order to establish clinical governance .

  Background & Aim: Lack of knowledge about acute myocardial infarction and its treatment result in feeling anxious among the patients. Implementing appropriate educational methods can decrease anxiety in patients with acute myocardial infarction. This study was conducted to compare effects of two educational methods (face-to-face and electronic educational methods) on anxiety among patients with acute myocardial infarction .

  Methods & Materials: This was an experimental study in which 105 patients hospitalized with acute myocardial infarction in the "CCUs" of three educational hospitals were selected based on eligibility criteria and were allocated into three groups including face-to-face educational group, electronic education group, and control group using block randomized allocation. Data were collected using demographic check-list and the Spielberger state-trait anxiety inventory questionnaire. The level of anxiety was measured before and immediately after the interventions in all three groups. Data were analyzed in the SPSS-16.

  Results: Both educational methods reduced anxiety significantly in patients with acute myocardial infarction. There were no significant difference between the two educational method groups in the anxiety level (P=0.94) .

  Conclusion: Both face-to-face and electronic educational methods reduced anxiety in patients with acute myocardial infarction. It is recommended that nurses use one of these educational methods to reduce anxiety among the patients .

  Nurses’ turnover phenomenon is a major concern in healthcare systems of many countries. In recent years, nursing shortages in Iran has become a major challenge for healthcare system managers. Based on the definition, “turnover” is a process in which employees leave an organization or transfer to other departments or units of the organization. However, in this definition it has not been specified whether members’ turnover is voluntarily or involuntarily (1). Also, nurses are vital components of healthcare systems, so that as the largest group, they constitute about 56% of the hospital staff (2). Lack of knowledge about nurses’ turnover makes it hard for managers of healthcare systems to recognize its effect and it complicates the efforts to fill nurses’ vacancies (3). This complex issue has been affected by several factors. Turnover and relocation of nursing employees have affected medical expenses through impact on patients’ resultants.

  Background & Aim: Patients with multiple sclerosis suffer from permanent pain. It is being increased to apply relaxation therapy to decrease patients' pain. The progressive muscle relaxation make the muscles feel more relaxed. The aim of this study was to assess the effect of progressive muscle relaxation on pain among patients with multiple sclerosis .

  Methods & Materials: A randomized controlled trial was carried out among 70 patients with multiple sclerosis selected from Hamadan Multiple Sclerosis Society patients. Inclusion criteria involved diagnosed with multiple sclerosis, 20-65 year old patients, having ability to do daily 20-minute exercises, feeling pain, having an EDSS score equal or less than 4.5. Patients were randomly divided into two groups of control and intervention. Patients' pain was measured using the VAS scale in the two groups at baseline. The relaxation training was implemented among intervention group patients and was repeated three times a week for four weeks. Each session lasted 40 minutes and the patients continued doing exercise at home for the other eight weeks. The control group patients were observed routinely. Patients' pain was measured eight weeks later in both groups. Data were analyzed using the paired independent t-test in the SPSS-16 .

  Results: Muscle relaxation had significant effect on pain among patients with multiple sclerosis (P<0.05). The mean of pain severity decreased from 4.60 ± 1.75 to 3.26±1.88 in the intervention group after the intervention. The mean of pain severity remained constant .

  Conclusion: This progressive muscle relaxation can be used for decreasing pain among patients with multiple sclerosis as a non-expensive, safe and simple method .

  Background & Aim: Technology advancement has increased the survival rates of premature infants. Preterm newborns frequently experience oral feeding difficulties due to lack of coordination in sucking, swallowing and respiration. This may negatively affect attainment of independent oral feeding skill and leads to longer hospital stays. This study aimed to examine the effects of non-nutritive sucking vs. oral massage therapy on attainment of independent oral feeding and length of stay in the NICU .

  Methods & Materials: This clinical trial was conducted on 72 premature infants (28-32 week gestational age) hospitalized in the NICU of Alzahra Hospital in Tabriz in 2013. The eligible infants were randomly allocated to one of the three groups: oral massage, non-nutritive sucking, and control groups. Newborn infants in the oral massage group received pre- and intraoral massage therapy (before gavage) for at least 10 days. The newborn infants in the non-nutritive sucking group were encouraged to suck on a finger of mother or the researcher before gavage. The control group received usual care. The time to attain independent oral feeding and length of stay in the hospital were compared in the groups . 

  Results: Compared to the control group, the time to oral intake was significantly shorter in both experimental groups (P<0.001). There was no significant difference between the duration to achieve independent oral feeding status among the groups (P=0.915). Length of stay in the hospital did not significantly differ among the three study groups (P=0.342) .

  Conclusion: Findings indicated that both oral massage and non-nutritive sucking therapy groups could accelerate attainment of independent oral feeding in premature newborn infants .

  Background & Aim: Insertion of chest tubes is a necessary measurement in chest trauma. The trauma patients need specific skills for self-care. This study aimed to determine the effect of using supportive-educative system on self-care skills in trauma patients with chest drainage system .

  Methods & Materials: In this quasi-experimental study, 62 trauma patients with chest-tube were selected from three surgery wards of Besat hospital in Hamadan from December 2012 to May 2013. Two wards were randomly allocated into the experiment group (n=31) and one ward was allocated into the control group (n=31). Participants were selected using convenience sampling. The supportive-educative system was designed based on the patients’ needs and was implemented to the experimental group in three consecutive days. The study instruments included self-care needs assessment form and self-care skills checklist. Measurements were completed once the patients were admitted to the wards and three days later by an external observer. Data were analyzed using t-test, Chi-squared test, Mann-Whitney and Wilcoxon tests with a 95% confidence level in the SPSS-16 . 

  Results: There were no significant differences between the two groups in the study variables at baseline (P>0.05). Although self-care skills in both control (P<0.01) and experiment (P<0.001) groups were improved, using educative-supportive system led to better self-care skills in the intervention group in compare to the control group (P<0.001) .

  Conclusion: In general, self-care skills of patients with chest drainage system could be improved by supportive-educative system. The improvement in the control group can be attributed to self-care trainings conducted routinely by doctors and nurses .

  Background & Aim: Transition from studentship to working life is a stressful and challenging event. The concept of transition is important in nursing education, management, and practice issues. However, despite its supreme importance, there are certain ambiguities about the concept of transition in nursing. The aim of this study was to analyze the concept of transition in the context of nursing in Iran.

  Methods & Materials: We used the three-phase hybrid concept analysis model including the theoretical phase, the fieldwork phase, and the final analytic phase in this study. In the theoretical phase, we conducted an online literature search to find relevant articles published prior to 2012. In the fieldwork phase, five novice nurses, two experienced nurses, and one head-nurse were interviewed. Interviews were transcribed verbatim and analyzed using thematic analysis approach. During the final analytic phase, we compared the findings of the first two phases to provide a clear and comprehensive definition of the concept of transition . 

  Results: The findings of the theoretical phase revealed that transition was a process phenomenon having defined attributes such as detachment, individual perception, awareness, and human response patterns. According to the findings of the fieldwork phase, transition was an interactive, evolutionary, and time-bound phenomenon that embodies attributes such as socialization, unavoidability, and competence and ability development. In the final analytic phase, a comprehensive definition was provided for the concept of transition in the context of nursing in Iran .

  Conclusion: This study provided a comprehensive understanding of the concept of transition from nursing studentship to working life in Iran. The findings of this study can be used to develop theories, instruments, and criteria for evaluation of novice nurses’ transition to experienced nurses .

  Background & Aim: Nurses’ clinical judgment is an evolving complex concept. In order to understand the concept, clarification is needed. This study aimed to conduct the concept analysis of clinical judgment in nursing .

  Methods & Materials: Based on the Rodgers’s evolutionary method, evolving concept of clinical judgment in nursing was analyzed. Literature was retrieved from scientific databases during 1980 to 2013. Based on the inclusion criteria, 42 articles, three books and one dissertation were analyzed using thematic analysis method . 

  Results: The results showed that clinical judgment in nursing was a complicated process with attributes including intention, observation, data collection and information process, interpretation, prioritization and inference. Antecedents included knowledge, experience, evidences, clinical reasoning, intuition, critical thinking and consequences included nursing diagnosis and clinical decision making .

  Conclusion: Clinical judgment in nursing is a critical thinking process, situational based and beyond observation and assessment. This concept analysis could distinct the transposition concept of clinical judgment and other related concepts. The results of this study would help to develop theories and clinical judgment measurement instruments in practice, research and educational settings .

  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.

  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 .

  Background & Aim: Depression is common among nursing and midwifery students. Problem-solving is a short-term intervention that can be used to treat psychological problems. This study was carried out to evaluate the effect of problem-solving skills training on depression scores among nursing and midwifery students .

  Methods & Materials: This was a clinical trial. Nursing and Midwifery st udents (n=900) studying at Tabriz and Urmia universities were recruited in the study during 2 010-2011. The Beck Depression Scale was administered in both schools. Ninety two students who achieved a score above 10 in the Beck Depression Scale were selected. One school was randomly allocated to the intervention group and the other one was allocated to the control group. Students in the intervention group received six sessions of problem-solving skills training within three weeks. T he questionnaire was completed by the participants in both schools after the intervention. Data were analyzed using the independent t-test . 

  Results: After the intervention, the Beck Depression Inventory score in the intervention group decreased from 18.60 to 13.41 (P<0.01). There were no differences in the control group before and after the intervention (P<0.01) .

  Conclusion: The problem-solving skills training program reduced depression scores. Providing information and using the problem-solving skills training are recommended .

  Background & Aim: One of the key factors affecting the physical and mental health of fetus is peace. According to Quran, this factor is a fundamental Principle in different fields of Islamic Ethics and law and it also affects all orders and Prohibitions. That’s because of conditions that are ordained during Pregnancy Period and of course it affects the benefits and losses of the Person in next Periods of growth. This study assessed the fundamental role of peace during pregnancy and fetal life from the perspective of the holy Quran and its priority to other functions of marriage .

  Methods & Materials: This study is a retrospective review which was performed by searching library sources and 15 relevant sources were found. The concept of peace in holy Quran can be followed by keywords such as, Assurance / Etminan (Raad/28), tranquility/ Sakineh ( Fath/24), inhabitancy / Sakana (Tobeh/103), Security / Amniyat (Thein/3), Permanency / Sobat( Forghan/47). In addition, Keywords such as, Health, Pregnancy, and Sprit were studied too . 

  Results: Meanwhile, the topic of marriage and finding a family (including matrimony, spousal time, pregnancy and reproduction) is a composition of religious orders and prohibitions. According to some studies based on the Quran's verses and his successor’s anecdote considerable results such as reproduction, correct sexual satisfactory, moral and psychological peace was achieved. Relaxation in pregnancy phase is very important and vital process for the embryonic formation particularly in view of his/her future corporeal and spiritual life. Such standpoint is firmly emphasized by Islamic orders due to healthy generation among the human being .

  Conclusion: Aquiring spiritual relaxation and developing it according to psychological guidelines and strategies of the holy Quran is necessary to achieve a peaceful and satisfactory condition during pregnancy and birth of a healthy and righteous child .

  Background & Aim: Several studies have indicated that hospitalizing infants causes disruption on mother-infant attachment. The aim of this study was to assess the effect of infant massage by mothers on maternal attachment behavior in infants hospitalized in the neonatal care units .

  Methods & Materials: In this clinical trial, 42 mothers and their neonates were recruited and randomly allocated to the intervention and control groups. Mothers in the intervention group received training by means of educational movies about practical exercises on how to massage the infants. The trained mothers used massage techniques on their infants for five days. The process lasted 15 minutes. The attachment of the mothers on their infants was assessed before and on the day 5 after the massage. Data were collected using the scale of mother-to-infant attachment. Data were analyzed using the Chi-squared test, Fisher’s exact test and the t-test in the SPSS-19 . 

  Results: There were no differences between the two groups in terms of demographic variables and the mean of maternal attachment at baseline (P>0.05). Five days after the massage, there were statistically significant differences between the two groups in the mean maternal attachment (P<0.001) .

  Conclusion: According to the role of massage in attachment behavior, this traditional care is recommended to be used in neonatal units .

  Background & Aim: The major problem with mechanically ventilated patients receiving enteral nutrition hospitalized in the intensive care units is delayed gastric emptying. Acupressure can increase gastric motility. This study aimed to determine the effect of acupressure on the amount of gastric emptying in mechanically ventilated patients hospitalized in the intensive care units .

  Methods & Materials: In this clinical trial, 78 mechanically ventilated patients were recruited using convenience sampling method and were randomly divided into two control and experimental groups. Acupressure was applied on the Neiguan point for four days in the experimental group. The control group patients received no intervention. Gastric residual volume was measured in the admission time and before the gavages. The mean gastric residual volume of the admission time and the 1-4 days after the admission were compared in the two groups. Data were analyzed using the independent t-test, Chi-squared test, covariance analysis and repeated measured tests in the SPSS-16. 

  Results: The results revealed that there were no differences between the two groups in the admission time and the first day (P>0.05). There were statistically significant differences between the two groups in the admission time and 2-4 days after the admission (P<0.05). The difference of mean scores of gastric residual volume were significantly different between the two groups during the four days of post intervention constantly (Repeated measured ANOVA P=0.011) .

  Conclusion: The acupressure increased the gastric emptying in mechanically ventilated patients hospitalized in the intensive care units. Since the acupressure wristband was an easy to use, non-expensive, available procedure, it can be used to improve gastric emptying and prevent delayed gastric emptying complications .

  Background & Aim: The aim of present study was to assess psychometric properties of premenstrual symptoms screening tool (PSST) to provide a fast and appropriate screening tool for women who suffer from severe PMS/PMDD and their clinicians .

  Methods & Materials: It was a cross-sectional study. The study included 404 female students studying at Semnan University who were randomly selected using stratified method. In order to assess psychometric properties, we used the exploratory factor analysis, convergent validity (evaluated by symptom checklist-90-Revised), criterion-related validity (calculated by comparing psychiatrist diagnosis and PSST). Sensitivity and specificity coefficients of optimal cutoff points were calculated by the ROC Curve and construct validity was evaluated by the PSST ability to separate PMS and PMDD groups from healthy group. Reliability was evaluated using the cronbach’s alpha and test-retest method . 

  Results: The p rinciple component analysis revealed that the PSST consists of four factors: interest reduction, interference in functions, physical and neurotic symptoms, and eating and sleep patterns. As an evidence of convergent validity, PSST scores showed significant correlations with the SCL-90-R’s dimensions. Agreement coefficient between psychiatrists and the PSST diagnosis was 0.314 for the PMS and 0.80 for the PMDD. This tool separated the PMS and PMDD groups from healthy group well. Optimal Cutoff point for separating females suffering from PMDD was 2.22. The sensitivity and specificity coefficients were 0.9 and 0.77, respectively. The cronbach’s alpha was 0.91 and the test-retest reliability was 0.56 for the total tool .

  Conclusion: The translated version of the premenstrual symptoms screening tool can be used as a valid tool for Iranian females. This instrument can be useful for rapid screening and identifying women who suffer from severe PMS/PMDD, especially in clinical settings .

  Self-care is a series of learned actions and goal-directed activities done by individuals in order to provide, maintain, and promote health. Self-care activities involve health promotion, disease prevention, treatment of diseases and injuries, and treatment of chronic diseases. Although the impact of the self-care on improvement of health outcomes and reduction of costs are proven in numerous studies, implementation of self-care programs requires systematic educational and supportive interventions provided by health care providers including nurses to overcome health problems.
Many health professionals in Iran emphasize on negative aspects of unhealthy behaviors to persuade people to do preventive and healthy behaviors. For example, in drug abuse preventive programs, disadvantages of drug abuse as well as the increasing rate of drug abuse and other addictive behaviors, and the economic costs resulting from drug abuse are presented to youth.
Although the emphasis on negative aspects and side effects of unhealthy behaviors is worthy, especially when negotiating the budget with the competent organizations and key supplier, it is not always the best way of proposing behavior change to individuals. For example, showing the pictures of amputated parts of body, and/or blindness to patients with diabetes who are mostly depressed and seek treatment in the diabetes clinics does not seem to be an appropriate approach. Is not there any other positive ways to announce messages to people?
To answer this question, let's take a look at the concept of commercial marketing. Do successful companies highlight negative content of their products and services? The answer is: not often. In commercial marketing, products are presented in a positive way. In fact, everything from cars to clothing, from food products to furniture is offered positively in the market. Car reminds success, health and welfare; cloths helps people to seem younger and more fit; food products help people to feel refreshed, healthy and happy; even furniture is for a modern and convenient life. In commercial marketing, foot blisters of a walking individual are never shown to make people to buy cars.
 

  Background & Aim: Medication usage is the bases of disease management in patients who undergo hemodialysis. Non-adherence to medication regimen increases the incidence of complications among the patients . The aim of this study was to investigate the effect of a cognitive-behavioral intervention on medication adherence in patients undergoing hemodialysis .

  Methods & Materials: In this clinical trial, 70 patients were selected from Imam Reza and Valiasr hospitals. Patients were assigned into two intervention (n=35) and control (n=35) groups. The intervention group received a cognitive-behavioral intervention including six steps: 1) Identifying the problem 2) Creating confidence and commitment 3) Increasing awareness of behavior 4) Developing and implementing the action plan 5) Evaluating the plan and 6) Maintaining the desired behavior. Adherence to medication regimen was assessed using a self-report questionnaire before and immediately after the intervention. Data were analyzed using the independent t-test . 

  Results: At baseline, there was no significant difference in adherence to medicine regimen between the intervention (20.77 ± 4.56) and control (22.34 ± 3.65) groups (P=0.1). After the intervention, significant difference was observed between the two groups in adherence to medication regimen (P<0.001) .

  Conclusion: Cognitive–behavioral intervention could improve medication adherence in patients undergoing hemodialysis. It is recommended for nurses to use this approach to improve medical care among the patients .