Background & Aim: Quality of health care services shows the degree of achievement of health outcomes. From ethical and legal perspectives, nurses should be responsible for quality of presented care. Retired nurses can help to elaborate real and valuable concepts related to effective factors on quality of nursing care due to their experiences. The aim of this study was to explore the perspectives of retired nurses on factors that affect quality of nursing care in Semnan.

Methods & Materials: In this qualitative content analysis method, 20 retired nurses were invited to the study using purposeful sampling. Data were collected mainly using semi-structured interviews. The analysis was carried out using content analysis.

Results: Findings of the study yielded to three significant themes including: 1) necessity of humanistic relationships 2) suitable selection and education (3) planning and organizing nursing cares related to quality of nursing cares.

Conclusion: Findings of this study explored perspectives of retired nurses on the effective factors on quality of nursing care. The three themes emerged in the study should be mentioned in planning programs.

Background & Aim: Patient satisfaction has been recognized as a key indicator of health care quality which is used by accreditation agencies to monitor quality of care in hospitals. A high proportion of health caregivers are nurses. The services provided by nurses are significantly influential in satisfaction of patients. The aim of this study was to assess patients&apos satisfaction from nursing care in hospitals of Iran University of Medical Sciences in 2010.

Methods & Materials: In this cross-sectional study, we recruited 200 patients from different wards (except for special wards, Emergency department, Pediatric and Psychiatric wards) at the time of discharge from hospital through multistage sampling method. Data were collected using Patient Satisfaction Instrument (PSI). Data analysis was performed using descriptive statistics, chi-square and regression analysis.

Results: Majority of patients (72%) were moderately satisfied. Patient satisfaction had a significant relationship with the type of ward (P≤0.001), and type of hospital (P≤0.001). Of demographic variables, only patients&apos level of education was significantly associated with patient satisfaction (P≤0.019).

Conclusion: In this study, patients were moderately satisfied from nursing care services. Educating hospital staff, especially nurses and encouraging them to actively participate in activities to promote patient satisfaction should be a priority for hospital management. We should also consider that in a competitive market of health and treatment care giving, institutions that put patient satisfaction as their main goal are more successful.

Background & Aim: Home care visits have unique advantages in many social problems and health complications such as psychologic complications and adverse birth outcomes. The aim of this study was to identify the effect of postpartum care at home on quality of life among low risk mothers.

Methods & Materials: This interventional study was conducted in Akbarabad health center of Tehran University of Medical Sciences in 2010. A total of 200 mothers were randomly allocated in two intervention and control groups. Mothers in the control group received two post partum visits in health care center and the intervention group received care at home. Data were collected through a questionnaire including demographic characteristics and the mothers&apos quality of life items along with a growth and development monitoring chart for newborns. For analyzing data, Mann-Withney U, Wilcoxon and Chi-square tests were used.

Results: Most of the mothers aged 20-29 years old. The number of visits were statistically different between the two groups (P=0.00, P=0.01). Dimensions of quality of life in the two groups were not statistically different: (Physical dimension: P=0.052), (Emotional dimension: P=0.775), (Public health dimension: P=0.068), (Social performance dimension: P=0.780) and (Total score: P=0.213).

Conclusion: the results of our study did not show no positive improvements in home postpartum care in comparison with the health care centers care. More studies are recommended.

Background & Aim: Hypothermia is a main side effect during surgery in which blood pressure, heart rate, intra cranial pressure, oxygen consumption, pain and discomfort increase. The rate of cesarean section in Iran is three times more than global standard. This study aimed to investigate effect of pre-warmed intravenous fluid therapy on prevention of shivering after general anesthesia in cesarean section.

Methods & Materials: A total of 62 women undergoing general anesthesia for elective cesarean section were randomly allocated into two intervention and control groups. In the intervention group, patients received pre-warmed serum (37°C) and in the control group, patients received serum at room temperature (25.5°C). The postoperative shivering and some homodynamic parameters of the participants were assessed in recovery room.

Results: The mean of body temperature in the intervention and control groups were 35.9°C±0.48 and 35.42°C±0.6, respectively (P<0.05). The incidence of post operative shivering in the intervention and control groups were 13% and 35%, respectively (P<0.05).

Conclusion: Infusion of pre-warmed serum (37°C) would prevent postoperative shivering and could improve nursing care for women underwent general anesthesia in cesarean section.

Background & Objective: Due to physical and mental complications, stroke causes disability in self-care and adherence to rehabilitation in patients. The purpose of this study was to assess the adherence to rehabilitation regimen in family caregivers of patients with stroke.

Methods & Materials: In this cross-sectional study, 180 family caregivers of patients with stroke were recruited to the study using convenience sampling method. The participants were asked to complete demographic sheet and the Adherence-of-Therapeutic-Regime Questionnaires during two months of stroke. Data were statistically analyzed using descriptive and inferential tests in the SPSS-16.

Results: Findings indicated that only about 10% of caregivers were in good levels of adherence to the rehabilitation regimen and about 25% of them were weak. The weaknesses of the adherence were related to rehabilitation of motion, cognitive and emotional deficiencies, and also prevention of respiratory and skin disorders.

Conclusion: According to the study, a small number of family caregivers were in appropriate level for adherence to the rehabilitation regimen. The nurses should be able to empower the family caregivers to decrease physical and psychological disorders related to stroke in patients.

Background & Aim: Caregivers of elderly with Alzheimer&aposs disease, particularly females, encounter challenges. Their different roles in giving care to the patients could result in physical and mental disorders. The self-efficacy seems to be an essential factor in empowering individuals coping with stressful situations and challenging tasks. The aim of this study was to investigate general self-efficacy among women as family caregivers of elderly with Alzheimer&aposs disease.

Methods & Materials: In this cross-sectional descriptive study, 112 women reffered to the Iran Alzheimer Association, Tehran were selected through convenience sampling method. The General Self-Efficacy Scale (GSE-10) was used to collect data. Data were entered into the SPSS-16 and then processed using descriptive statistics and independent t-test, ANOVA and Scheffe.

Results: The mean score of the general self-efficacy was 28.24±6.34 indicating that considerable percentage of the participants had unsatisfactory level of self-efficacy (65.2%). In addition, there were significant relationships between the women&aposs general self-efficacy with educational and economic statuses (P<0.05). There were no significant relationships between general self-efficacy with age, marital status, occupational status and duration of caring.

Conclusion: According to the findings, a considerable percentage of the participants had unsatisfactory level of self-efficacy. Therefore, it is essential to promote the caregivers self-efficacy in order to give them the ability of better adaptation with the life&aposs challenges. In particular, the self-efficacy promotive programs should be implemented among caregivers with lower educational and economic status.

Background & Aim: The presence of pain is a common phenomenon among patients in critical care units. Critically ill patients are often unable to communicate because of illness or sedation so, recognition and assessment of their pain is difficult. In these patients, observational behavioral indices can be used to evaluate pain. The aim of this study was to investigate the effect of application of critical-care pain observation tool in patients with decreased level of consciousness on performance of nurses in documentation and reassessment of pain after palliative intervention.

Methods & Materials: In this before and after quasi-experimental study, 106 nurses working in general intensive care units in selected hospitals affiliated to Tehran University of Medical Sciences were selected. First, we examined the nurses&apos performance three times in relation to documentation and reassessment of pain after palliative intervention, position change and suction procedure in patients with decreased level of consciousness using a researcher-made check list. Then, we taught nurses individually, how to use this tool to investigate the pain of patient in a session lasting an hour. A week after the training, the researcher reevaluated performance of trained nurses in relation to documentation and reassessment of pain after palliative intervention in patients with decreased level of consciousness. Finally, those data collected before and after the training of the CPOT to nurses were compared using the Wilcoxon test.

Results: Findings showed that the CPOT could not lead to improved nurses&apos function in relation to documentation of pain in the patients records (P=0.209) and recording palliative measures related to pain (P=0.117). However, there were significant statistical differences between nurses&apos function in relation to reassessment of pain after palliative intervention, before and after the training and application of the CPOT. Comparing the mean function scores before and after the intervention, demonstrated that the performance of nurses in this area has been improved after the intervention.

Conclusion: The critical-care pain observation tool can increase nurses&apos sensitivity to pain in patients with decreased level of consciousness. It forces the nurses to reassess the pain after palliative intervention. This tool does not motivate in nurses to document pain palliative process. So it is recommended that future studies investigate the impact of this tool on other aspects of pain management, such as diagnosis of pain and using of drugs and non-drug measures.

Background & Aim: Poor sleep quality is a common problem among patients hospitalized in the CCUs. This study aimed to determine the effect of environmental factors modification strategies on quality of sleep among patients admitted to CCU.

Methods & Materials: This was a quasi-experimental study with a single-blinded design. Sixty patients admitted to the CCU of Shariati hospital were divided into two experiment and control groups. Sleep quality was measured in the first day of admission and three days later using the Pittsburgh sleep quality index in both groups. In the intervention group, we implemented a modified work environment between the two measurements. Data were analyzed using the Chi-squared and t-test in the SPSS v.18.

Results: Findings showed a significant decrease in sleep quality in the control group after hospitalization, compared with the intervention group (P<0.001). There were no statistically significant changes in the sleep quality before and after hospitalization in the intervention group (P=0.053).

Conclusion: Using environmental factors mitigation strategies can improve sleep quality of patients admitted to CCUs.

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

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

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

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

  Background & Aim: Access to quality care is important in delivering health services. Patients' safety and satisfaction are indicators of quality of care evaluation. Competent nurses may deliver quality care . This study aimed to investigate the impact of using competent nurses on patients’ safety and satisfaction .

  Methods & Materials: In t his interventional study with non-equivalent control group, we selected 120 patients admitted to the emergency department of Imam Khomeini hospital in 2012 using convenience sampling method . Nursing care for the experimental group (n=40 ) was provided by nurses who had high competency scores and in the control group ( n=80), nursing care was provided by usual emergency department nurses . Data were collected using the patient satisfaction with nursing care quality (PSNCQ), and patient safety inventory. Data were analyzed in the SPSS v.16 using descriptive and inferential statistics . The significance level for all statistical tests was considered at P<0.05 .

  Results: Mean age of the intervention and control groups were 48.1 ( ±12.5) and 40.5 ( ±16.7), respectively (P<0.018). There was a significant difference between the two groups in terms of employment (P<0.009). The two groups were similar in terms of other variables such as gender, marital status, level of education, having health insurance , and the reasons for seeking admission . The results showed that there were significant differences between the two groups in patients’ safety and satisfaction with nursing care (P<0.001). Regression test was used to eliminate the effects of age and job satisfaction the results showed effect of intervention on the patients’ safety and satisfaction with nursing care .

  Conclusion: These findings indicated that using competent nurses in providing nursing care promotes patients’ safety and satisfaction with nursing care. Training nurses focusing on the level of competency is required in scheduling, staffing, and implementing nursing care to enhance safety, patient satisfaction , and quality of care.

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

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

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

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

  Background & Aim: The ventilator associated pneumonia is a common problem in critical care units. It is associated with increased mortality, cost and length of stay. Nurses have great role in preventing the ventilator associated pneumonia. The aim of this study was to assess nurses' performance in prevention of ventilator associated pneumonia .

  Methods & Materials: In this descriptive study, 110 nurses working in selected hospitals affiliated to Tehran University of Medical Sciences were selected using convenience sampling method. A 32-item observational checklist was provided based on the ventilator associated pneumonia prevention guideline. The nurses' performance was observed three times. Data were analyzed using descriptive statistics in the SPSS-16 . 

  Results: This study showed that the mean score of the nurses' prevention was 46.8±5.79. Most of the nurses (66.4%) had poor performance and 36.6% had relatively good performance. There were no nurses with favorable performance in the prevention of ventilator associated pneumonia. The highest score was in contact precaution (72±9.67) and the lowest score was in mouth hygiene (18.78 ± 17.4) .

  Conclusion: The majority of nurses had poor performance in prevention of ventilator associated pneumonia. More attention should be paid for planning appropriate training programs for nurses and giving adequate facilities to improve health care quality .

  Background & Aim: Several studies have shown that the self-care activity of patients with implantable cardioverter defibrillator is inadequate. This study was conducted to assess the effect of an educational program based on the Orem’s self-care model in self-care ability of the patients .

  Methods & Materials: This clinical trial was conducted among 66 patients with implantable cardioverter defibrillator. Four educational sessions were held based on the patient's needs and Orem’s self-care model. Data was collected using a self-report questionnaire at baseline and one month after the intervention. Data were analyzed using statistical tests (x², t-test, paired t-test) in the SPSS-18 . 

  Results: There were no significant differences in the self-care awareness, tendency to self-care, self-care skills, and self-care ability between the control and intervention groups. After the intervention, the self-care awareness score remained 22.06 ± 3.26 in the control group and increased (28.69 ± 1.51) in the intervention group (P<0.000). There was also significant difference in the tendency to self-care between the control (25 ± 3.31) and intervention (28.9 ± 1.33) groups (P<0.000). The self-care skills differed significantly between the control (14.9±3.06) and intervention (29.03±1.15) groups after the intervention (P<0.000). After the intervention, the self-care ability was also significantly different among the control (61.96±8.06) and intervention (86.63±2.93) groups (P<0.000) .

  Conclusion: The results of this study showed that implementing educational programs based on the Orem’s self-care model can improve self-care ability in patients with implantable cardioverter defibrillator. Applying this method is recommended in nursing interventions to promote health status of the patients .

  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: 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: 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: Mothers often feel anxious about giving care to their premature babies. This maternal stress is associated with negative attitudes and behaviors towards babies. The aim of this study was to assess the effect of Kangaroo mother care on stress among mothers with premature babies .

  Methods & Materials: This quasi-experimental study was carried out on 46 pairs of mothers and their premature babies hospitalized in the ICUs of Shahid Sadooghi and Tamin Ejtemaee hospitals. The participants were selected using convenience sampling method and were assigned into two intervention and control groups. In the intervention group, the Kangaroo mother care was provided to the babies after breastfeeding for about 30 minutes once a day for four weeks. Maternal stress was measured using the Parental Stress Scale before and immediately after the intervention. Data were analyzed using the Chi-squared test, t-test, and Mann-Whitney test . 

  Results: The mean of stress score in mothers of the intervention and control groups were 102.0 ± 17.02 and 174.52 ± 18.25, respectively (P<0.001). The stress score was significantly different before and after the intervention among mothers of the intervention group (P<0.001) .

  Conclusion: The Kangaroo mother care decreased stress score among mothers who had premature babies. The Kangaroo mother care is strongly recommended to be used by mothers with premature babies .

  Background & Aim: Exacerbation of the symptoms among patients with chronic obstructive pulmonary disease is a part of the disease's cycle . Despite having medical treatments, most patients experience severe degrees of dyspnea. Self-management programs can help relieving the symptoms. T his study aimed to assess the effect of a self-management program on dyspnea and fatigue severity in patients with chronic obstructive pulmonary disease (COPD) .

  Methods & Materials: In this randomized clinical trial, 50 patients with COPD referred to Apadana clinic in Ahvaz were recruited into the study. Patients were randomly allocated to control and intervention groups. The intervention group received a self-management program designed based on the 5A model the control group did not receive any intervention. Patients were assessed using the Fatigue Severity Scale and the Borg Dyspnea Scale at baseline and three month later. The Chi-squared test and t-test were used to analyze the data . 

  Results: There was no significant difference between the two groups in fatigue severity at baseline. At the end of the three months, the fatigue severity score differed significantly between the two groups (P=0.004). There was also significant reduction in the patients' dyspnea in the intervention group than the control group after 12 weeks (P<0.001) .

  Conclusion: Our program was effective in reducing the COPD symptoms among patients. This simple and non-expensive program can be applied as a beneficial intervention to decline major difficulties of the disease among patients with COPD .

  Caring is the most central concept in nursing. This concept distinguishes nursing from other health professions. However, according to some experts’ opinions, caring is not an only-nursing concept it is defined as the heart of all health professions. Caring is entered in the philosophy, vision and mission of several health organizations (1) and is introduced as the essence of nursing and the fourth complementary concepts of nursing Meta paradigm (2). Caring, as a central concept in nursing, has led to developing various caring theories. The most popular ones involve the cultural care theory of Leninger and the human care theory of Watson that were presented in the 1970s. In addition, the theory of Roach was developed in the 1980s. Another theory was presented by Boykin and Schoenhofer in the 1990s. These theories can be compared in some aspects including origin, domain, and definition of caring, description of nursing and other key components (3).