Background & Aim: Self-care activity is a key factor in managing Rheumatoid Arthritis (RA) in order to reduce disability caused by the disease. Predisposing factors including knowledge, attitude, and self-efficacy are introduced as determinants of self-care behaviors in the forth phase of PRECEDE model, i.e., ecological and educational assessment. This study aimed to assess the relationship between the predisposing factors and self-care behaviors in patients with RA in Yazd, Iran.

Methods & Materials: In this cross-sectional study, a convenience sampling was used to recruit 181 outpatients with RA referred to a rheumatology clinic in Yazd, Iran. Data were collected by conducting interviews with the participants using a survey questionnaire included knowledge, attitude, and self-efficacy, as predisposing factors and self-care behaviors items. Reliability and validity of the instruments were examined and approved. The statistical tests included bivariate correlations, Mann-Whitney U test, and linear regression.

Results: Knowledge, attitude, and self-efficacy scores were 71.7%, 66.9%, and 47.5%, respectively. The total predisposing factors score was 62.3%. There was a significant positive correlation between the self-care behaviors with attitude and self-efficacy. However, there was no significant correlation between the patients&apos knowledge and self-care behaviors. Totally, the measures explained 39.3% of total self-care behaviors variance within which the self-efficacy was the strongest predictor (β=0.41).

Conclusion: Regarding the high power of predisposing factors, especially self-efficacy, in predicting self-care behaviors and the low scores of self-efficacy, health promotion planners should pay more attention to predisposing factors of self-care behaviors especially the self-efficacy in designing health promotion programs.

Background & Aim: Hospital infections are still one of the main causes of death. These infections may be transferred from one patient to another or through medical devices. The prevalence of hospital-acquired infection is 6%-12%. This rate increases to about 65% in some underdeveloped countries. The goal of this study was to compare the efficacy of Isopropyl alcohol and Ethanol in disinfection in pediatrics ward and neonatal intensive care unit.

Methods & Materials: In this trial, 116 specimens were collected from medical devices before and after disinfecting with Isopropyl alcohol and Ethanol. In order to assess the exact effect of these two disinfectants, some of the medical devices were exposed directly to microorganism colonies and then were disinfected using Isopropyl alcohol or Ethanol. Samples were cultured on Petri dishes.

Results: The results of cultured specimens before disinfection showed that some microorganisms such as Staphylococcus, Escherichia-Coli (E. coli), Pseudomonas, and Enterobacter were grown on medical devices. After disinfection, only two microorganisms grew (staphylococcus and Escherichia-Coli) on devices that were disinfected with Ethanol and there were no growth on the devices that were disinfected with Isopropyl alcohol.

Conclusion: The results of the study showed that the Isopropyl Alcohol is more effective in disinfecting than the Ethanol. Since the Ethanol needs more time and specific procedures to act, it should be better to use disinfectants like Isopropyl Alcohol that acts faster and simpler.

Background & Aim: Osteoporosis is a silent and preventable disease that mostly affects women. Osteoporosis prevention requires enhancing knowledge and awareness of students. The purpose of this study was to assess the effectiveness of education on prevention of osteoporosis among high school female students in the sixth distinct of Tehran.

Methods & Materials: In this randomized controlled trial, 600 students were selected using cluster sampling method. Data were gathered using a three-part questionnaire including demographic, knowledge, and practice items. After the baseline measurement, the students were randomly allocated into intervention and control groups. Two educational sessions were held for the intervention group. At the end of the sessions, educational booklets were distributed among the students. The educational strategies included giving lectures, and practicing physical exercises. After two weeks, the participants completed the questionnaires again. The educational classes were held for the control group after the last measurements.

Results: Data analysis showed that the mean of knowledge score and the participants&apos practice were significantly different between two groups after the intervention (P<0.001).

Conclusion: Regarding the effect of education on enhancing students&apos awareness and practice about osteoporosis prevention, designing educational programs could be beneficial.

Background & Aim: Cardiac rehabilitation is one of the most effective ways of secondary prevention in patients with myocardial infarction manifestations. This study aimed to assess the effectiveness of cardiac rehabilitation on clinical manifestations of myocardial infarction in post-MI patients.

Methods & Materials: In this interventional study, 66 patients (58 males and eight females) with myocardial infarction who were hospitalized in public hospitals of Ahwaz were selected using purposeful sampling. The participants were randomly allocated into intervention and control groups. Data was collected using a self-structured valid and reliable instrument. The intervention group participated in an 8-week cardiac rehabilitation program. Data on the clinical manifestations were collected eight weeks later. Data were analyzed in SPSS.

Results: The results showed that there was significant differences between two groups in hypertension crisis (P=0.03), chest pain, dyspnea, fatigue and palpitation after the cardiac rehabilitation (P<0.001).

Conclusion: Cardiac rehabilitation program decreased the clinical manifestations of myocardial infarction in post-MI patients. It is recommended to perform this procedure in the post-MI patients.

Background & Aim: Pregnancy and post-partum period are accompanied by important changes in women&aposs quality of life. Patient counseling is an effective way to improve quality of life. This study aimed to assess the effect of telephone counseling on the quality of life among women with a normal vaginal delivery in Razi hospital in Marand.
Methods & Materials: In this randomized clinical trial, 260 women were recruited to the study. The participants who had met the inclusion criteria were randomly allocated in two intervention and control groups. The intervention group (n=130) received telephone counseling twice at the first week for 20 minutes and then once a week from the 2^nd week to the 6^th week. Moreover, we had provided a 24-hour hotline for women. The control group (n=130) received the routine care. Data were gathered using a demographic sheet, a postpartum problem&aposs checklist, and the SF-36 quality of life questionnaire. Data were analyzed using SPSS-13.
Results: The results showed no significant differences in physical and mental quality of life in the first day of post-partum between two groups. The women&aposs quality of life in both physical and mental dimension were significantly higher in the intervention group in the 42^nd day after childbirth (P<0.001).
Conclusion: Telephone counseling by midwives could help to improve women&aposs quality of life in post-partum period. More studies are recommended.

 

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

 

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

 

Background & Objective: Prenatal period is a unique opportunity to assist the women to adopt healthy behaviors. The nutritional behaviors of pregnant women affect not only their own health but also the fetal growth and development. The purpose of this study was to determine the effect of nutrition education on nutritional behaviors in pregnant women.
Methods & Materials: In this randomized trial, 272 primigravida women were recruited using stratified cluster sampling method from eight family health clinics in Semnan. The participants were allocated in two groups randomly. The intervention group received the nutrition education through two 90-minute sessions with one week interval. Data were gathered using a questionnaire including demographic characteristics and nutritional behaviors at baseline and six weeks after the education. Data were analyzed in the SPSS.
Results: The results showed that there was not any significant difference in the mean score of the nutritional behaviors between two groups before the intervention. Significant difference was found between two groups after the intervention. The mean score in the intervention group was higher than in the control group (P<0.001).
Conclusion: The results of the study showed that nutrition education affected the nutritional behaviors in pregnant women. Therefore, the nutrition education should be integrated in educational topics provided for pregnant women.

 

Background & Aim: Despite the advancement of medical science, readmission of the heart failure patient remains a serous problem. The aim of this study was to assess the effect of continuous care and educational intervention on the rate of readmissions, refers to physician, and health costs in patients discharged from hospital.
Methods & Materials: This study was a randomized clinical trial in which 110 patients were studied. The participants were allocated in two experimental and control groups. Data were gathered using questionnaires. Home visits were carried out in the experimental group during six months. At the end of the intervention, the rate of readmissions, referrals, and health care costs were compared in the two groups. Data were analyzed using independent t-test, Fisher&aposs exact test, and Chi-square test.
Results: Results indicated that the rate of readmissions (1.65±1.01 vs. 2.74±1.07, respectively), and refers to physicians (2.73±1.24 vs. 3.32±0.94, respectively) were lower in the experiment group than the control group (P<0.05) after the intervention. The average health care cost in the intervention group (2494000±172150 Rials) did not differ significantly with the control group (2736800±167360 Rials) (P>0.05).
Conclusion: The results of this study indicated that the nursing interventions such as home visits are effective in lowering readmissions and refers to physicians in patients with heart failure. It seems that home visits are necessary in promoting the patients health. 

 

Background & Objective: Life style has potential role in bone mass density and prevention of osteoporosis in adolescents. The aim of this study was to determine the life style of female students influencing osteoporosis prevention in Nursing and Midwifery school at Zanjan University of Medical Sciences.
Methods & Materials: All female students (n=166) were recruited in this cross-sectional study. Data were gathered using three questionnaires: 1) demographic questionnaire, 2) General Practitioner Physical Activity Questionnaire, and 3) dietary recall questionnaire. Validity and reliability of the questionnaires were determined. Date was analyzed using descriptive statistic, Chi-square, and t-test.
Results: Mean calcium intake was statistically different between dormitory and non-dormitory students (P<0.001). Regarding physical activity, only 19.2% of the students had appropriate activity. The main activity of the students was walking (83.5%). There was a significant difference between economic status and life style (P=0.047). There was no statistically significant difference between life style with the parents&apos educational level, and the educational program.
Conclusion: It seems that life style-related osteoporosis preventive behaviors are not appropriate among nursing and midwifery students. Planning appropriate educational programs could promote high standard nutritional plans and physical activity among the female students.

 

Background & Aim: The prevalence of cardiovascular diseases is high in most of the countries. Cardiac catheterization is a routine diagnostic test for coronary heart diseases. In order to minimize the post-procedure complications, patients are restricted to bed for 8-24 hours in flat position. The aim of this study was to assess the effect of changing position and early ambulation on back pain and the amount of bleeding after cardiac catheterization.
Methods & Materials: In this quasi-experimental study, 90 patients undergoing diagnostic angiography were selected using convenience sampling method in Shariati hospital. The patients were allocated in two intervention and control groups. The control group remained in supine position for 8-24 hours and the sandbag remained for eight hours. The patients&apos position in the intervention group was intermittently changed during the first hour after catheterization. The head of bed was set at 15 degree angle. In the second hour, the position changed to flat and the head of bed raised to 30 degree. In the third hour, the head of bed angle was set in 45 degree. In the first three hours sandbag was placed in catheter insertion site. After the third hour, patients could rest in any position (15-30 degree). Patients were ambulated in the sixth hour. Back pain intensity and level of bleeding were assessed immediately after admission, in the sixth, 24^th hour and after the seventh day of catheterization.
Results: The results indicated that there was no statistically significant difference in age, gender, education level, back pain intensity, and the level of bleeding immediately after the catheterization. Back pain intensity was lower in the intervention group than the control one after 6 and 24 hours of catheterization (P<0.001). There was no statistically significant difference between the intervention and control groups in the level of bleeding after 6 hours, 24 hours, and seven days of catheterization (P>0.05).
Conclusion: Patients should be allowed to change their positions in bed cardiac catheterization. Patients can be ambulated earlier (in the sixth hour) after cardiac diagnostic catheterization.

 

Background & Aim: Regarding the importance of determining the determinants of diabetes self-care, this study aimed to examine two major determinants of self-care activities, i.e. perceived barriers, and perceived self-efficacy among type two diabetic patients in Tehran, Iran.
Methods & Materials: In this cross-sectional study, 128 patients were recruited to the study using convenience sampling. The validated diabetes instruments were completed by the patients. The included participants aged older than 18 years. Data were analyzed using bivariate correlation and path analysis.
Results: The mean score of the perceived barriers and perceived self-efficacy were 3.05 and 2.18, respectively. The maximum score of self-care was 4.18. There was a positive correlation between self-efficacy and the self-care (r=0.22 P<0.01). Positive correlations were also found between education with self-efficacy and self-care (r=0.28 P<0.05), (r=0.29 P<0.05). There was a negative correlation between perceived barriers and self-care behaviors (r=-0.68 P<0.000). Using serial multiple regressions and path analysis, we had a final model (RMSEA=0.05 GFI=0.95 CFI=0.98 P=0.44 and Chi-Square=26.5). This model showed that perceived barriers were the strongest predictor for self-care behaviors. Perceived barriers mediated the effect of self-efficacy on the self-care behaviors.
Conclusion: The intervention efforts that address the studied determinants related to self-care behavior could potentially impact type two diabetic patients&apos self-care activities. These determinants should be mentioned in the program developing.

 

Background & Aim: Intradialytic hypotension is the most frequent complication in patients receiving haemodialysis (HD). This complication not only contributes to the illness of the patients, but also decreases the efficacy of the HD. So, hypotension prevention is a major challenge for medical team, especially for nurses. One of the preventive methods that have recently been presented is the use of sodium profile and ultra filtration (UF) profile. The aim of this study was to compare the effects of linear sodium + UF profile (type1) with stepwise sodium + UF profile (type3) on systolic and diastolic blood pressure in HD patients.

Methods & Materials: In this crossover design study, 26 HD patients from two dialysis centers at Esfahan University underwent three kinds of treatment: (1) control, constant dialysate sodium concentration of 138 mmol/L with constant UF (2) linear sodium profile + UF profile (type1), a linearly decreasing dialysate sodium concentration (146-138mmol/L) in combination with a linearly decreasing UF rate and (3) stepwise sodium profile + UF profile (type2), a stepwise decreasing dialysate sodium concentration (146-138 mmol/L) in combination with a stepwise decreasing UF rate. Each treatment was applied in three dialysis sessions. Data were analyzed using repeated measure ANOVA test in the SPSS.

Results: Twenty six patients participated in the study. A total of 234 dialysis sessions were analyzed. There were no significant differences in the systolic blood pressure between three groups during predialysis and first and the second hours (P>0.05). The mean of systolic blood pressures were higher in the third hour and postdialysis during two types of profiles (1&3) compared with the routine care group (P<0.05). The mean of diastolic blood pressure was also higher in postdialysis during two types of profiles (1&3) compared with the routine group (P<0.05). There was no significant difference between the profiles 1and 3 (P>0.05).

Conclusion: In conclusion, sodium profile + UF profile is a simple and cost-effective method that modulate the dialysate sodium and ultra filtration rate and preserve the homodynamic status and blood pressure of patients during dialysis. Therefore, using sodium profile + UF profile (type1 & type3) is recommended in order to prevent hypotension and reduce nursing work during hemodialysis process.

Background & Objective: Privacy is a basic humanity principle. Protecting patients&apos privacy is a necessity in health care organizations and along with the patients&apos satisfaction, is one of the main indicators of quality of care. The objective of this study was to assess patients&apos privacy protecting by medical staff and its relation to patients&apos satisfaction.

Methods & Materials: This is a cross-sectional survey in which 360 inpatients were recruited using convenience sampling method from an emergency department. Data were collected using a questionnaire and were analyzed using statistical tests in the SPSS.

Results: According to the results, about one half of the patients reported poor privacy protecting and one other half (49.4%) reported that their privacy was protected "relatively good" to "good". A strong correlation was found between level of privacy protected and the patients&apos satisfaction in various dimensions. There was significant correlation between some of demographic variables with privacy protecting and patients&apos satisfaction.

Conclusion: In our study, protecting patients&apos privacy and also patients&apos satisfaction was not generally appropriate. More attempts of clinicians are required to improve the quality of care to promote patients&apos privacy as well as patients&apos satisfaction.

In the many definitions that are accompanied with nursing, in addition to the scientific aspect, art has always been mentioned. Since Florence Nightingale introduced nursing as an art, several theorists have emphasized the aesthetic aspect of nursing in their literature. However, many experts believe that the word "art" has been accepted in nursing without deep thought and criticism.To judge the statement: "Nursing is an art", it seems that it is necessary to review the similarities and differences of "art" concept in nursing and other fields literature. Art has a complex and multidimensional meaning that is the backbone of many theories presented however, they each have their own strengths and weaknesses. Nursing has artistic properties but this characteristic is referred to as folk art and not to specific features of art. In comparing these theories with the concept of art used in nursing, it is essential to note that art in nursing refers to skills of nursing. In other words, nursing is not a kind of fine art.From the aesthetic perspective, nursing can be easily defined as a form of art however, we must put great importance in the inseparable words of "aesthetic" and "art of nursing". With such a connection, we are able to introduce and capture the true spirit of both art and nursing. In this article, we have reviewed the most important definitions and theories of art as a "specific term", and as "skill", where they have linked nursing to art. Moreover, we have discussed their similarities and differences.

Background & Objective: Pregnancy is a situational crisis in women&aposs lives that is potentially related to anxiety. Massage, a kind of relaxation technique, is a non-pharmacological intervention for anxiety relief. Slow stroke back massage is an independent nursing procedure that is closely associated with the caring nature of nursing. This study aimed to assess the effect of slow stroke back massages on anxiety level among primigravid women in two clinics in Shiraz in 2007.
Methods & Materials: In this clinical trial, 80 primigravid women aged 15-35 who were in the 3^rd trimester of pregnancy were enrolled in the study. The participants were randomly allocated in the intervention and control groups. The intervention group received slow stroke back massage for 10 minutes in three consecutive mornings. Anxiety level was measured before and immediately after the intervention in both groups. Data were gathered using the state anxiety Spielberger questionnaire and were analyzed using Chi-square test, Fisher&aposs Exact test, Paired t-test, and Independent statistic test (t-test).
Results: The means of the anxiety level were 51±6.6 and 49.90±6.6 at baseline in the intervention and control groups, respectively (P=0.460). After the intervention, the means of anxiety level were 48.18±6.52 and 51.50±7.39 in the intervention and control groups, respectively (P=0.036).
Conclusion: According to the results, slow stroke back massage seems to be an effective nursing intervention for anxiety relief in primigravid women. It provides an opportunity for nurses to offer individualized and holistic patient care.

Background & Objective: Labor pain is usually the most severe pain women experience in their lives. Most women suffer from low back pain during first stage of labor. The pain can produce adverse effects on delivery procedure. Because of potential side effects of medications used in labor, alternative methods for pain relief have received more attention nowadays. The aim of this study was to evaluate the effect of subcutaneous injection of sterile water on labor pain, type of labor, and satisfaction with pain management in nulliparous women.
Methods & Materials: This was a randomized single-blind study. Samples were consisted of 80 women who were randomly allocated to two intervention and control groups. In the intervention group (40 women) sterile water was injected subcutaneously in four sacral regions during first stage of labor. In the control group, we just inserted a needle in the same area. Low back pain intensity was assessed before and 10, 45, and 90 minutes after the injections using visual scales in both groups. Data were analyzed using descriptive (relative & absolute frequencies, mean and standard deviation) and inferential statistics (t-test, paired t-test and c²) in the SPSS.
Results: There was no significant difference between two groups at baseline. The mean of pain intensity in 10 and 45 minutes after the injection was decreased significantly in the intervention group (P=0.00). There was no significant difference between two groups in the 90^th minute. There was no difference in the type of labor between two groups. The mean of the satisfaction score was higher in the intervention group than in the control one.
Conclusion: It seems that subcutaneous sacral injection of sterile water might be an effective and safe method to alleviate labor pain in women

Background & Objective: Physical activity is one of the main components of lifestyle. Lack of physical activity along with unhealthy eating result in chronic diseases such as heart diseases, diabetes, and osteoporosis. This study aimed to design an educational program for improving physical activity in secondary school female students in Tonkabon in 2008.
Methods & Materials: This study was an educational intervention in which 600 students enrolled in the study. The participants were allocated randomly in the intervention (n=300) and control (n=300) groups. Data were gathered using "International Physical Activity Questionnaire" and a standardized questionnaire -according to PRECEDE model- at baseline. The program was planned according to the PRECEDE model and was implemented in the intervention group students. Data were gathered two months after the intervention in both groups. Data were analyzed using Chi-Square, t-test, variance and regression analysis tests in the SPSS and STATA.
Results: Following the educational intervention, the mean scores of the predisposing factors (knowledge and attitude), enabling factors, and reinforcing factors as well as the behavior were significantly increased in the intervention group compared to the control group (P<0.001).
Conclusion: The findings showed that this structured program is useful in improving physical activity in female students.

Background & Aim: Exercise is an integral component of physical and mental health. Attention to exercise in women, regarding their physiologic situation is essential. This study aimed to investigate the effect of a specific aerobic exercise program on fetal growth in pregnant women.
Methods & Materials: In this clinical trial, 39 pregnant women in 24-32 weeks of gestation were enrolled. The participants were randomly allocated to experimental (n=18) and control (n=21) groups. Women with single pregnancies and intact amniotic membranes were included. Women who had any contraindications for exercise were excluded from the study. Exercise program included stretching and flexibility exercise and aerobic exercise (constant walking for 30-45 minuets) three days a week for eight weeks. Data were analyzed using descriptive statistics, c², t-test, Kolmogro-smirnov and repeated measurements. P<0.05 was considered to be significant.
Results: The results showed a 1.37% increase in the newborns&apos weight in the intervention group however, the difference was not statistically significant. The average of head circumference and newborns&apos length in the intervention group&aposs newborns were 0.21cm and 0.09cm more than the control group&aposs newborns, respectively. These differences were not statistically significant too (P>0.05).
Conclusion: There were no reductions in the growth of the fetuses following the exercise activities. This kind of exercise has no adverse effect on fetal growth.

Background & Objective: Labor potentially causes stress and anxiety, especially in nulliparous women. In Iran, many pregnant women undergo cesarean section electively due to fear of labor pain. The purpose of this study was to investigate the effect of reflexology on the anxiety level, blood pressure, and pulse in nulliparous women in Kerman.
Methods & Materials: In this clinical trial, 70 nulliparous women with gestational age more than 37 weeks and cervical dilatation of 3-4 cm were recruited for the study. The participants were randomly allocated to two equal reflexology and control groups. The reflexology group received the intervention for 20 minutes (each foot: 10 minutes) on their feet and the control group received massage for 20 minutes on their legs. Anxiety level, blood pressure and pulse rate were measured at baseline and immediately after the intervention using Spielberger questionnaire.
Results: Anxiety level did not differ between the two groups at baseline (P=0.85). After the intervention, the mean of anxiety level was significantly lower in the reflexology group than in the control one (P<0.001). The pulse rate (P=0.44) and blood pressure (P=0.59) did not differ significantly in two study groups after the intervention.
Conclusion: Reflexology reduced anxiety level in labor.