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Introduction: With a dramatic increase in costly mass casualty incidents over the past few decades, disaster planning and preparedness now represent a prominent part of health care policy and practice. Administration of computer technologies, including computerized simulation techniques, in hospitals can improve management of future incidents.

Materials and Methods: In this research, we used SIMAN/ARENA software of disaster management in one of the teaching hospitals of Tehran University of Medical Sciences. Data about the patients&apos need for specific surgeries, possibility of re-operation, length of operations and necessary equipment’s including number of operating rooms and staff, imaging facilities and treatment stations in emergency department were collected. Two teams took part in this program: a simulation team and the hospital staff team. Both teams were trained before taking part in this study.

Results: With the help of simulation system, the simulation team created various preplanned “events” and simulated in and out hospital situations. Hospital staff team reacted to these situations and was able to recognize and solve various problems in different critical points in hospital by using different tactical means.

Conclusion: Simulation technique used in this limited scale drill was useful in evaluating and improving preparedness of hospitals for managing a multi-casualty incident. The current system can be used in all hospitals in Iran to improve preparedness for receiving victims of a multi-casualty incident.

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Introduction: The delivery of placenta and membranes (third stage of labor) is an important stage of delivery. Complications of this stage can increase maternal mortality rate. There is controversy regarding the routine use of oxytocic drugs in this stage of labor. These drugs may shorten duration of third stage but have side effects. Furthermore, management of delivery in physiologic way causes minimum damage to the mother and newborn.

Materials and Methods: The present research is a clinical trial study. A total of 94 subjects were divided into two groups. All subjects in active group received 10 units of Syntocinon in 500 cc serum. The cord was clamped and cut after cessation of pulsation and the placenta was delivered by Brandt–Andrews maneuver. Women in the physiologic group received 1cc of placebo in 500 cc serum, no clamping of the cord was attempted until pulsation had ceased and the placenta was delivered by minimal traction on the cord and with maternal effort without any maneuver.

Results: Two groups were matched in the subjects’ characteristics. The rate of postpartum hemorrhage in physiologic group (14.58%) was higher than active group (10.64%) but the statistical tests showed no significant differences between two groups (p=0.2945). The mean duration of the third stage of labor in the physiologic group (13 minutes) was longer than active group (9 minutes) but the statistical test showed no significant differences between two groups. The statistical tests also showed no significant differences between rate of retained placenta (p=0.5) or piece of the placenta and membranes (0.2428) in two groups.

Conclusion: Statistical tests showed no significant differences between duration and complications of the third stage of labor in two groups. The routine use of Syntocinon in management of third stage of labor can not be recommended.

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Background & Aim: Performance appraisal is one of the most important duties for nursing managers. This will improve the quality of nursing care, and it needs suitable approaches and effective strategies in nursing services. The aim of this study is to determine the impact of performance appraisal using management by objective approach on nursing care quality.

Methods & Materials: This was a quasi-experimental and single-blind study that was carried out in two surgical units of an affiliated hospital of Tehran University of Medical Sciences. 80 patients were selected using a randomized sampling. The quality of nursing care were controlled in both experiment and control units before and after the performance appraisal procedure. The procedure was programmed on the basis of management by objective approach for six months in the experiment unit. In the intervention unit, nursing performance appraisal was done three times and in every time head nurse and supervisors participated in giving feedbacks and recommendations for the nurses. At the end of the intervention, quality of nursing care was assessed in both groups blindly. The results were compared and statistically analyzed.

Results: Significant difference was found between quality of nursing care in the experiment and control units (P<0.001). Quality of nursing care was significantly different before and after intervention in the experiment unit (P=0.009).

Conclusion: Performance appraisal using management by objective approach could increase the quality of nursing care. As a result, using nursing performance appraisal plans according to the basis of MBO could be an effective evaluation way to access the quality of nursing care.

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Background & Aim: The present research attempted to investigate the effect of time management training on work-life conflict among two hospitals&apos nurses.

Methods & Materials: In this randomized trial, we recruited all nurses of two public hospitals (n=106) in Hamadan and Tehran according to the inclusion criteria. We used balanced (permuted) block randomization for assigning the study sample into control (n=53) and intervention (n=47) groups. Six individuals did not participate in the study. Data were collected using two instruments: 1) work-family conflict scale and 2) time management behaviors scale. For content validity, ten experts in the field of the study commented on the items. The reliability coefficients (Cronbach&aposs alpha) for these scales were 0.86 and 0.75, respectively. All participants completed the questionnaires at baseline. The time management skills were taught in the intervention group for eight hours. One month later, all participants in two groups completed the questionnaires again.

Results: Considering the baseline characteristics, the groups were homogenous. Independent sample t-test indicated no significant differences between the two groups in all dimensions before the intervention (P>0.05). There was significant difference between two groups in the work-family conflict after the intervention (P<0.001). Also, the paired t-test showed significant difference in work-family conflict before and after the intervention in the intervention group (P<0.001).

Conclusion: According to our findings in the present research, time management training intervention had positive effect on work-family conflict among hospital nurses.

 

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Background & Aim: The objective of this study was to investigate perspectives of managers regarding change management in nursing and midwifery schools.

Methods & Materials: In this qualitative study, we used a descriptive exploratory approach with triangulation. We used snow ball sampling to recruit faculty members of nursing and midwifery schools in Tehran. The participants were included in the study if they had at least 1-year experience as a faculty member. Data were gathered using semi-structured interviews in which a guide and field notes were used. Data were saturated after observing repetition of the codes. Latent content analysis was used for data analysis. The trustworthiness was achieved using a prolonged field experience, member check, peer check and sharing the content with two qualitative research experts.

Results: Ten participants (seven females and three males) aged 38-54 were interviewed. Three participants were employed in highly recognized management levels. Immediately after interviews, conceptual codes were extracted. Suggested themes were classified as concentration in management, managers&apos characteristics, and attitude toward change.

Conclusion: Accordingly, the concept of change management was postulated as the purpose of this study. Furthermore, its influencing factors were identified. The results of this study can be used by faculties of the nursing and midwifery schools to use them according to their organizational culture.

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Background & Aim: Pain can detrimentally affect physical functioning, psychological well-being and social interaction. Various attitudinal factors may be associated with inadequate pain control. Hence, studies should be undertaken to gain a better understanding of association between pain control attitudes and use of analgesics and cancer pain intensity. This study aimed to determine relationship between pain control attitudes and use of analgesics and pain intensity in cancer patients with pain.

Methods & Materials: A descriptive cross-sectional study was conducted with 200 cancer patients who underwent chemotherapy or radiotherapy and experienced pain in previous 24 hours. The pain control attitudes, use of analgesics, worrisome about using analgesics and physical and psychological impacts of pain were measured using questionnaires. The cancer pain intensity was measured using the visual analogue scale. Validity and reliability of the instruments were evaluated. Data were analyzed using independent t-test and ANOVA.

Results: About 58% of patients agreed that they would wait before asking for help. Beside, the findings indicated that willing to tolerate pain and perceived control over pain were associated with the time and frequency of taking analgesic and pain intensity in previous 24 hours and last week. Also concerns about addiction to pain-relieving medications were related to the analgesic type and pain intensity within last week (P=0.03), and fear of injection was related to analgesic use and pain intensity within last week (P<0.001).

Conclusion: Many cancer patients had attitudes which could interfere with pain relieving. Suggestions are made for developing patient education programs, accessing effective cancer pain controls and decision making for cancer pain relief.

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Background & Aim: Asthma is one of the most prevalent chronic diseases worldwide. About 6.5 million people suffer from asthma in Iran. The Effective strategy to control asthma is related to education. The self-management has a major role in the standard education program. This study aimed to assess the effect of education on using peak flow meter and follow up via SMS on asthma self management.

Methods & Materials: This study was a quasi-experimental controlled clinical trial. The samples included 98 patients, suffering from asthma referred to the pulmonary clinic in Imam Khomeini and Shariati hospitals. Patients were selected using convenient sampling method and were randomly assigned into the experiment (n=47) and control (n=51) groups through blocking method. Two educational sessions were held in the experiment group about how-to-use peak flow meter. Accordingly, the patients in the experiment group sent their peak flow rates via SMS to the researcher within 12 weeks. The researchers provided feedback to the patients about their asthma control via phone, weekly. Patients in the control group did not receive any education. Data were collected using the Asthma Control Test before and three months after the intervention. Data were analyzed using the statistical tests of Chi-square, Mann-Whitney, Independent t-test and Kolmogorov-Smirnov.

Results: There was a significant statistical difference between the two groups of experiment and control in terms of asthma control (P=0.002).

Conclusion: The education using peak flow meter and following up via SMS promotes asthma self-management. With regard to the significant role of nurses in patient education, educating patients with asthma by nurses is recommended at the Iranian Society of Asthma and Allergies clinics and medical centers.

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Background & Aim: Stress is a main problem among nurses which affects their professional performance and personal life resulting in conflict between work and life. The aim of this study was to determine the effect of stress management on work-family conflicts.

Methods & Materials: In a quasi-experimental two-group study, 64 medical nurses were selected randomly to the study from Shahid lavasani hospital in Tehran. Data were gathered using a questionnaire including demographic characteristics, work-family conflict items, and nursing stress scale. Then, the experimental group participated in a 2-day stress management course. The questionnaire was completed by the participants one month later. Data were analyzed in the SPSS v.18.

Results: The mean work-family conflict score was 3.97 in the experimental group at baseline. It declined after the intervention to 3.357 (P<0.001). There was statistically significant difference between the two groups on work-family conflict after the intervention (P=0.007). There was a significant decrease in the job stress from baseline (46.52) to the post-intervention measurement (35.61) in the experimental group (P<0.001). There was a statistically significant difference between the two groups in the mean of job stress after the intervention (P=0.014).

Conclusion: Stress management education declined work-family conflict and job stress among nurses. This education should be used in nursing clinical and educational training programs.

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Background & Aim: The premenstrual syndrome (PMS) is a set of physical and psychological symptoms that occurs periodically and affects women’s social and individual functionings. This study aimed to investigate the effect of stress management group counseling on the symptoms of premenstrual syndrome.
Methods & Materials: This semi-experimental study (IRCT2016052127994N1) was conducted on 44 students with PMS (22 in the intervention group and 22 in the control group) from Zanjan University of Medical Sciences in 2016. Data were collected using a demographic characteristics form and premenstrual symptoms screening test (PSST). Descriptive and inferential statistics including independent t-test, Chi-square, ANCOVA and repeated measurement test were used for data analysis via the SPSS software version 21.
Results: Before treatment, the mean scores of mood-behavioral symptoms, physical symptoms and the impact of symptoms on life had not any significant differences between the two groups. At the first month after treatment, mood-behavioral symptoms (P<0.001) and the impact of symptoms on life (P=0.007) were different between the two groups. Two months after the intervention, the mean scores of mood-behavioral symptoms in the intervention group (53.2±4.84) were significantly different from those in the control group (70.2±4.81). There was a significant difference in the mean score of physical symptoms between the intervention group (36.7±5.87) and control group (64.9±7.84). Also, the mean score of the impact of symptoms on life had a significant difference between the intervention group (36±4.73) and control group (58.3±2.73) (P<0.001).
Conclusion: Stress management group counseling is effective in reducing the symptoms of premenstrual syndrome, and it can be used as a non-pharmacological method with no side effects.
 

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Background & Aim: Diabetes is the most common metabolic disease that needs self-management. The aim of this study was to compare the effects of loss- and gain-framed messages on knowledge, self-efficacy and self-management in diabetic patients.
Methods & Materials: In this randomized clinical trial (IRCT2016122931653N1), 112 patients with type 2 diabetes referred to the 17th Shahrivar Diabetes clinic in Borazjan in 2017, were divided into three groups including loss-framed message, gain-framed message, and control. The data were collected by questionnaires in three steps; before, one week and three months after intervention. Chi-square test, one way analysis of variance and repeated measures analysis of variance were used to analyze the data on the SPSS software version 22.
Results: Before the intervention, mean scores for knowledge, self-efficacy and self-management in loss-framed messages group and gain-framed messages group were lower than control. One week and three months after the intervention, mean scores for knowledge, self-efficacy and self-management in both the loss-framed messages and gain-framed messages groups showed a significant increase compared to the control group (P<0.001). One week after the education, self-management score in the gain-framed messages group was 102.26±11.20, in the loss-framed messages group was 111.53±13.73 and in the control was 88.75±11.41. Three months after the education, self-management score in the mentioned groups were 105.58±11.80, 108.72±15.39 and 88.49±13.51, respectively.
Conclusion: The results of this study showed that designing and implementing educational programs based on loss-framed messages and especially gain-framed messages can improve knowledge, self-efficacy and self-management behavior in diabetic patients.
 
 

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Background & Aim: Sleep disturbances in type II diabetes patients due to insulin resistance is a risk factor for the exacerbation of the disease. Therefore, assessment of the factors affecting the improvement of sleep in diabetic patients is a necessity for health care providers. The aim of this study was to investigate the relationship between sleep quality and self-management in type 2 diabetes patients.
Methods & Materials: This is a descriptive, cross-sectional study. A total number of 170 patients with type 2 diabetes referred to the medical centers affiliated to Qazvin University of Medical Sciences were included using the convenience sampling method in 2018-2019. Data were collected by the Richards-Campbell Sleep Questionnaire (RCSQ) and the Diabetes Self-management Questionnaire (DSMQ). Data were analyzed by the SPSS software version 21 using the descriptive/analytical statistics.
Results: The results showed that the mean score of sleep quality was 49.89±25.90 (range: 0-100) and mean score of self-management was 31.82±6.80 (range: 0-48). The results from the Pearson correlation analysis showed a significant relationship between sleep quality and self-management (P<0.05). Also, the stepwise linear regression model showed that the use of health care systems and physical activity and other variables such as marital status and weight of patients had a significant effect on their sleep quality (P<0.05).
Conclusion: The results of the study showed that an increase in the patients’ self-care status, use of health care systems, increased daily physical activity and having an ideal weight can be predictors in improving patients' sleep quality. Therefore, providing infrastructure programs such as continuing education and providing appropriate care programs for diabetics to improve self-management activities, as well as increasing daily physical activity, increasing the use of health systems, and weight control can improve the sleep quality of this group of patients who account for a significant proportion of chronic diseases in communities.
 

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Background & Aim: Patients with heart failure experience some outcomes such as poor self-management, poor adherence to treatment and low quality of life. The aim of the current study was to evaluate the effect of self-management based discharge planning on treatment adherence in patients with heart failure.
Methods & Materials: In this quasi-experimental research, 80 patients with heart failure hospitalized in teaching hospitals in Zahedan in 2019-2020, were selected by convenience sampling and were randomly allocated into either intervention or control groups. The self-management-based discharge plan consisted of four educational sessions in hospital for the intervention group. In order to follow up, the first call was made 2-3 days after discharge. Then, the patients or their family caregivers were contacted weekly in the first month and twice a month in the second and third month. Data were collected by the treatment adherence questionnaire and were analyzed using independent sample t-test, Fisher exact test, Chi-square and repeated measures ANOVA by the SPSS software version 16.
Results: The two-way repeated measures analysis of variance showed a significant difference in the mean scores of treatment adherence over time (P<0.001) and in the intervention and control groups (P<0.001).
Conclusion: According to the findings, it is recommended that self-management-based discharge plan be employed in an integrated manner for patients with heart failure in medical wards.
 

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Background & Aim: Childhood vaccination as the most common iatrogenic pain is the main source of pain, anxiety and stress in children and parents, which is often done without pain management. Therefore, given the importance of pain control in children, and the recognition and application of pain control methods by the health team members, this study was conducted to evaluate the effect of ShotBlocker on vaccination pain in 6-month-old infants.
Methods & Materials: In this clinical trial study, 80 infants referred to Mehrshahr health center in Birjand in 2018-2019, were selected using the convenience sampling method based on the study criteria, and then randomly assigned to the control or experimental groups. In the experimental group, 20 seconds before the injection until the end of the injection, pressure was applied to the injection site with a ShotBlocker. The control group only received routine care. The pain status in the two groups was measured using the Pain Behavioral Response Scale (FLACC) 15 seconds after injection, and also the duration of crying from the time of vaccine injection to the end of crying was compared between the two groups. Data was analyzed using descriptive and inferential statistics including Mann-Whitney, t-test, and analysis of covariance at the significance level of less than 0.05.
Results: The study results revealed the mean pain intensity (4.32±0.99), duration of crying (14.4±3.92), and the time of onset of crying (4.05±0.933) were lower in the experimental group than those of in the control group (P<0.001).
Conclusion: Considering that ShotBlocker is effective in reducing pain intensity, the duration of crying and delay in onset of crying, it is recommended to use this simple, safe, and low-cost device to manage pain during vaccine injection.
Clinical trial registry: IRCT20191128045534N1
 

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Background & Aim: Patient safety in general and medication errors in particular are the important indicators of hospital care quality. Risk management is an important and fundamental approach to preventing events caused by medication errors. The aim of this study was to determine the effect of risk management program on the rate of medication errors among intensive care unit nurses.
Methods & Materials: The present study was a non-randomized pre-test, post-test study with a control group, conducted in 2020 in two hospitals in Tehran. The hospitals were randomly assigned to either an experimental group or a control group. According to the inclusion and exclusion criteria, 150 nurses (75 nurses in each group) were selected by the convenience sampling method. For the experimental group, a risk management program was implemented. Data collection tools included the nurses’ demographic questionnaire, the 14-item Wakefield medication error self-reporting questionnaire, and the nurses’ medication quality checklist. Data was collected before and after the intervention and analyzed by the SPSS software version 16 using descriptive and inferential statistics.
Results: The results of independent t-test showed no statistically significant difference between two groups in demographic information and the rate of medication errors before the study (P>0.05). After the intervention, difference in the rate of medication errors was statistically significant between the two groups (P<0.005), indicating a decrease in medication errors in the nurses of the experimental group compared to the control group. The results also showed that the rate of medication error observed in nurses was significantly higher than the error reported by them (P<0.001).
Conclusion: The results showed that the implementation of risk management program was effective in reducing nurses’ medication errors. Implementing a risk management program is recommended to nurses as a way to promote safe medication and achieve safe and desirable nursing care.
 

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Background & Aim: Self-care and self-management, as two effective strategies play an effective role in controlling pain and quality of life. Therefore, considering the characteristics and dimensions of these two concepts, this study aimed to compare the effect of self-care education and pain self-management on the nature of pain and quality of life in patients with sickle cell disease.
Methods & Materials: In this clinical trial study, 75 patients with sickle cell disease, referred to the thalassemia clinic of Baqaei hospital 2 in Ahvaz and Shahid Beheshti hospital in Abadan, were selected and randomly divided into three groups of 25 people (self-care, pain self-management and control groups). The two intervention groups (self-care and pain self-management) were divided into groups of five people, and received specific training during four sessions for three months. The nature of pain and quality of life of patients were assessed four times (before the intervention, one month, two months and three months after the intervention) using the McGill Pain Questionnaire and Quality of Life Questionnaire. The SPSS software version 22 was used to analyze the data.
Results: The results showed that pain self-management and self-care programs were effective in improving the quality of life and pain of patients with sickle cell. However, there was no statistically significant difference between the two intervention groups in the nature of pain and quality of life.
Conclusion: Self-care and pain self-management have similar effects on reducing patients’ pain and improving their quality of life.
Clinical trial registry: IRCT20160726029086N5