JOURNAL OF HOLISTIC NURSING AND MIDWIFERY
Year:2016 | Volume:25 | Issue:81|Papers Count:16

Introduction: Health of vision and audition is very effective in physical health and community health nurse plays an important role in the promotion of students’ health. Therefore studying the visual and auditory health of students by a health nurse can play an important role in the promotion of their health.Objective: This study aimed to determine the visual and auditory health condition of elementary students of Abadan villages.Methods: This cross-sectional descriptive and analytic study consisted of all students studying in 50 schools in primary schools of Abadan villages (5, 500 students). Using cluster random sampling method, 26 schools and from each class in every school, 24 students were selected. Finally, 624 students, including 322 girls and 302 boys in age range of 6 to 12 years old in first to sixth grade were enrolled. Data collection tools were Snellen chart and a checklist to record the data. In order to evaluate the auditory health, after training, the student sat against the wall with his/her index finger blocking the ear canal. The researcher stood behind the student and checked right ear, left ear and then both ears by saying two-syllable words. The use of glasses, hearing aids and the eyes and ears were examined and the results were recorded. The validity of the tool was determined by content validity. To determine the reliability, 15 subjects were studied with the tools, twice every other day.The correlation coefficient between the two stages was 1 which showed the reliability of the tool used. Each student was given verbal explanation about the objective and methods of performing the study by the researcher and if content, the students were entered into the study. The data were analyzed by descriptive statistics, measures of central tendency and dispersion, and chi-square with significance level P<0.05.Results: All of students surveyed 20.35 percent (22.98% girls and 17.55% boys) suffered from visual disorder. There was no significant difference between girls and boys (P=0.11). In the meantime 3.04 percent of them wore glasses. Also, 10.10 percent of students (11.80% girls and 8.28% boys) suffered from auditory disorder and there was no significant difference between girls and boys (P=0.18).Conclusion: In attention to study findings, more training on study style, TV watch, importance of wearing glasses and ear health observance especially for girls is necessary. Also referring students with disorder to relevant specialist is important. In this regard, the community health nurse can be very effective.

Introduction: Depression is one of the most common psychiatric disorders in children and adolescents. In the past decade, coinciding with the increased prevalence of depression in younger age, much attention has been attracted to the diagnosis and treatment of depression in children and adolescents.Objective: This study aimed to determine the prevalence of depression symptoms in guidance school children and assessment of its relation with some personal and family factors.Methods: This is a cross-sectional descriptive and analytical study which used random multi-stage cluster sampling. First, educational districts 1 and 2 of Rasht city were considered as the two main clusters. In the next stage, in each cluster separately, according to sex (girls' and boys' schools), school type (public, private) and grades (sixth and seventh in primary and third in secondary school), a total of 24 grades in districts 1 and 2 were calculated. The sample size of 618 students was determined based on results of the pilot study. Given that the entire class was considered as a cluster, the number of samples increased to 775 (31 clusters).753 of all parents returned the completed form.The research tool included Children Depression Inventory (CDI) and a questionnaire on demographic characteristics (personal-family) which were given to subjects with answer sheets by the researchers. They were asked to answer the questions honestly and accurately according to what they felt at the moment. CDI psychometrics with cut-off 22 had been determined in Iran. The data were analyzed with descriptive and inferential statistics (chi-square, logistic regression and t-test).Results: Most of subjects were 13 years old (37.6%). Frequency of the girls and boys were 398 (52.9%) and 355 (47.1%), respectively. Moreover, the frequency of the students in sixth and seventh of primary and third grade of secondary school were 249, 268, 236, respectively.70.8% of the students were at public and 29.2% in private schools. Most of them had educational improvement (64.1%), without parents with history of depression (87% fathers, 87.9% mothers).Results revealed 10% of the subjects with depression symptoms (8.5% in boys, 11.3% in girls) in sixth (11.6%) and seventh grades of primary (5.2%) and third grade of secondary (13.1%) in public (4.5%) and private schools (12.2%).10.6% of the students had educational improvement.8.9% lacked it. Depression history was recorded for 2% of fathers and 7.7% of mothers. Moreover, 7.9% of fathers and 10.5% of mothers had chronic diseases. Families with monthly income of less than 150 $ had the highest percent of depression (14.4%). Most symptoms of depression were seen in children whose parents were illiterate (12.3%) and high school graduate (4.8%).19% of unemployed fathers and 10.3% of homemaker mothers had children with highest depression symptoms. Students living in a rental house (10.9%) as well as those whose mother's was dead showed the most symptoms (33.3%).Results indicated that depression symptoms were significantly related to grade (p=0.008), type of school (p=0.001), and no history of depression in father (p=0.005). Third grade of secondary school students had the highest symptoms. Most of these students were at public than private schools (95% CI, 1.3-5.1- odd ratio: 2.5). Students with father's history of depression had fewer symptoms (2% vs.11%).Conclusion: Although depression symptoms based on our tool did not necessarily suggest the depression disorder in terms of severity and duration of the symptoms, a significant association was observed between scores of depression and some personal and family factors which insists on considering the importance of these factors in preventive programs for children depression.

Introduction: Empowerment during pregnancy is defined as a sense of self- fulfillment and increased independence, promotion of interaction with individuals and environment leading to an increase in the spontaneous psychological energy to achieve successful pregnancy and childbirth. Education during pregnancy empowers women for better adjustment confronting physical and emotional changes associated with pregnancy and experiencing a satisfying delivery.Objective: Present study was conducted to determine the empowerment of pregnant women referring to Tonekabon health centers.Methods: This cross-sectional study was conducted on 200 pregnant women who referred for prenatal care clinics to in Tonekabon in 2013. Pregnant women participating in the study were at least literate and had no significant medical problems or obstetrical pregnancy indicating a high-risk pregnancy. Besides, they had no history of previous cesarean section and gave consent to participate in the study. Cluster sampling method was used. Two centers of clusters were randomly selected. All pregnant women referring to these two centers for prenatal care were included after obtaining the written consent.The data collection tool was a questionnaire designed in two parts. The first part contained demographic and obstetric information and the second part was pregnant women's empowerment questionnaire by Kameda, with 27 questions in five dimensions; Self-efficacy (6 questions), future image (6 questions), self- esteem (7 questions), support and assurance from others (4 questions), and joy of an addition to the family (4 questions) which were answered based on the Likert scale from strongly disagree to strongly agree with 1 to 4. Minimum score of 27 and maximum score of 108 were given to the answers. The mean score was used to judge about the answers.The data were analyzed using descriptive statistics and ANOVA (given the normal distribution of data) at significance level of 95% and p=0.05. Data collection was performed after approval by the Research Council of Azad University, Tonekabon Branch.Results: The mean age of subjects was 26.38 ± 3.76 years old.36% of women were in their first trimester of pregnancy. The majority of pregnant women (55.55%) experienced their first pregnancy and had high school education (40%) and wanted pregnancies (79.5%).90.5% of them were homemaker. This study found the mean and standard deviation of empowerment as 78.74 ± 6.71 (Minimum score 27 and maximum score 108).Of all empowerment dimensions, the highest mean score dedicated to self-esteem (19.19 ±1.82) and the lowest to the support and assurance from others (12.70 ± 1.59) and joy of an addition to the family (13.66 ±1.79). The results showed a significant correlation between mother's education and empowerment score (p= 0.03). Moreover, the relationship between interest to continue the pregnancy and empowerment was statistically significant (p=0.005). No significant difference was observed between other variables such as pregnancy age, mother's age and number of pregnancy, mother's job and support of spouse, level of income and unwanted pregnancy and total score of empowerment.Conclusion: The findings of this study can be effective in assessment of prenatal care, planning and implementing delivery preparation classes and promotion of empowerment of pregnant women. Given the role of education in promoting women's empowerment it is suggested that the effect of natural childbirth in empowering pregnant women be considered in future studies. Prenatal education brings about positive feelings, happiness in the family, promoted ability to deal with new conditions, promoted maternal and newborn health, increased confidence, satisfaction of having children, active participation of family members in maintaining family health and promoted ability to adapt and cope with the problems and responsibilities of life.

Delirium is the most common neurological diagnosis among patients in intensive care units. The prevalence of delirium in the ICU patients is high and this is associated with many complications. Thus, by assessment and identifying predictive factors of delirium, its incidence can largely be prevented in intensive care units.Objective: This study aims to determine predictive factors of delirium incidence in patients hospitalized in intensive care units.Methods: This study is a descriptive-analytic study which included all patients admitted to intensive care units (neurology, general and trauma) in one of the training centers, Rasht for three months in 2013 without any symptoms and signs of delirium before hospitalization. There was no age limit for selection of samples. At least 24 hours after admission to ICU, with and without mechanical ventilation, ability to see and hear, Persian language, conscious or semi-conscious, not receiving neuromuscular blockers, coma, history of severe nerve damage (such as acute stroke, dementia, aphasia), chronic renal failure, alcohol abuse and drug abuse were the study inclusion criteria. Patients who used painkiller and sedatives during the study were excluded. Thus, samples were selected gradually considering the inclusion criteria. Based on the preliminary results with 20 samples, the study sample size was estimated 81. The tools used in this study were Richmond Agitation Sedation Scale (RASS) and Confusion Assessment Method for the Intensive Care Unit (CAM-ICU). RASS is the standard tool to assess the level of restlessness and sedation in ICU patients. CAM-ICU examines four main characteristics of delirium; acute change or fluctuations in mental status, lack of concentration, disturbance of consciousness and unorganized thinking.The first part consisted of demographic characteristics including age, sex, Charleson comorbidity index, Acute Physiology Score (APS) in three ranges of 0-9, 10-14-and≥15, white blood cell count, serum total bilirubin, days of mechanical ventilation, and days of ICU stay and hospitalization.Charlson comorbidity index had 19 conditions in which the patient is scored based on its potential impact on mortality rate. APS is the biggest part of APATCH (Acute Physiology and Chronic Health Evaluation), obtained from 13 clinical evaluations performed 24 hours after ICU admission in which higher scores is indicative of worsening patient's physical condition. The second part consisted of examining the incidence of delirium in which patients were assessed by RASS in terms of level of consciousness. This tool consisted of 10 items, each representing one level of consciousness (of Combative to Unarousable). To determine RASS, without any interaction, the patient was only observed and if conscious, she was scored 0 to+4. If the patient was unconscious, his/her name was called loudly and asked to look at the researcher. If the patient responded to call, appropriate score (1-3) was assigned. If there was no response, the patient's shoulder was shaken. If no response was observed, his/her sternum was strongly squeezed and appropriate score (4-5) was given. In case of no consciousness level disorder based on RASS, the subjects were assessed by CAM-ICU for examining delirium which took about 3-5 minutes.The collected data were analyzed using descriptive and analytical statistics (Fisher and chi-square).For multivariate analysis of the associated factors with delirium, Backward Logistic Regression model was used. P<0.05 was considered the significance level. The probability of exclusion from the model was considered P<0.1.Results: 64.2% of the subjects were male and most of them (48.1%) were hospitalized in the general ward. The majority of samples (49.4%) scored 0-9 in terms of APS. Charlson comorbidity index also showed most cases (29.6%) with 1-2 scores. The mean and SD of patients were 50.95 ±21.33 years, the maximum tracheal intubation days was 146 days. The maximum duration of ICU stay was 147 days and 150 days in the hospital. Furthermore, the maximum total bilirubin was 4.2 mg dl and the highest number of white blood cells was 29.2000 mg dl. Delirium was observed in 27.2% of samples using CAM-ICU. Delirium distribution was not significant based on qualitative variables; sex, ward and Charlson score whereas APS score which was significant (p=0.048).Distribution of delirium was significant in terms of age (P=0.06). However, it was not statistically significant in terms of the number of mechanical ventilation days, hospitalization and ICU stay, total bilirubin and white blood cell count.Based on logistic regression model, age, sex, days of tracheal intubation, ICU and hospitalization days, total bilirubin, white blood cell count, and Charlson index were not predictors of delirium.Only APS (considering the range of 0-9 scores as the reference) in two ranges of 10-14 (P<0.038) and³15 (P<0.043) were identified as predictors of delirium. Thus, individuals with a score of APS=10-14 (OR=3.3, 95% CI: 1.03-10.71) and APS³15 (OR=4.2, 95% CI: 1.08-16.7) had higher delirium compared to those with APS=0-9 Conclusion: Patients with APS points higher than those with lower scores are more likely to develop delirium.

Introduction: Patient education is one of the important aspects of nursing care and is among nursing key roles in delivery of health services.Objective: This study aimed to determine the barriers to patient education from nurses' viewpoint employed in educational hospitals affiliated to Shahid Sadoughi University of Medical Sciences in Yazd.Methods: This study was a cross-sectional and descriptiveanalytical study in which 162 nursing personnel were selected by stratified-random sampling method. In order to perform the sampling according to the population of each hospital, the numbers of samples were determined. Data were collected with a two-part questionnaire. First part contained personal and demographic information such as age, sex, marital status, education and working experience. The second part included 19 questions on patient education barriers which evaluated four domains of working conditions, management, nursing attitude and training skills. The data were analyzed by descriptive statistics and chi-square statistical test. Answers were designed based on a Likert scale from low to average and high impact with scores of 1-3, respectively. In management domain, the scores ranged from 6 to 18. Scores less than 10 showed "low impact", 10 to 14 "average impact" and more than 14 "high impact". In the domain of working conditions, similar scores were obtained. The findings displayed that nurses' attitude ranged from 2 to 6 scores. Scores less than 3 showed "low impact", 3-4.5 "average impact" and more than 4.5 "high impact". In domain of training skills, scores ranged from 5 to 15. Scores less than 8 indicated "low impact", 8 to 11.5 "average impact" and more than 11.5 "high impact". The data were analyzed with descriptive statistics and chi-square. The study was approved by the Ethics Committee of Health Faculty, Shahid Sadoughi University of Medical Sciences in Yazd.Results: In this study, 149 of the 162 questionnaires were answered indicating92% response rate.The data showed that 45.2% of male nurses and 47.3% of female nurses blamed working condition barriers with highest impact on the implementation of patient education. Moreover, 45.8% of single and 47.5% of married nurses had the same opinion. Chi-square test found no significant relationship between the variables of age, sex, working experience, employment status, marital status, and educational level with patient education barriers (P≥0.05).The data showed that 31.5% of nurses believed that barriers related to management had the greatest impact on the implementation of patient education followed by 47.7% barriers to working condition, 2.7% attitude of nurses and 14.1% training skills. Chi-square test showed a significant correlation between the domains of working condition and type of hospital (P=0.048). Working condition was proved as the most important factor. Management was the second factor followed by training skills as the third. Finally, attitude of nurses was identified as the least important patient education barrier.The results of the present study revealed three factors with highest impact as education barriers in nurses' opinion; high working load (74.5%), insufficient nursing stuff in wards (71.8%) and nursingshifts in a row (70.4%) in working condition domain. The study population reported three factors with lowest impact; training as a specific task assigned for doctors (54.4%), lack of nurses ‘selfconfidence for training (43.5%) and not delivering the trainings to patients (40.3%).Conclusion: In attention to that the domain of nurses working conditions had the greatest impact on the education of the patients, it is recommended that official authorities to maintain nursing resource in hospitals and reduce their workload and provide facilities and conditions for educational programs to encourage nurses to consider this important issue.

Introduction: Living with schizophrenic patients is stressful. Caregivers without sufficient knowledge cannot perform their responsibilities very well. This situation leads to relapse and rehospitalization.Families experience a lot of stress facing such difficult situations which results in discomfort, tensions or despair in family members. High tensions impair family function unless the family adapt to the new situation.Objective: This study aimed to determine effectiveness of stress coping skills training with psychoeducational approach among caregivers` of schizophrenic patients on family function and psychological well-being.Methods: This is an experimental study with pretest-post test design and a control group comprising of main following variables; coping skills training with a psycho-educational approach (the independent variable) and family function and psychological well-being (two dependent variables).The study population included 220 caregivers of patients with schizophrenia who had referred to psychiatric clinic and had a history of hospitalization. Since the number of members in a psychotherapy group should be very limited, the sample size was considered 30. Sampling was performed with convenience method. Data collection tools included Ryff Psychological Well-Being and Family Assessment Device questionnaires. The psychometrics of both questionnaires had been confirmed in Iran. Ryff assesses six main components of psychological well-being. Therefore, it has 6 subscales (each subscale contains 14 items) and 84 items. The subjects specified their level of agreement, "agree "to" disagree", in a 6-point Likert scale. To obtain a score for each subscale, the score of each item on the related subscale should be summed. The total score of all 84 items equals the total psychological well-being. The subscales include self-acceptance, positive relations with others, autonomy, environmental mastery, purposeful life and personal growth.Family Assessment Device is a questionnaire with 60 items in domains of problem-solving, relationships, roles, effective response, effective involvement, behavior control, and general functioning. They were answered in a 4-Likert scale. In order to obtain the score of each subscale, all subscale scores have to be added then divided by number of items of each subscale. Higher scores show poor functioning. In this study, the mean score was used to compare the groups.The researcher referred to the psychiatry clinic and specified the records of patients diagnosed with schizophrenia and had the inclusion criteria; being main caregiver, educated and living in Rasht.The families were then contacted.30 patients were randomly selected whose psychological wellbeing and family function score had one SD below the mean of questionnaires scores. They were placed in two experimental and control groups (15 per group). During the intervention, six subjects (3 per group) withdrew due to family problems and the disease recurrence. Again in the last session, the questionnaires were completed by the subjects. The interventions were performed twice a week for 90 minutes in twelve consecutive sessions. Homogeneity of the two groups in terms of evaluated variables was approved using ANOVA. Then, the variance-covariance analysis was used to determine the effectiveness of stress coping skill straining with psyche-educational approach on variables of family function and psychological well-being.Results: Most of the subjects (58.3%) were women with mean age of 53.9±5.87. Majority of them (79.2%) had secondary education. Analysis of data showed that the mean score of family function in the experimental group in pretest was 183.42 ± 13.96 and 177.08±8.23 in the control group. The mean score of the psychological well-being was 224.58±27.03 in the experimental and 228.33±12.01in the control group. In the posttest, the mean score of family function equaled121.83±15.59 and the control group 172.58±4.25. Moreover, in the post test the mean of psychological well-being of the experimental group and the control group were 373.33±23.96 and 242.67±7.27, respectively.Analysis of variance test with Wilks' lambda to determine the effectiveness of stress coping skills training on family function and psychological well-being in combination, indicated the significant impact of education (p<0.0001). Using ANOVA confirmed the significant effect of these training on family function (p<0.0001) and psychological well-being (p<0.0001) as well.Stress coping skills training with the psycho-educational approach is effective on family function and psycho-educational well-being in caregivers of schizophrenic patients.

Introduction: Attachment styles are important factors in determining the psychological harms in people especially aggression.Objective: This study aimed at determining the level of aggression in different types of attachment styles in 15 to 17 -year-old high school students in Rasht city.Methods: This correlational descriptive study was conducted on 576 students studying at first to third grade of high school in Rasht in 2013. The study sample was classified based on district classification of Office of Education, type of school, sex and grade.46 classes (n=576 students) were selected by systematic random sampling method. Classes were considered as clusters.Data collection tool was a questionnaire including three parts. First part contained demographic characteristics such as age, sex, grade, field of study, and type of school, birth order, having siblings, education level of family breadwinner, father's job and family income. Second part was the aggression questionnaire by Arnold and Perry which had 29 questions and 4 sub-scales (Physical and verbal aggression, anger, hostility).Total score of the questionnaire ranged from 29 to 145.Thus, the minimum and maximum scores of physical aggression (Min=9, Max=45), verbal aggression (Min=5, Max=25), anger (Min=7, Max=35) and hostility (Min=8, Max=40) were obtained. Scores higher than the mean showed aggression in all of them.Third part comprised of an adult attachment style questionnaire by Hazan and Shaver with 15 questions on secure, avoidant and anxious-ambivalent attachment styles. The final score was calculated based on sum of all obtained scores. Minimum and Maximum scores in all three aspects ranged from 5 to 35. Scores higher than the mean showed using that aspect. To determine the reliability of the aggression tool, a pilot study was conducted on 25 samples. Cronbach's alpha coefficient was obtained 0.85 for determining the internal consistency of the instrument for all questions and 0.73 for physical aggression, 0.78 for verbal aggression, 0.74 for anger and 0.78 for hostility sub-scales. Due to the frequent use of this questionnaire in many papers, re-determining its validity was discarded. In order to confirm the scientific validity of the attachment style questionnaire, content validity was used. Internal consistency of this instrument was investigated in a pilot study using Cronbach's alpha coefficient. The alpha coefficient was obtained 0.88 for avoidant, 0.69 for anxious-ambivalent and 0.68 for secure attachment styles. Data were analyzed by descriptive statistics (frequency, percent, mean, standard deviation and median) and inferential statistics (Kruskal-wallis and multivariate logistic regression). P<0.05 was considered the significant level.Results: The mean age of study samples was 15.5 ±0.9 years old. Majority of them were girl (54.1%), first year high school student (49.1%) in public schools (88%) in field of Experimental Sciences (39.9%) with high school graduate parents (44.4%), a brother (45.7%), no sister (46%), three family members (63.7%), average family monthly income eqal 150 – 200 $ (25.9%) and self-employed father's job (51.6%). Based on the findings, none of the demographic variables had a statistically significant relationship with total score of aggression in adolescents. Moreover, the results showed that the total aggression score was significant in terms of attachment styles (p< 0.002).Backward multivariate logistic regression model reveled a significant association between attachment styles by controlling for demographic variables with adolescent aggression score.Adolescents with anxious-ambivalent attachment style were 1.8 times more aggressive than the ones with secure attachment style (P=0.027).Furthermore, among individual and social variables, field of study and education level of parents were associated with aggression score. Adolescents who had parents with lower education level than high school diploma were less aggressive than the students with university educated parents (p=0.046).About field of study, adolescents in Humanities (p=0.019), Experimental Sciences (p=0.030) and Mathematics (p=0.017) were less aggressive compared to students in Work and Knowledge.Conclusion: According to the study findings, adolescents with a secure attachment style had lower aggression than the ones with avoidant and anxiety styles. Secure and avoidant attachment styles had the highest and lowest frequency, respectively. The quality of a person's attachment can predict the kind of his/her relationship in the future as well as rate of growth, health, copping strategies with emotions and stresses, independency and mental disorders.

Introduction: Depression during pregnancy is among the most important types of depression in women, which can have serious consequences for both mother and child.Objective: Therefore, this study aimed to determine the prevalence of depression and its effective factors in pregnant women attending health centers in Neyshabur in 2013.Methods: This cross-sectional descriptive and analytic study was conducted on 280 pregnant women referring to health centers in Neyshabur in 2013. Five of nine health centers were randomly selected using cluster sampling method. Sample size was determined considering ratio data and the referrals to each center using random systematic method. They were enrolled after obtaining verbal consent.In this study, data collection tool was a two-part questionnaire. First part consisted of demographic information (age, number of previous deliveries, gestational age (in weeks), pregnant woman's job, year (s) of marriage, family monthly income, age difference with husband, pregnant women' s education, spouse's education level, abortion history, planned or unplanned pregnancy, personal or family depression history). Second part contained Beck Depression Inventory with 21 items which measures physical, behavioral and cognitive symptoms of depression. Each question has four options that can be scored from 0 to 3 and each item specifies various degrees of depression from mild to severe. Total range of its scores ranges between 0 to 63. Scores less than 10 represent a normal status, 11- 16 mild depression, 17-20 need consultation with psychologist or a psychiatrist, 21-30 relative depression, 31-40 severe depression and more than 40 very severe depressions. Since the onset of some symptoms such as sleep disorders, weight fluctuations and energy reduction can exist in a normal pregnancy, diagnosing depression may be difficult. Although developing depression score is considered to be higher than 10, scores higher than 16 were considered as the threshold of depression in pregnant women. Descriptive and inferential statistics were used to analyze the data. For univariate analysis, chi-square was determined to compare the qualitative variables. T-test and Mann–Whitney test were used to compare the quantitative and ordinal variables, respectively. Moreover, logistic regression model (Backward) was used to examine the relationship between study variables and depression. Significance level was considered less than 0.05.Results: The mean age of the patients was 25.5 ± 5.24 years.135 (48.2%) of the 280 women were under 25 years of age.55 cases had (19.6%) less than high school education.158 women (56.4%) experienced their first pregnancy.53 cases (19.9%) were in their first trimester of pregnancy. In this study, 84 (30%) of pregnant women had some degrees of depression symptoms.50 of them were under 25 years (59.5%) and 34 (40.5%) were over 25 years old.46.2% of women whose family monthly income was less than or equal to 150 $, and 24.5% of women with income above this amount had symptoms of depression. Furthermore, 25.3% of women with planned pregnancy and 74.1% of those with unplanned pregnancy had symptoms of depression. Using the chi-square test, a statistically significant relationship was observed between age, pregnant woman's job, monthly family income, level of education, spouse's education level, planned or unplanned pregnancy with symptoms of depression during pregnancy (p<0.05). Yet, other variables (number of previous deliveries, gestational age, year (s) of marriage, age difference with husband, abortion and depression history) were not significantly associated with symptoms of depression during pregnancy (p>0.05). Finally, using multivariate logistic regression model showed a significant relationship between age of pregnant women (P<0.001, OR=0.35), family monthly income (P<0.00, 1, OR=0.32) and planned or unplanned pregnancy (P<0.001, OR=11.66) with symptoms of depression during pregnancy.Conclusion: In attention to study findings, it seems that pregnant women's depression level in Neyshabur is high. Therefore, it is suggested that managers of therapeutic health care centers implement appropriate interventions in order to reduce or prevent depression during pregnancy.

Reproductive tract infections are recognized as one of the most serious health problems in the world. These infections can be associated with many consequences.Objective: This study aimed to determine the condition of preventive behavior related to genital tract infections and its effective factors.Methods: This is a descriptive analytical study on preventive behaviors related to reproductive tract infections and its risk factors in women admitted to health centers in Tabriz city in 2013.Twenty two health centers and stations (including 9 centers and 13 stations) out of 27 centers and 38 stations were randomly selected. In the next stage, according to sample size, 25-30 records were randomly selected from all women's records. The sample size was measured according to the pilot study and using the ratio formula for 384 patients and considering coefficient of 1.5, the final sample size equaled 584.Our study included married 15 to 49-year-old women who had referred for health care and had health records, higher than primary education level and willingness to participate in research.Women who were unwilling to participate for complete more than 20% of the questionnaire were excluded.The data collection tool was a researcher-made questionnaire including questions related to behavioral prevention assessment of reproductive tract infections and questions about factors influencing these behaviors as well as demographic characteristics and obstetrical and fertility history, and questions on knowledge of the risk factors. In order to determine the preventive behavior, the scores of 2, 1, 0 were given to items "always", "sometimes" and "never", respectively.The sum of scores was calculated. The mean score was considered as the score of study tool. Of all the behavioral prevention questions, the ones with the lowest and highest score were reported. To determine the knowledge about non-sexually transmitted infections, "correct" and "incorrect/I don’t Know" answers were given 1 and zero scores, respectively. Then the total scores were calculated.Knowledge score£5 was considered poor, 6-10 average and 15-11 good. To determine the level of knowledge about sexually transmitted infections, according to the number of questions and range of scores (0-37), score£12 was considered poor, 13-24 average and 25-37 good. The scientific validity of the questionnaire was determined by content validity and reliability using test-retest. The reliability coefficient was 82.0. Descriptive statistics was used to determine the absolute and relative frequency, mean and 95% confidence interval. T-test and ANOVA were used to control the confounding factors and linear regression was used to determine their effects. The variables with P<0.1 were entered into the model. In this study, p<0.05 was considered as significant.Results: Most women (56.1%) were in age range of 20-29 years old. Most of them were high school graduates (48.3%), homemaker (90.2%) and had sufficient income (59.4%) in their own opinion. A statistically significant relationship was found between behavioral prevention with age, education level, occupation and income (p<0.05). Half of the subjects had a history of RTIs. Anal, oral, and vaginal-anal sex, sex with husband only and replacement or transfusion of blood in husband were significant related to behavioral prevention score (p<0.05).Mean score of behavioral prevention equaled 25.39 ± 4.6 of possible scores ranging from zero to 34. Mean score of knowledge of genital non-sexually transmitted infections was 9.6±3.19 of possible scores ranging from zero to 15. Thus, research subjects had average level of knowledge.Mean score of knowledge on sexually transmitted infections was 17.08 ± 7.42 of possible scores ranging from zero to 37. Hence, they had average to poor knowledge.A statistical significant relationship was observed between the level of knowledge and behavioral prevention score (p<0.001). In other words, behavioral prevention had a significant increase with increased score of knowledge.After adjusting the possible confounding factors, multivariate analysis showed a statistically significant relationship between preventive behaviors and knowledge score (R2-0.06, P-0.002), family income (R2-0.023, P<0.001), sex only with husband (R2-0.015, P-0.047), anal sex, oral sex (R2-0.054, P-0.003) and blood transfusion history (R2-0.028, P-0.005). A statistical significant association was detected between the level of knowledge and behavioral prevention score (p<0.001) so that increased knowledge significantly raised the score of behavioral prevention.Conclusion: Trainings on these infections especially in school and pre-marital ages seem necessary as well as providing related public services. Health trainers should be consistent with this strategy.Primary prevention of such infections should be prioritized in health training.

Introduction: Problem solving is an essential skill for living at present century. Problem solving skills and knowledge-based decision making are expected behaviors from nursing students and learning these skills should be initiated during student period.Objective: The purpose of present study was to determine the problem solving skills and their related factors in undergraduate nursing students of Guilan University of Medical Sciences.Methods: This is a descriptive-analytical study conducted on all undergraduate nursing students (N=456) enrolled in faculties of Shahid Beheshti Nursing and Midwifery (N=317) and East Guilan (N=139) and according to the inclusion criteria, they were not guest or transitional students. Finally from all eligible students, 404 entered the study after completing the written consent forms.Referring to classes and clinical training environments, the subjects were asked to complete the questionnaires in twenty minutes.Data collection tool was a two-part questionnaire. First part included Heppner & Petersen Problem Solving Inventory (PSI) with 32 items. The answers were designed with Likert scale ranging from 1 (completely agree), to 6 (completely disagree). The most and least scores of problem solving were 192 and 32, respectively. Scores lower than the mean indicated a higher ability in problem solving.This tool consisted of three components of self confidence in problem solving, proximity-avoidance and personal control. The tool was used with permission of the original author. The second part consisted of factors related to problem solving skills covering a two-part questionnaire of individual and educational factors.In order to determine the validity of this tool, 13 faculty members were asked to review it. Content validity ratio for all items of this questionnaire was 1. Furthermore, content validity index obtained was between 7.0 to 1. Cronbach's alpha coefficient and test-retest were used to define the internal consistency with a ten-day interval. In a pilot study, 20 questionnaires were given to 20 undergraduate nursing students. For re-test, after ten days the same tool was given to them.Cronbach's alpha coefficient showed a good internal consistency (problem-solving skillsα=0.80, proximity-avoidanceα=.81, self-confidence α=0.71, personal control α=0.78). Internal correlation coefficient for this tool and all its dimensions were between 0.82-0.97 which indicated the reliability of the tool. Data were analyzed by descriptive statistics (mean and standard deviation) and inferential statistics (Chi-square, Kruskal-wallis, Mann-Whitney, Spearman’s correlation coefficients and multiple regressions). P<0.05 was considered as the significance level.In order to determine the most important factors related to problem-solving skills, all significant or nearly significant variables in univariate analysis were entered into the regression model by backward step wise (LR) method (Entry 0.05, Removal 0.1). In this model, the response variable, the problem solving skill was analyzed considering zero for scores>mean and 1 for scores≤ mean.Results: The mean age of students was 21.35 ± 2.75 years old. Most of them were female (60.6%), single (91.9%) and local (81.1%).48.1% of them were living with their family.41% of students' fathers and 41.8% of mothers had high school diploma.51.4% of their income was equal to between 175 -350 $. Results showed 94.3% had no smoking and 98% no alcohol or drug use experience.44.6% of the students saw themselves successful in solving problems. Majority of them (63.6%) requested their family support when dealing with a problem. Most of these students believed their parents were democratic (73.8% of fathers' behavior and 70.4% of mothers' behavior).82.5% had acceptable grades in their university courses and 97.7% with no failure.81.3% of all samples had never participated in life skills classes.52.2% declared their academic success was average.Results suggested that the total mean score of problem-solving skills equaled to 91.45 ± 20.90 (ranging from 32 to 192). The problem solving score was less than mean among these students. The mean of all scores of self-confidence in problem solving was 30.27± 6.92 (ranging from 11-66), avoidance-proximity 44.12± 12.28 (ranging from 16-96) and personal control 17.06 ± 5.53 (ranging from 5-30). In addition, the students had a lower score than mean in self-confidence and avoidanceproximity dimensions and lower and near to mean in personal control.Conclusion: Surveying the socio-demographic and educational factors revealed that based on multivariate logistic regression model, a positive relationship existed between the number of siblings (P=0.019, OR=0.85), mothers’ educational status (p=0.026, OR=0.74), success in problem solving (p=0.0001, OR=1.95), perceptions about their mothers’ attitude (p=0.011, OR=2.01), school and department of education (p=0.024, OR=1.76), satisfaction with field of study (p=0.006, OR=1.44) and success in professional and clinical skills (p=0.03, OR=1.48).

Introduction: Premenstrual syndrome is defined as a set of physical and psychological symptoms that occur during the luteal phase of the menstrual cycle and gets better at beginning or during the first few days of menstruation. Among these complaints, depression and anxiety are more common and aversive.Objective: The present study aimed to compare the effectiveness of group cognitive behavioral therapy and group cognitive hypnotism for anxiety and depression in women with premenstrual syndrome.Methods: This quasi-experimental study was conducted on 300 women referring to health centers affiliated to one of the health centers in Rasht in 2013. According to Morgan sampling table (after Spiegel test, to evaluate the possibility of hypnosis and completing the premenstrual syndrome questionnaire during two consecutive cycles).30 patients with the highest score of anxiety and depression were selected using purposeful sampling. Sample size was determined considering the fact that group psychological therapies usually include 8-12 individuals. After obtaining consent from the participants, they were divided into three groups randomly (two experimental and one control). The first experimental group received eight sessions of cognitive behavioral group therapy aimed at reducing depression and anxiety during menstrual cycle. Similarly, the second group received eight sessions of group cognitive hypnosis therapy to reduce anxiety and depression in their monthly period. The third group served as a control group.Inclusion criteria were reproductive age, upper than high school education and no mental illness.Exclusion criteria were positive Spiegel test (unable to move pupils) to perform the hypnosis.Spiegel is a common test to evaluate the possibility of being hypnotized. It has three degrees and the pupils' movements are used for estimation. The ones who have a poor ability to raise their pupils have a little possibility for hypnotism while the third degree shows the ability to raise pupils which manifest Sclera. The following instruments and tests were used to measure the study variables: 1.Premenstrual questionnaire: evaluates the severity of symptoms related to premenstrual syndrome which was completed during two consecutive cycles by patients who had referred to health centers. The minimum and maximum scores of this tool was designed zero to 66.2. Beck Depression Inventory (BDI): Beck's questionnaire on Symptoms of Depression.3. Beck Anxiety Inventory (BAI): is a self-report questionnaire to measure the severity of anxiety symptoms. The minimum and maximum anxiety and depression scores were between zero and 63, respectively. Mean of all of the three tools were used for judgment.After scoring all questionnaires by the three groups in pretest and posttest, the data were analyzed using descriptive and inferential statistics including t-test, ANCOVA, ANOVA and Tukey test.Results: Most of the subjects were more than 20 years old, married and high school graduate. The results showed that both cognitive behavioral therapy and hypnosis were effective on reducing anxiety and depression symptoms in premenstrual syndrome (p<0.05). Moreover, no significant difference was observed between cognitive behavioral therapy and hypnosis in reducing anxiety and depression.Comparison of means showed a significant difference in reducing symptoms of depression between cognitive behavioral therapy and control group (P=0.005). Interestingly, after treatment a significant was seen in level of anxiety between the groups (P=0.001). Hypnosis group compared with the control group, showed a significant difference in the symptoms of depression (P=0.018) and anxiety (P=0.005). Finally, the results suggested that both cognitive behavioral treatments and cognitive hypnosis significantly reduced depression and anxiety in the intervention groups.However, no significant difference was found between these two treatments in reducing depression and anxiety. In other words, both cognitive behavioral therapy and cognitive hypnosis were effective on reducing anxiety and depression to the same extent.Conclusion: Study results showed effectiveness of psychological therapies on treatment of premenstrual syndrome. Due to less complication, these therapies are more recommended than medical treatments. Considering the similar effectiveness of cognitive behavioral group therapy and hypnotism therapy, hypnotherapy is suggested especially in women's diseases.

Introduction: Ventilator-associated pneumonia (VAP) is a subset of hospital infections occurring 24 hours after intubation or mechanical ventilation. Considering the outcome of VAP, prevention is of a high importance in the care of patients who are being treated by mechanical ventilation. Thus, evidence-based guidelines have been published by researchers to prevent ventilator-associated pneumonia and can effectively reduce its incidence.Objective: The purpose of this study was to review the knowledge on these evidence-based guidelines in prevention of ventilator-associated pneumonia.Method: This is a descriptive -analytical, cross-sectional study which used census sampling method.171 nurses with bachelor and master degree participated in the study. To determine their knowledge of evidence based guidelines for prevention of ventilator-associated pneumonia, a two-part questionnaire was used. The first part included demographic information including age, sex, nursing position title, university degree, working experience and years in the intensive care unit as well as ICU specifications such as type and number of beds and internet access. The second part had Labeau et al. questionnaire that consisted of 9 multiple-choice questions. Questionnaires were given to the participants during morning, afternoon and night shifts by a researcher in each ward. The response time was 15 minutes. After collecting the questionnaires, correct responses were calculated in percentage and the mean of total score was determined. In this study, evaluations and judgments were based on the mean of score. In order to analyze the data, descriptive statistics were used to estimate the frequency. Chi-square, t-test and ANOVA were used to examine the relationship between level of knowledge, demographic variables and characteristics of intensive care unit.Results: 171 of 219 ICU nurses participated in this study and 48 patients were excluded due to vaccation at the time of sampling or unwillingness. Most of the study population was women (93.6%) with a Bachelor' s Degree (94.7%) and nurse position title (89.5%).In this study, 59.9% of the nurses had not passed any ICU specific training course.42.7% of them were in ICU with more than 8 beds. The majority of them (40.4%) had between 1-5 years of working experience. Furthermore, the mean score of nine one-score questions equaled 4.63±1.708. The most wrong answers belonged to the questions about "ventilator set's replacement frequency" and "the moisturizer's replacement period". The most correct answers were about "choosing a semi-sitting position for reducing VAP". Mean of scores obtained by women was higher than men. The independent t-test showed no significant difference between the two groups (P=0.721). The mean score was higher in nurses with master degree and the ones who had passed specific ICU nursing courses than the ones who did not. Independent t-test manifested no significant difference (P=0.189, P=0.204) in this regard.Among the participants who had replacement nurse position, nurses working in ICUs with more than 8 beds and nurses with more than 10 years of experience had a higher mean score. Yet, ANOVA showed no significant difference among these groups (P=0.168, P=0.882, P=0.327).Conclusion: This results in more attention to training purposes in some parts of the guidelines.Lack of nurses' knowledge of evidence-based guidelines for preventing ventilator-associatedpneumonia is one of the potential barriers and increasing the awareness level will be the first step in a successful training program.The findings seem to highlight the importance of specific parts of the guidelines that should be considered in trainings. Lack of nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia is one of the potential barriers. Increasing their awareness will be the first step for a successful training program on VAP prevention.