Nursing And Midwifery Journal
Year:2016 | Volume:14 | Issue:2 (79)|Papers Count:13

Background & Aims: Being discharged on the contrary to the medical advice from the hospital cancause the premature discontinuation of treatment by patients or their family, and sometimes it results inthe re-hospitalization or death of patients. It can be a detector of serious problem and patientdissatisfaction. This study aimed to assess the rate and causes of discharge against medical advice ininpatient and outpatient wards of Shahid Madani hospital in khoy.Materials & Method: This cross-sectional study was performed in Shahid Madani hospital in khoy cityin 2014. All of inpatient and outpatient (1663 patients) that discharged the hospital against medicaladvice during the study period were included in the study. Data collection tool was a check list. Datawere analyzed by using descriptive and inferential statistics in SPSS 18.Results: The patients, who were discharged from the hospital against medical advice, were 6.82% of allinpatients and 19.65% of all outpatients in emergency ward. The most important reason for discharging(47.8%) was prolongation of hospital stay. Other reasons were listed as feeling better, tending to stay inthe hospital medical center, denial of treatment, dissatisfaction with the doctor, lack of facilities, dissatisfaction with the service provider and end stage of the patient.Conclusion: As far as being discharged against medical advice can disrupt the patient's treatment, so itis advised to prevent it by increasing the patients awareness to the possible effects of illness, planning abetter treatment protocol for patients, stabilizing the clinical social workers to identify and assessing thepatient’s problems, creating a better space to relax patients and their relatives, and by creating a pleasantenvironment.

Background & Aims: Due to the chronic nature of diabetes and its long process and the high prevalenceof foot ulcer complications in patients with diabetes and spending a lot finance and service of for healthcare providers related to the care of wounds, using self-care programs such Orem's self-care programcan be effective. This study aimed to determine the effect of self-care program based on Orem's modelon self-care behaviors of patients with diabetic foot ulcers referred to Ayatollah Taleghani Hospital inUrmia.Materials and Methods: The present study is a quasi-experimental study.60 patients with diabetic footulcers referred to Ayatollah Taleghani hospital in Urmia were selected by available sampling approach. All the patients had inclusion criteria, and they were randomly divided into two equal groups controland intervention, each having 30 members. Data collection tools were demographic, measure of selfcare and assessment based on Orem's model questionnaires that were completed In two stages, beforeand after the implementation of Orem's self-care program. The data were analyzed via SPSS software v.16, using descriptive and statistical testes.Results: The results showed that mean score of self-care status before intervention in the interventionand control groups was not statistically significant (P=0.11). But the t-test indicates a statisticallysignificant difference between the two groups in self-care status after the intervention (P<0.001).Conclusion: Implementing Orem's self-care program can cause the increase of self-care behaviors indiabetic patients. Therefore, it is recommended to improve the patient’s knowledge and adherence toself-care behaviors. The nurses should use different patient-centered communication approaches toimprove it.

Background & Aims: Family-centered education has an important role in diabetes control byestablishing an effective relationship with self-care. This study aimed to evaluate family-centerededucation on self-care of patients with Type 2 diabetes.Materials and Methods: This experimental study consisted of 60 patients with type 2 diabetes who wererandomly assigned in two groups: control group (n=30) and treatment group (n=30). Data were collectedusing a questionnaire consisted of demographic characteristics and self-care items measuring. Familycentered education in the intervention group lasted for three months. Data collecting process wasperformed at two points; at the baseline of the study, and after 3 months. Data were analyzed by SPSS21 using descriptive and inferential statistics.Results: The study revealed that family-centered education on self-care included five dimensionsconsisting of nutrition, physical activity, blood glucose control, and foot care. After intervention, thedifference between two groups were statistically significant d (p<0.001). Applying medication regimendidn’t show any significant difference (p>0.05) between two groups.Discussion: Family-centered education by a nurse for three months could have important effects on selfcare, and its dimensions included nutrition, physical activity, blood glucose control, foot care in thediabetes type II. Therefore, it is recommended to the nurses to include family education in patients withdiabetes.

Background & Aims: There are numerous errors in food-drug administration through feeding tube. Appropriate performance of nurses can improve patient safety and prevention of complications. The aimof this study is to assess the effectiveness of small group teaching on the nurses’ performance of fooddrug administration.Materials & Methods: This was an experimental study that was done in Urmia Emam Khomeinihospital.80 nurses were enrolled in the study by using census method. The intervention group wasdivided into four groups, and for each group, four training sessions (one and half hour) with the creationof thoughtful learning situation was held. Knowledge and performance in relation to food-drugadministration were evaluated before, and one month after the training program.Results: The results showed that before training, status of nurses’ knowledge was poor in the control (90.6 percent) and intervention groups (80 percent). After the implementation of training for theintervention group, 97.1 percent of status of nurses’ knowledge in the intervention group was good.Before the training, most of the nurses did not have good performance in both groups. Implementationof the training for the intervention group caused improving the performance of the nurses.Conclusion: There are errors in the time of food-drug administration through feeding tube. This cancause adverse effects. Hence, improvement and use of proper techniques in food-drug administrationcan increase efficacy of drug feeding and nutrition, it can increase patient safety and reduce the occlusionnumber of tube feeding.

Background & Aims: Proper sleep quality is essential for physical and mental health, and it isassociated with many negative outcomes. The purpose of this study was to investigate the relationshipbetween students’ cell phone overuse and their sleep habits and sleep disorders.Materials & Methods: In this descriptive- correlational study, 400 students (50% male and 50% femal) have been selected from university students of Mohaghegh Ardabili in 2012-2013. The studentscompleted a researcher made demographic questionnaire, Cell Phone Overuse Scale (COS) and thePittsburg Sleep Quality Index (PSQI). The data were analyzed by Pearson Correlation Coefficient, andmultivariate regression analysis on SPSS-16 software (p<0.05).Results: Results showed that the most common sleep problem was disability in sleep (69.75%) and cellphone overuse has positive relationship with bedtime and awakeness time, awakness duration beforesleep, subjective sleep quality, delay in sleeping, sleep disturbance and daily dysfunction (p<0.05).Regression results also indicated that cell phone overuse explains between 12-29% of sleep habits andsleep disorder variances in students.Conclusion: These results showed the necessity of double attention of health profesionals in order toprevent the adverse effects of cell phone overuse as a risk factor of sleep health, and promotion ofstudents biopsychosocial health.

Background & Aims: Evaluation of clinical and educational environment is a key determinant inqualitative student-center training programs. In order to evaluate and understand this environment avalid and reliable instrument is required. Reliable and valid measurement, however, can be problematic-especially as instruments developed and tested in one culture are translated for use in another. The aimof this study was to exam the psychometric properties of undergraduate clinical education environmentmeasure (UCEEM) in internship nursing and midwifery students in Islamic Azad University in Iran.Materials & Methods: In this descriptive-cross sectional study, 215 internship nursing and midwiferystudents completed the Persian versions of (UCEEM).The construct validity of the (UCEEM) wasexamined by using exploratory factor analysis and Pearson correlations. Cronbakh’s Alfa coefficientwas calculated to determine internal consistency. Data analyses were performed with SPSS 17.Results: Exploratory factor analysis confirms the original four subscales of the UCEEM questionnaire. Overall internal consistency of the translated measure was good (a=0.93).Conclusion: The Persian version of the UCEEM appears to be reliable and potentially validinstrument for use in Iranian Nursing and midwifery Schools. It may be favorable in evaluating theclinical learning environments of nursing and midwifery programs nationwide.

Background & Aims: Infant health and its consequences are the main concerns of women at risk ofpreterm birth, which can cause maternal anxiety. Some interventions can be effective on reducing theanxiety. This study was aimed to determine the effect of supportive counseling on the anxiety of womenat risk of preterm birth.Materials and Methods: This clinical trial study was performed on 88 women (43 in intervention group, and 45 in control group) at risk of preterm birth. The intervention was inclusive supportive counselingprogram, performed after determining the level of maternal anxiety by Spielberger AnxietyQuestionnaire. After intervention, maternal anxiety was determined as well. The data were analyzed byFisher's exact test, Mann-Whitney and also by using the SPSS-22 software.Results: In the intervention group, the findings revealed that supportive counseling decreasedsignificantly trait and situational anxiety. In the control group, trait anxiety increased briefly, butsituational anxiety reduced. The mean difference between the two groups was significant statistically.Conclusion: Supportive counseling can significantly reduce maternal anxiety in women at risk ofpreterm birth. Therefore, it is recommended that health care personnel take into account supportivecounselling sessions to reduce anxiety and to provide safe labor condition.

Background and purpose: "Organizing and Direction of operations" are important aspects ofoperational planning. One of the problems in management of hospitals is the lack of on time and correctorganization and direction of operations for operational planning. This study has been conducted toevaluate the effect of organization and direction of operations on operational planning in hospitals in2013-14 in Iran.Materials and Methods: In this applied study, in which revisal, comparative, quantitative methods hasbeen used, the theoretical models of operational planning were examined through Library Studies, andafter determining the variables of different models of operational planning, a questionnaire wasdeveloped. A survey from 176 experts from academic and administrates of hospitals was carried out aswell. The data was collected. Exploratory and confirmatory factor analysis was performed as well.Results: The effect of the “Organization of planning team" and "Direction of planning team" onoperational planning in hospitals based on factor analysis of regression coefficients were estimated tobe 0.761 and 0.916. Also in the results obtained from the survey from the experts, the question of "Formation of operational planning team and determining of their duties" with the mean of 4.60 and"Recognition of strategic problems and prioritizing them" with the mean of 4.31 have been the highestscore. In factor analysis with varimax method, the questions of the “Collecting, protecting and analysisof data related to operational planning" and "Formation team that directs and supervises the plansperformance process" with 0.628 and 0.797 have the highest score, respectively.Conclusion: The use of appropriate and correct recognition of organization and direction of operationscan improve the performance of operational planning in hospital.

Background & Aim: There is lack of knowledge about features of midwife-mother relationship indifferent condition and setting where the midwife has different levels of responsibility in terms of thenormal and high-risk pregnancy. This study aimed to develop a scale for evaluating the midwife-motherrelationship in delivery room.Methods & Materials: This is a methodological research. Participants were 480 mothers whohospitalized at post-partum ward in a university hospital of Arak, Iran in 2014. Preliminary item poolwas developed by qualitative part of the study and literature review. Target group determined the validityof the instrument by using the impact item method. The validity of the questionnaire was determinedwith content validity ratio (CVR), content validity index (CVI), face validity and exploratory factoranalysis. Reliability of the instrument was reported by Alpha Cronbach coefficient.Results: In the qualitative phase 66-item of questionnaire was developed. Those with impact item indexover 1.5, CVR over 0.42, and CVI over 0.79 were considered as valid; while the rest were eliminatedresulting in a 48-item scale. Exploratory factor analysis loaded a 43-item with a four factor solution thatjointly accounted for 60.4% of observed variance. Cronbach’s alpha coefficient showed excellentinternal consistency (α=0.93).Conclusion: The findings showed that the designed questionnaire was a valid and reliable instrumentfor measuring midwife- mother relationship in delivery room. It is easy to use the scale, and it containsthe most significant features of midwife-mother relationship.

Background & Aim: APACHE IV could predict mortality rate and length of stay for ICU patients. Atthis study, we compared predicted mortality rate for patients who were admitted in the intensive careunit of Babol Ayatollah Rohani Hospital based on APACHE IV.Materials & Methods: In this cross-sectional study which was carried out from April 2012 to April2013, all the patients who were admitted in the medical intensive care unit of Ayatollah Rohani Hospitalwere evaluated. Exclusion criteria included all the patients less than 16 years of old, pregnant, aftercardiopulmonary resuscitation, patients who died within 24 hours in the ICU. The method of datacollection was based on questionnaires APACHE IV. All data were collected in the first 24 hours of ICU admission. The observed mortality rate and length of stay were compared with predicted mortalityand the predicted length of stay.Results: The study was conducted on 106 patients admitted to ICU with 54 patients (50.9%) males and52 (49.1%) were female. The mean age of patients was 64.43±18.62, and the mean length of stay was 19.3±17.54. During this study, 56 patients (53.8%) were transferred from the ICU, and 50 patients(47.2%) died. Mortality rate predicted by APACHE IV is %34.58±24.76, and the length of stay predictedby APACHE IV is 4.76±1.59 days. The actual and predicted mortality rate were statistically associated (P<0.001), and a weak correlation was found between predicted and actual length of stay (P=0.002, and correlation=0.298).Conclusion: The actual mortality rate was similar to the mortality predicted by APACHE IV. The lengthof hospital stay was greater than the expected time. The results indicated an acceptable quality of healthcare provided in the intensive care unit of Ayatollah Rohani Hospital.