Journal of Research Development in Nursing and Midwifery
Year:2014 | Volume:11 | Issue:2|Papers Count:12

Background and objective: The rate of end-stage renal disorder (ESRD) in Iran, 12%, is more than the worldwide range. The people with Hemodialysis are greatly under physical, mental and social pressures that make the acceptance of Hemodialysis difficult. Since the acceptance can be the beginning point of adaptation, this study aimed to explore the challenge in acceptance of Hemodialysis.Material and Methods: This grounded theory study was undertaken in the Hemodialysis wards of the hospitals affiliated with Shaheed Beheshti University of Medical Sciences in Tehran. The first samples were selected via purposive sampling and the later ones with theoretical sampling till data saturation (N=24). Semi-structured interview, field notes and memos were used for data collection. The data was analyzed by using Strauss and Corbin method. Data rigor was confirmed by Lincoln and Goba criteria, considering ethical points.Results: The challenge in acceptance of Hemodialysis emerged the categories of acceptance (by force, experience, reasoning or social norms) and lack of acceptance (subjective or objective) of necessity of Hemodialysis as well as their related codes.Conclusion: The people on Hemodialysis encounter a challenge for acceptance of Hemodialysis. Education as well as personal, familial and social supports can resolve this challenge by changing lack of acceptance (subjective or objective) or acceptance by force to acceptance (by experience, reasoning or social norms).

Background and objective: Hypotension and Muscle cramp are the common complications of Hemodialysis. One approach that has recently been proposed to prevent this complication is the change in the concentration of sodium and ultrafiltration. The purpose of this study was to investigate the influence of sodium dialysate variation and ultrafiltration in preventing hypotension and muscle cramp during hemodialysis process.Material and Methods: In this clinical trial study, 44 Hemodialysis patients were divided randomly into four groups. For each group, four treatment protocols (six-session Hemodialysis) were conducted. Protocol A: Sodium dialysate and ultrafiltration were constant. Protocol II: sodium was linear and ultrafiltration was constant. Protocol III: Sodium and ultrafiltration were linear. Protocol IV (routine): Sodium and ultrafiltration were constant. Using Chi-Square and relative risk, the data was analyzed (P<0.05).Results: The incidence of hypotension, at the end of the fourth hour of dialysis in Protocol 3, was significantly decreased compared to that of routine method (P<0.05), while at the end of first, second and third hour, this difference was not significant. Muscle cramp in the routine method was more than other protocols (P=0.034). The relative risk of muscle cramp in the routine method was 2.08 times of protocol I, 1.09 of Protocol II, 2.08 of protocol III.Conclusion: Sodium and ultrafiltration profile is simple and cost-free, and it reduces the incidence of hypotension and muscle cramp during dialysis. Thus, we recommend using sodium and UF profile instead of routine protocol to reduce these effects.

Background and objective: Multiple sclerosis (MS) is a chronic, autoimmune, inflammatory nervous system disease. It leads to the loss of myelin in the white matter of brain, spinal cord and optic nerves, and causes tiredness, muscle cramp, tremor, unsteady gait and some inability to move. The aim of this study was to investigate the effect of Pilates exercises and aquatic training on walking speed of women with MS.Material and Methods: This clinical trial was conducted in 2012 on 45 women, referring to MS clinic of Kashani Hospital in Isfahan. The subjects with the age of 20-40, physical disablement of 4.5 and disease duration of 8±2 years were randomly allocated to one of the three groups of Pilates exercises, aquatic training and control. Training program for pilates and aquatic group was carried out in 12 weeks, three sessions per week, and each session lasted about one hour.Patients' walking speed was measured, using 25-foot walk test, before and after exercise. The data was analyzed by descriptive statistics, covariance and paired comparisons of adjusted means.Results: The adjusted mean of walking speed scores of the experimental groups are significantly different (P<0.05). While, the comparison of paired means between the two groups was not significant.Conclusion: Because of increased effect on walking speed, we recommend Pilates exercises and aquatic training as a complementary treatment alongside medicinal treatments for MS patients.

Background and objective: Cardiovascular disease is the leading problem of the elders. It is progressive disorder that is initiated in childhood and its clinical demonstration is revealed after middle-aged period. This study aimed to determine the relationship between coronary artery disease- related risk-factors and aging.Material and Methods: This descriptive-analytical study was conducted on all 772 elders referring to Kosar Angiography Center in Golestan province, 2008-2009. The subjects were divided into coronary disorder group and normal group. The risk factors including age, gender, body mass index (BMI), blood pressure, diabetes mellitus, smoking and drug addiction were assessed. The data was analyzed by SPSS-16, using Mann-Whitney and T-test.Results: Most of the subjects were between 65 to 75 years. Of the three main vessels, the most involved one was circumflex (31.5%). The factors such as gender and systolic hypertension were significantly different in two groups. Furthermore, the Risk ratio in the patients with systolic hypertension (1.13 times) and the ones with diastolic hypertension (1.11 times) was more than normal group.Conclusion: Gender and systolic hypertension in the elders with CAD are the main and predisposing factors. Therefore, if we control hypertension, it may be possible to prevent from the CAD progress.

Background and Objective: One of the most common complications of IUD users is dysmenorrhea, which is not the same in different IUDs. The aim of this study was to compare the dysmenorrhea in IUD multi-load 375 and IUD copper T 380 A.Material and Methods: A randomized double- blinded controlled clinical trial was conducted on 48 women referring to a health-center in Tabriz, from 2011 jan-2012 oct. The participants were randomly allocated to two groups of multi-load 375 IUD and the copper T 380A IUD (located in a four-member and six-member block). We measured the amount of dysmenorrhea with Visual Analog Scale, before the IUD insertion and four mouths later. The data was analyzed by SPSS-13, using Mann-Whitney, Regression, Fridmans test.Results: The results showed that the severity and duration of dysmenorrhea in two groups of IUD were significantly different, considering the factors such as the baseline dismenorrhea, the utilized drug and the interval between the last labor and IUD insertion. The dysmenorrhea in multi-load group was decreased and in copper T increased significantly.Conclusion: Based on the results, multi-load IUD results in considerable reduction in the severity and duration of dysmenorrhea. Therefore, it is reccomended counseling about both multi-load IUD and Copper T in the family planning service centers.

Background and objective: Coronary Bypass Graft Surgery (CBG) is one of the therapeutic approaches having the leading effects on the function of the patients. Because of paramount importance of self-efficacy and self-esteem, we aimed to evaluate the effectiveness of family centered empowerment on the self- efficacy and self-esteem of the patients undergoing coronary bypass surgery.Material and Methods: This case control clinical trial was conducted on 102 patients with elective heart surgery and 102 of their active family members in 2011. The patients were selected via convenience sampling and randomly assigned to experimental and control group. After measuring the self-efficacy and self-esteem, family-centered empowerment care, including individual training, group discussion, film and active participation, was performed in experimental and just routine care in control group. Using PASW statistics-18, we analyzed the data.Results: The results showed that the two groups were the same considering population variables and the mean scores of self-efficacy and self-esteem. The level of self-efficacy and self-esteem in case group were significantly higher than those of controls (P<0.000). After intervention, the mean score of self-efficacy and self-esteem were increased (P<0.0000).Conclusion: In regard with the results, family-centered empowerment care in patients undergoing CBG is practically feasible, and it can be helpful in improving self-efficacy and self-esteem.

Background and Objective: With increasing older people population, the need to provide health care services in nursing homes is increasing. The aim of this study was to determine the effect of an educational program about the management of common problems in old age on the level of job stress in the caregivers of Golestan province nursing homes.Material and Methods: This pre-experimental study was conducted on all 24 caregivers (11 males and 13 females) working in the nursing homes of Golestan province. The valid and reliable instruments were a researcher-made questionnaire to evaluate the knowledge and Osipow's job stress questionnaire, the intervention was an educational package to increase their knowledge and skills about the management of old age problems. The questionnaires were completed before, immediately after, one month and three months after the training. The data was analyzed by analysis variance, Pearson correlation, independent t-test and paired t-test.Results: With increasing the knowledge of the caregivers, a significant reduction in job stress scores (p<0.001) was found after three months. Two components of job stress including overload (p<0.001) and insufficiency (p=0.002) showed significant decreases after three months compared to the mean scores before training.Conclusion: Due to The effect of training on stress reduction, providing comprehensive training programs for caregivers may lead to higher quality services and health promotion for both elders and their caregivers.

Background and objective: Diabetes Mellitus (DM) leading to increasing risk in the health of society is one of the main problems worldwide. The main goal is having normal blood glucose to reduce the progression of neurovascular complications. We aimed at comparing the performance of five glucometer devices with that of standard laboratory technique in patients with DM admitted to endocrinology ward of Razi Hospital in Rasht.Material and Methods: This comparative-analytic study was conducted on 250 diabetic patients. A part of venous blood sample was investigated by five glucometer devices (Glucoplas, Accu-chek, Easyguloco, Bionime and On-kalyz) and the remaining tested by standard laboratory technique. The data was analyzed by SPSS software, using paired-t-test.Results: The results showed that the mean of Glucoplus was the least (237.52) and that of On-kalyz was the highest (297.82). Using Paired-sample t-test, the mean difference between venous blood glucose by Glucometer and that of standard laboratory technique was reported in order 2.40 mg/dl for Bionim, -3.62 mg/dl for Easyguloco and -4.34 for Accu-chek Glucometer. Glucoplas and Onkalyz were significantly different from Laboratory standard method (p<0.0001).Conclusion: The mean difference of On-kalyz and Glucoplas glucometer devices that is orderly greater than the mean difference of laboratory standard method are less reliable for measuring blood glucose levels, compared to Bionime, Easyguloco avd Accu-chek having the least difference.

Background and Objective: Back pain is one of the most common and most costly occupational injuries. Due to the nature of nursing career, low- back pain is highly prevalent in nurses. The aim of this study was to survey the prevalence of low-back pain and its correlation with nurses’ demographic characteristics and occupational factors in hospitals of Isfahan, Iran.Material and Methods: This descriptive- co relational study was conducted on 244 out of 260 nurses selected via stratified random sampling. Using Visual Analogue Scale (VAS) and Oswestry Functional Disability Questionnaire (ODQ), the Pain and functional disability variables were measured, respectively. To analyze the data, we used independent t-test and correlation coefficient (p<0.05).Results: The findings showed that 55% of the nurses have different intensity of low back pain (LBP). The LBP and monthly working hours (r=0.55), LBP and functional disability (r=0.53), LBP and age (r=0.30), and LBP and record of services (0.29) were significantly correlated, But it was not the case for LBP and gender.Conclusion: Based on the findings that about 55% of the nurses suffer from low- back pain, it seems that a comprehensive change in life style and physical activity pattern of the nurses are paramount importance.

Background and Objective: This study aimed to assess nurses' attitude toward the effect of nursing electronic reports on patient care.Material and Methods: This descriptive-analytical study was conducted on 316 nurses in the hospitals affiliated to Semnan University of Medical Sciences and social security organization, 2012. The instrument was a researcher-made questionnaire, valid and reliable. The data was analyzed by Chi Square, Fisher and Phi test.Results: Forty-seven five point percent of the nurses completely disagreed with the impact of electronic reporting on patient assessment (1.8±1.06) and 54.4% completely disagreed with its impact on the selection of clinical intervention (1.8±1.06). On the other hand, 50% of nurses agreed with the effect of the computer program on patient care (2.2±0.99), 42.4% were satisfied with its effect on patient's diet planning (2.1±1.5) and 40.7% with the computer program on nursing diagnosis (2.01±1.09).There was significant relationship between some of the nurses' demographic characteristics and their attitude (P<0.05).Conclusion: Based on the results, nurses’ attitudes can be attributed to some defects in the computer programs and to the nurses’ compliance with information technology. To improve the effectiveness of electronic reporting, first, the quality of computer programs of clinical settings should be enhanced, and then changes should be occurred in organizational policies and in electronic documentation. Further, we should consider the impact of Levine's theory of change, indicating the staff's resistance to technology adoption in workplace.

Background and objective: Contribution is the main element in inter-professional relationship between the nurse and physician, requiring collaborative relationship and sharing information to reach a common therapeutic goal. the collaboration between the nurse and physician in clinical decision-making is a necessity for high-quality care in hospitals. This study aimed to determine nurses' perspective about collaboration in clinical decision-making.Material and Methods: This descriptive study was conducted on the nurses selected by convenience sampling and inclusion criteria in state, private and social well-fare hospitals, 2011. The data was collected by a questionnaire including demographic and nurse-physician collaboration questions, whose validity and reliability were evaluated by content validity and test re-test. Descriptive statistics such as frequency mean and standard deviation was used.Results: The results showed that the samples (76.5%) were females, aged between 30 and 39.5 (58.3%), BSc of nursing (93.5%), contract employment (53.8%) and 5-9 year record of services (50%). The viewpoint of the nurses about collaboration in decision-making was moderate (70.8%), good (7.5%) and weak (14%).Conclusion: Based on the results, a few nurses are satisfied their collaboration with physician in decision-making. It seems that the nurse-physician contribution in therapeutic procedure got the highest point, and absence of opportunity in giving comment got the lowest score.

Background and objective: Burnout is one of the key factors in reducing efficiency and it causes loss of manpower and physical complications. Personality characteristics such as resiliency is a buffer against stressful events and work-related psychological problems such as burnout. Given the important role of nurses in health-care system, this study investigates The relationship between resiliency and burnout in nurses.Material and Methods: This descriptive study was conducted on 304 nurses working in the hospitals in Tehran, 2010. The subjects were chosen by multi-stage cluster sampling. The instruments were Maslach burnout inventory (MBI), Connor-Davidson Resiliency Scale (CDRISC) and a demographic check-list. The data was analyzed by SPSS-18.Results: Overall, the findings showed high emotional exhaustion, (32.6% in frequency, 9.9% in intensity), depersonalization (25.7% in frequency, 18.1% in severity) and personal failure (42.1% in frequency, 60.9% in severity). The relationship between burnout and resiliency was significant (0.01).Conclusion: Given the resiliency is one of the predictors of burnout, we recommend some workshops to increase the resiliency-related skills of the nurses.