Military Caring Sciences
Year:2018 | Volume:5 | Issue:1 (15) |Papers Count:8

Introduction: Of the most important health indices in countries are deaths of children and pregnant females, which can provide health services at the right time to prevent their deaths. Objective: The purpose of this study was to develop a curriculum for professional health care providers (Nurse, Midwife, and practical nurses) to prepare for the provision of health care services for mothers and newborns in disasters. Materials and Methods: This research was an applied research and in terms of the research method, a quantitative research with delphi method, which was carried out at the AJA university of Medical Sciences in 2017, was conducted. In the first stage, the proposed curriculum was developed by referring to domestic and international sources and based on the results of the need assessment. In the second step, in order to determine the desirability of the offered curriculum, a Delphi method was used in two rounds. The statistical sample of this study was 12 experts in this field, who were sampled with Targeted and snowball selection. In this study, the consensus was more than 90% of the criteria agreed by experts. Results: Based on the need assessment from Armed Healthcare Provider in Tehran, a curriculum for maternity and newborn health care in disasters was developed based on the six-step Kern process. Discussion and Conclusion: The curriculum developed in this study has functional quality and can play a decisive role in raising the level of knowledge of army health care providers in providing services to mothers and newborns in disasters.

Introduction: The role of heart failure in reducing the quality of life is approved. However, with regard to the impact of a healthcare plan based on the Pender health promotion model on quality of life, there are few studies with conflicting results on this group of patients. Objective: The current study aimed at investigating the effect of a healthcare program based on Pender Health Promotion Model on quality of life in patients with heart failure in a military hospital. Materials and Methods: In the current clinical trial, 48 patients with heart failure (grades 2 and 3) referred to the heart clinic of a military hospital in 2017 were selected by the purposive sampling method and randomly divided into two groups including the case (n=24) and the control (n=24) groups. In order to assess the quality of life, the SF-36 standard questionnaire with confirmed validity and reliability was used. Then, a healthcare program developed based on the Pender health promotion model-based care program was performed in the case group. The quality of life of patients was assessed in both groups in pre-test and post-test. Data were analyzed with SPSS version 21 using statistical tests such as independent t test, paired t test, chi-square, the Mann-Whitney U and the Fisher exact tests. P<0. 05 was considered the level of significance. Results: The results of independent t test showed no significant difference in the total score of quality of life and its dimensions between the two groups prior to implementation of the healthcare plan (P<0. 05). However, after the intervention there was a significant difference between the mean score of the subjects in the case group in terms of the dimensions: physical functioning, physical role functioning, public health, vitality, social role functioning, and mental health, and also between intervention and control groups in the total score of quality of life in favore of the intervention group (P<0. 05); however, after the intervention no significant difference was observed between the mean score of the subjects in both groups in terms of the following dimensions: bodily pains and emotional role functioning (P<0. 05). Moreover, according to the results of paired t test, there were no significant differences among the subjects of the control group in physical functioning, physical role functioning, public health, vitality, social role functioning, and mental health after the intervention (P <0. 05); however, after the intervention there was a significant difference between the mean score of the subjects in the control group in bodily pains and emotional role functioning (P <0. 05). In addition, before and after the intervention there was a significant difference between the mean score of the subjects in the intervention group in all dimensions, except emotional role functioning (P <0. 05). Discussion and Conclusion: Use of a health care program based on the Pender health promotion model significantly affected the quality of life in patients with heart failure. Therefore, it is recommended to take appropriate measures by nurses, administrators, and other health care providers in order to improve the quality of life of such patients.

Introduction: Safety is defined as the avoidance of any damage to individuals, while daily activities continue. Safety has a wide range and various aspects, such as safety in health-care environments. Consideration of safety principles in health-care environments is one of the key factors playing an effective role in the improvement of patients in the centers. Objectives: The current study aimed at determining the level of awareness and adherence to safety instructions on hospitalized patients in nursing and medical staff. Materials and Methods: The current descriptive, cross sectional study was conducted on 132 nurses and physicians selected by stratum-based method. Data collection was performed using a standard localized scale to assess patient’ s safety culture. Data was analyzed with SPSS version 16. According to the scale guidelines, obtaining ≥ 70% of total score indicates a high level of safety culture, while getting 50%-69% of total score shows an average safety culture level; and scores <50% represents a low level of safety culture. Results: In the present research, majority of the participants was nurses and midwives (70%). Most of the participants (65%) had more five years of experience. Results showed that the staff worked at this center got an average level of patient safety culture. According to 12 aspects of patient safety culture, two indices of teamwork and non-punitive responses to errors were among the high-level positive responses, with the average positive response rates of 70% and 68%, respectively. On the other hand, the indices of event reporting and organizational learning were in the lowest levels, with the average positive response rates of 38% and 40%, respectively. Discussion and Conclusion: The results of the current study shows the importance of improving patients’ safety by the managers and hospital staff, in terms of reporting the incidents, improving inter-sectional team works, and nonpunitive responses in the case of errors.

Introduction: Pain evaluation in patients admitted to intensive care unit (ICU) that are often not able to communicate verbally due to changes in consciousness, mechanical ventilation, and taking relaxation medications is a complicated task and one of the most basic problems for nurses. Proper pain measurement in such patients requires the use of a valid and reliable scale. Non-verbal pain scale (NVPS) includes behavioral and physiological indicators. The behavioral part of the scale includes facial expressions, activity/mobility, and guarding, and the physiological part includes the vital signs as blood pressure, heart rate, and respiration. The validity of the scale as a reliable instrument to monitor and evaluate pain in patients without verbal communications was confirmed in many studies and accordingly it was introduced by the American Pain Society, but it is not translated into Persian language and accordingly not validated in Iran. Objective: The current study aimed at translating, reviewing, and validating NVPS in patients without verbal communication who admitted to ICU. Materials and Methods: The current methodological research was conducted from May 2011 to May 2012 in ICUs of military hospitals in Kerman, Iran. After the translation of NVPS by experts, reviewing and reforming its items, the qualitative validity was confirmed based on the comments of the respondents and the method of determining the clinical impact was used to determine its quantitative face validity. The content validity was determined by the panel of experts and opinion polls. Structural validity was determined by the hypothesis testing method. The method of agreement between evaluators was used to estimate reliability, and by the use of intra-cluster correlation within the group, the agreement between the experts was measured. Results: The content validity ratio was calculated based on the number of experts in the panel using the modified Lowsheh table and cut off point was 0. 49. The content validity of the scale was 0. 82 using the average content validity index; the relevance of the item to the pain of the patients was confirmed for all the items. The agreement between the researcher and under study nurses was assessed using the Kappa agreement coefficient for facial, activity, guard state, and excitement items as >0. 4. The scale reliability was also confirmed in the items. Discussion and Conclusion: Translation and revision of NVPS provided an appropriate and standard tool for the nurses to assess the level of pain in adult patients without verbal communication admitted to ICU. The training and application of this scale have made it possible to empower the treatment staff, especially nurses, to be able to monitor, manage, and control the pain of the patients, which by reducing the level of pain and its duration, the quality of care can also be improved in such patients.

Introduction: Health care-related infections are serious problems that influence patient› s safety settings. Hand hygiene is the most effective method for preventing these infections. Objectives: The current study aimed at investigating health care workers› knowledge and attitude towards hand hygiene in intensive care units of educational hospitals affiliated to Zanjan University of Medical Sciences, during year 2014. Materials and Methods: The present study was a descriptive cross-sectional study, which was conducted on 88 health care workers of Intensive Care Unit (ICU) and Coronary Care Unit (CCU) in two educational hospitals affiliated to Zanjan University of Medical Sciences, who were selected by random sampling. Knowledge and attitude of the participants toward hand hygiene, was examined through World Health Organization (WHO) recommended standardized questionnaire and researcher-designed questionnaire, respectively. All health care workers, including physicians, nurses and others (radiology and laboratory technicians), were enrolled in the study during May 2014. Collected data were analyzed by using SPSS software, version 16. Results: The findings showed that none of the participants had poor knowledge, 47. 7% had moderate knowledge, 34. 1% had good knowledge, and only 18. 2% had very good knowledge. Regarding attitude, 95. 4% of the participants had a positive attitude towords hand hygiene. T-test and Kruskal-Wallis statistical tests on demographic characteristics also showed that variables, such as level of education, professional status, and the last round of retraining course with knowledge and workplace had a significant relationship with attitude. The result of the correlation test showed a significant relationship between knowledge and attitude. Discussion and Conclusion: Despite the positive attitude of intensive care unit staff towards hand hygiene, their knowledge is not desirable and optimal, and having favorable knowledge and performance requires more training.

Introduction: Drug order is an important patient care practice and also a life threatening event if not observed by the nurses. Objective: The current study aimed at comparing the types, causes, and strategies of medication error reduction from the viewpoint of nursing teachers and students. Materials and Methods: The current cross sectional study was conducted on nursing teachers (n = 20) and students (n = 80) of School of Nursing and Midwifery of Ahvaz, Iran, in 2017. The data collection tool was a researcher-made questionnaire, which its validity was assessed based on the viewpoint of 10 faculty members. The test-retest method was used to determine the reliability of the questionnaire. Data were analyzed with SPSS version 16 using descriptive and inferential statistics. The significant level was <0. 05 for all tests. Results: The results showed that majority of teachers (75%) observed at least once a medication error made by nursing students and 75. 48% of nursing students reported commitment in medication errors more than once. The commonest type of medication error from the viewpoints of teachers (17. 3%) was the wrong drug, and high speed infusion from the viewpoint of nursing students (16. 49%). The main causes of medication errors from the viewpoint of teachers were inadequate drug information (4. 95 ± 0. 22), and carelessness and distraction from the viewpoints of nursing students (4. 3 ± 0. 77). The most drugs involved in such errors are cefazolin, gentamicin, and ranitidine, respectively. The best strategies to reduce medical errors from the viewpoints of teachers (20. 89%) was the allocation of more time on the internship to develop drug information and dosages. The students (17. 90%) believed that a course of pharmacology for nursing care can be helpful. Discussion and Conclusion: Since medication errors are very evident from the viewpoint of nursing teachers and students, designing a curriculum to develop drug information and reduce such errors is essential.

Introduction: Traditional methods of leadership and management in today dynamic and changing world are not helpful. Use of modern leadership methods such as transformational in nursing management seems necessary. Objective: The current study aimed at determining the relationship between transformational leadership and work engagement. Materials and Methods: In the current descriptive-analytical study, 240 nurses from teaching hospitals in Ahvaz, Iran, in 2016 were selected by census method to assess the required data, and complete multifactor leadership style and work enthusiasm questionnaires. Data were analysed by simple and multiple correlation coefficient. Results: The results of the study showed positive and significant correlations between the aspects of transformational leadership (ideal influence (19. 19 ± 5. 97), inspirational motivation (10. 3 ± 3. 2), rational arousal (9. 74 ± 3. 22), consideration individual (8. 88 ± 3. 24), and level of passion for work (strength, endowment, and absorption) (P <0. 001). In addition, inspirational motivation (59. 0) had the most role in explaining work eagerness (P <0. 001). Discussion and Conclusion: Support and guidance of the staff, as the leadership style characteristics, can enhance psychological security of the nursing staff and through which their work engagement is strengthened.

Introduction: Peripheral venous catheter installation is one of the most common invasive practices used in hospitals to deliver fluids, drugs, and electrolytes intravenously during emergency events and the most common complication associated with their application is phlebitis. It is a serious complication, which can lead to clot formation, thrombophlebitis, embolism, and reduced use of intravenous catheters. Objectives: Therefore, the current study aimed at comparing the effect of clobetasol ointment and sterile gauze dressing on the prevention of phlebitis caused by peripheral venous catheter in patients admitted to a surgery ward. Methods and Method: The current clinical trial was performed on 96 patients admitted to the Department of Males’ Surgery in Vali-e-Asr Hospital, Arak, Iran in 2013. Patients were randomly divided into two groups of clobetasol ointment and sterile gauze dressing. In the clobetasol group, after catheterization of the venous, the ointment was applied to the distal area and the area was dressed and in the sterile gauze dressing group, after catheterization of the venous, gauze was applied in the distal area after sterilization. The location of phlebitis was investigated three times, 24, 48, and 72 hours after the catheterization, based on phlebitis scale. Results: The frequency of phlebitis in any degree after cannulation in the two groups showed no significant difference during the first 24 hours after installation (three cases of clobetasol ointment and four cases of sterile gauze dressing) (P=0. 059). However, there was a significant difference in 48 hours (three cases of clobetasol ointment and 18 cases of sterile gauze dressing) and 72 hours (27 cases of clobetasol ointment and 42 cases of sterile gauze dressing) after installation between the groups (P<0. 001). There was no significant difference between the two groups in terms of severity of phlebitis in 24 hours (P= 0. 31) and 48 hours (P=0. 54), but there was significant difference between the two groups after 72 hours (P<0. 001) of installation in favor of the clobetasol group. Conclusion: Use of clobetasol ointment as a method to prevent phlebitis due to venipuncture is recommended.