Iranian Journal of Nursing and Midwifery Research
Year:2013 | Volume:18 | Issue:5|Papers Count:15

Background: Employees feeling and attitude to their job has a significant role on their performance. Present study sought to investigate documents related to nurses job satisfaction, using systematic review and meta-analysis to estimate nurses job satisfaction in Iran.Materials and Methods: Papers on nurses job satisfaction were identified by searching different data bases using appropriate key words. Seventeen studies were extracted using inclusuion criteria. Data were analyzed using Meta-analysis command in STATA 11.Results: Considerable hetrogenecity is apparent in results of nurses job satisfaction studies. Although, according to random effect model, nurses total job satisfaction was estimated at 46.3 (CI: 32.1-60.4), this was estimated at 51.9 (CI=51.1-52.8) using fixed effect model. Additionally, a reverse relationship was observed between nurses overall job satisfaction and their age.Conclusion: Nurses’ job satisfaction in Iran is at a good level compared with other countries. The more satisfied the nurses are with their working conditions, the less is their intention to leave their job. Dissatisfaction is associated with higher resignment and turnover, paying deep attention to efficient factors on nurses dissatisfaction and trying to overcome them is important to improve nurses’ working conditions.

Background: Caring is a valuable task. The staff in any profession that involves patients’ fear, anxiety, pain, and suffering may experience similar feelings. As a professional group, oncology nurses deal with patients and their relatives and caregivers under very stressful conditions. They encounter pain, suffering, and death as a part of their daily life. A number of studies have evaluated the experiences of pediatric oncology nurses in other countries. Therefore, conducting a survey about the experiences of Iranian nurses of caring for children with cancer can reveal their demands, stress, and limitations.Materials and Methods: In a qualitative research, in-depth, unstructured individual interviews with open-ended questions were conducted to evaluate the experiences of pediatric oncology nurses in a hospital in a metropolitan city of Iran. The subjects all consented to participate and had at least one year of working experience in the ward. Content analysis was performed to analyze the data.Results: The lived experiences of pediatric oncology nurses were categorized in five main themes. These themes included attachment, supportive care, trying to repress feelings, feeling of helplessness, and the need to be supported.Conclusions: According to these results, nurses who provide care for children with cancer require support. This research also highlighted the roles, limitations, and needs of nurses in pediatric oncology wards.

Background: Dysmenorrhea is a common gynecologic disorder affecting as many as 60% of menstruating women. In the United States, work absenteeism due to dysmenorrhea is estimated to be 600 million work hours per year, and the economic consequences are estimated at $2 billion per year; therefore, it is a public problem nowadays.Aim: The purpose of this study was to compare the effects of combination of fennel extract/vitamin E with ibuprofen on the intensity of pain in primary dysmenorrhea among the students of Tabriz city in 2007-2009.Materials and Methods: This study was done by using double-blinded quasi-experimental research method. After taking the required licenses from ethics committee, 68 students from Medical and Tabriz universities, who were living in the dormitory, suffering from primary dysmenorrhea, and were eligible for the study, were randomly divided into two groups of 34 students each (the two groups used combination of fennel extract/vitamin E and ibuprofen cross-over form in the 2 months). We used Visual Analogue Scale (VAS) tool for ranking the intensity of the pain. Data analysis was done by using SPSS Ver.14.Results: The mean of peak pain intensity in the first, second, third, sixth, and forty-eighth hours in the group that had used combination of fennel extract/vitamin E was lower than the group that had used ibuprofen, and statistical differences were observed between the two groups in the first and second hours; combination of fennel extract/vitamin E was more effective than ibuprofen in the first hour (P<0.03) and second hour (P<0.04).Conclusion: Combination of fennel extract/vitamin E is effective on decreasing the intensity of pain of primary dysmenorrhea, and it is advised to those who cannot use chemical drugs.

Background: Prenatal care is a comprehensive antepartum care program involving a coordinated approach to medical care and psychosocial support that is optimally offered before conception. Inadequate care during pregnancy can lead to undesirable outcomes, including preterm labor and low birth weight. One of these new, accurate, and comprehensive indicator measurements is adequacy of prenatal care utilization index. This study aimed to assess the adequacy of care and its relationship with preterm labor and low birth weight.Materials and Methods: This analytic historical cohort study was performed on 420 mothers who referred to health centers in Sari during 2010. Data were collected by interviews and questionnaires. Based on the adequacy of prenatal care utilization, this care was classified into four groups: intensive, adequate, intermediate, and inadequate. Data were analyzed using chi-square test, analysis of variance (ANOVA), Spearman correlation coefficient, and relative risk (RR).Results: Of the 420 mothers who were studied, inadequate care was observed in 151 (36%) cases, which was the highest percentage of care. There was a significant relationship between the adequacy of prenatal care utilization and preterm labor and low birth weight (for both P<0.05). Performing inadequate care, the rate of preterm labor was RR=1.36 times and the rate of low birth weight was RR=1.08 times more than in adequate and intensive care.Conclusion: According to the programs that reduced the number of referrals of pregnant mothers (standardization protocol for mothers in Iran), this study confirms the efficacy of adequacy of prenatal care on reducing preterm labor and low birth weight. This study emphasizes on minimum care performance and the importance of conducting further studies to assess the relationship between quantities of care and other outcomes.

Background: Most countries use educated nurses called “nurse practitioners” (NPs) besides the family physicians for diagnosis, treatment, and specifically health education of the family. The main goal of this study was to redefine the role of NPs for better use of their capabilities in the so-called “family physician reform” in Iran.Materials and Methods: This is a qualitative and comparative study carried out in three stages (triangulation method) in 2011. In the first stage, we conducted a literature review to design a conceptual framework. The second stage was a comparative study on four countries. In this study, we focused on the role of NPs, which in turn helped to redefine this role in the health sector reform of Iran. In the third stage, two expert panels were involved and the suggested roles were confirmed.Results: In the United States, NPs are licensed by the state in which they practice and have a national board certification. In Canada, nurses involved in clinics should participate in specific training course of diagnosis and management of health care after registration. In Austria, nurses in Nursing homes and maternity do some of the medical procedures under the supervision of the physicians. In the United Kingdom, NPs increasingly substitute for GPs in the care of minor illness and routine management of chronic diseases.Conclusions: There is still debate in nursing and medical circles about what the focus of the NP roles should be. In Iran, whereas a noticeable reform toward “family physician” is ongoing, redefining the nurses’ role is essential. They can perform more active roles in associating with GPs in the clinics of family physicians, both in urban and rural areas, even with higher degrees of autonomy.

Background: Medication therapy is one of the most complex and high-risk clinical processes that nurses deal with. Medication error is the most common type of error that brings about damage and death to patients, especially pediatric ones. However, these errors are preventable. Identifying and preventing undesirable events leading to medication errors are the main risk management activities. The aim of this study was to investigate the effectiveness of a risk management program on the pediatric nurses’ medication error rate.Materials and Methods: This study is a quasi-experimental one with a comparison group. In this study, 200 nurses were recruited from two main pediatric hospitals in Tehran. In the experimental hospital, we applied the risk management program for a period of 6 months. Nurses of the control hospital did the hospital routine schedule. A pre- and post-test was performed to measure the frequency of the medication error events. SPSS software, t-test, and regression analysis were used for data analysis.Results: After the intervention, the medication error rate of nurses at the experimental hospital was significantly lower (P<0.001) and the error-reporting rate was higher (P<0.007) compared to before the intervention and also in comparison to the nurses of the control hospital.Conclusions: Based on the results of this study and taking into account the high-risk nature of the medical environment, applying the quality-control programs such as risk management can effectively prevent the occurrence of the hospital undesirable events. Nursing mangers can reduce the medication error rate by applying risk management programs. However, this program cannot succeed without nurses’ cooperation.

Background: Primary dysmenorrhoea without any specific pelvic disease is one of the common complaints in women`s medicine. The general purpose of this research is to define the effects of 12-week aquatic exercises on nonathletic girls’ primary dysmenorrhoea.Materials and Methods: This quasi-experimental was conducted on 40 nonathletic girls aged 18-25 years. Data gathering tools were: Evaluation form of primary dysmenorrhoea and the pain evaluation tool based on the McGill standard pain questionnaire completed before and after the intervention in 3 months (first, second, and third run). Then, 20 subjects were assigned to aquatic exercise group and the other 20 to control group. The subjects in experimental group did aquatic exercise for three sessions a week for 60 minutes for 12 weeks between two menstruations. Kruskal-Wallis and one way analysis of variance (ANOVA) tests were used to analyze the data.Results: The results of this research indicated that severity and duration of pain decreased after 12 weeks of aquatic exercises. Comparison of the two groups showed a significant difference in pain intensity based on visual analogue scale (VAS) scale after these exercises (first, second, and third runs). Present pain intensity (PPI) scale after these exercises (second and third runs) showed a significant difference. Comparison of the two groups showed a significant difference in length of pain after these exercises (third run).Conclusions: Totally, the findings of the present study showed that 12-week regular aquatic exercises are effective on decrease of the severity of the symptoms of primary dysmenorrhoea.

Background: Health care systems in rural areas face numerous challenges in meeting the community’s needs and adequate attention has not been paid to this problem. The aim of this study was to describe the outcomes of health care process in rural society.Materials and Methods: Twenty-six participants including twenty-one rural health care providers and five clients were selected according to purposive sampling. The data were collected via semi-structured individual interviews and a mini focus group. Data were analyzed by using qualitative content analysis based on methods described by Granheme and Landman.Results: Data analysis eventually led to formation of one category of inefficiency in health care process in rural society including subcategories such as arbitrary self-therapy, slow care process, dissatisfaction with the care process, superficial caring, job stress and burn out of caregivers, and ineffective caring relationship.Conclusion: Outcomes in health care in rural society of Iran represents inefficiency of the current health care process. These outcomes are related to the cultural and social context of rural communities and the structure of the health system. These outcomes in health care in the rural society of Iran represent impairment of the current health care process. The necessity of modifying the existing care trend with new models designed to improve the health care process is felt.

Background: Providing high-quality care in the intensive care units (ICUs) is a major goal of every medical system. Nurses play a crucial role in achieving this goal. One of the most important responsibilities of nurses is sedation and pain control of patients. The present study tried to assess the effect of nurses’ practice of a sedation protocol on sedation and consciousness levels and the doses of sedatives and analgesics in the ICU patients.Materials and Methods: This clinical trial was conducted on 132 ICU patients on mechanical ventilation. The patients were randomly allocated to two groups. While the control group received the ICU’s routine care, the intervention group was sedated by ICU nurses based on Jacob’s modified sedation protocol. The subjects’ sedation and consciousness levels were evaluated by the Richmond Agitation Sedation Scale (RASS) and the Glasgow Coma Scale (GCS), respectively. Doses of administered midazolam and morphine were also recorded.Results: The mean RASS score of the intervention group was closer to the ideal range (-1 to+1), compared to the control group (-0.95±0.3 vs. -1.88±0.4). Consciousness level of the control group was lower than that of the intervention group (8.4±0.4 vs.8.8±0.4). Finally, higher doses of midazolam and morphine were administered in the control group than in the intervention group.Conclusion: As nurses are in constant contact with the ICU patients, their practice of a sedation protocol can result in better sedation and pain control in the patients and reduce the administered doses of sedatives and analgesics.

Background: Understanding why the graduates from the high schools choose nursing is essential for the health policy makers in each country and Iran is not an exception. The aim of this study was to develop an instrument measuring the influential factors on career choice among Iranian nursing students.Materials and Methods: This methodological study employed both qualitative and quantitative approaches. In the first phase of the study, the items were generated for the instrument. These items were drawn from a relevant literature review along with taking a poll of experts’ opinions. Then the psychometric properties of instrument were measured using content validity, face validity, and construct (exploratory factor analysis) validity as well as its reliability.Results: Initially, a 35-item instrument was developed. In the second phase, a scale-level content validity index of 0.90 was obtained for the instrument. The factor structure of the inventory was identified by undertaking a principal component analysis in a sample of 139 nursing students. Three factors were extracted with a total variance account of 42.03%. Reliability was demonstrated with Cronbach’s alpha coefficient of 0.77 for the entire scale. Consistency of the instrument was established with test-retest reliability with an interval of 2 weeks (intra-cluster correlation=0.94, P<0.001). Wilcoxon signed-rank test demonstrated no significant differences between the test-retest scores (P>0.05).Conclusion: It seems a culturally sensitive instrument with a satisfactory level of validity and reliability has some implications for policy makers in nursing education.

Background: Menstruation signs are among the most common disorders in adolescents and are influenced by various environmental and psychosocial factors. This study aimed to define the association between menstruation signs and anxiety, depression, and stress in school girls in Mashhad in 2011-2012.Materials and Methods: This was a cross-sectional study on 407 high school girls in Mashhad who were selected through two-step random sampling. The students completed a questionnaire concerning demographic characteristics, menstruation, Depression, Anxiety, and Stress Scale of 21 questions (DASS-21), and menstruation signs in three phases of their menstruation. Data were analyzed by the statistical tests of Pearson correlation coefficient, Student’s t-test, one-way analysis of variance (ANOVA), and regression through SPSS version 14.Results: Based on the findings, 74% of the subjects reported pre-menstruation signs, 94% reported signs during bleeding, and 40.8% reported post-menstruation signs. About 44.3% of the subjects had anxiety, 45.5% had depression, and 47.2% had stress. In addition, Pearson correlation coefficient test showed a significant positive correlation between menstruation signs and depression, anxiety, and stress (P<0.05).Conclusion: With regard to the association between menstruation signs and psycho-cognitive variables, prevention and treatment of these disorders by the authorities of education and training and the Ministry of Health are essential.

Background: More than 30% of pregnancies in Iran are unintended and most of them happen among the women who use various contraceptive methods. Results of Integrated Monitoring and Evaluation System (IMES) showed that the rate of innovative contraceptive use in Mashhad has been 41.5%-57% in different urban areas. This study was conducted to explore the process of making decision toward using family planning methods in women of reproductive age in urban society of Mashhad, Iran.Materials and Methods: In this grounded theory study, semi-structured interviews were conducted with 45 purposefully selected participants including 28 women and 17 key informants including family health providers and managers, and participants’ mothers and husbands, who lived in urban society of Mashhad, Iran, in 2011-2012. Participants’ recruitment continued until data saturation occurred. Data were analyzed using Strauss and Corbin’s mode of analysis through constant comparative method, applying levels of open, axial, and selective coding with MAXqda software. Study rigor was confirmed through prolonged engagement, member check, expert debriefing, and thick description of the data.Results: The core category of “caring the comprehensive health of my family, “ which emerged from the data, described the process of couples’ decision making toward using family planning methods in this study. Other developed categories which were presented into a theoretical scheme consisted of 1) shaping the ideas of fertility control, 2) developing cognition about the fertility control methods, 3) appraising available choices and choosing the most appropriate one, 4) managing the course of using methods, and 5) realizing the fertility intentions.Conclusion: It is important that family planning providers understand the motivations, perceptions, and knowledge of women about contraceptive methods in their contextual situation, which illustrates their mode of interaction in the arenas of family planning decision making.

Background: Patients awaiting surgery typically experience significant physical and psychological stress. Vital signs and serum cortisol level are altered in response to anxiety. The aim of this study was to assess the effects of preoperative education on physiological indices and cortisol level of female patients undergoing elective surgeries.Materials and Methods: In this single-blinded randomized controlled trial, 60 women undergoing gynecological elective surgeries in Kowsar Hospital (Qazvin, Iran) were randomly assigned to either control or intervention group. The patients of the intervention group were assessed based on the nursing process after admission. Subjects with anxiety, inadequate awareness, and fear received necessary training on anxiety reduction techniques. The control group merely received routine care. A questionnaire including demographic characteristics, baseline and preoperative vital signs, and serum cortisol level was completed for all subjects. Data were analyzed by descriptive and inferential statistics (Fisher’s exact test, paired and independent t-tests, and Mann–Whitney U test) in SPSS17. P values less than 0.05 were considered significant.Results: The two groups were homogeneous in terms of age (P=0.20), marital status (P=0.50), education (P=0.10), employment status (P=0.13), and admission history (P=0.30). There were no significant differences in baseline vital signs between the intervention and control groups. Before surgery, the mean values of vital signs increased in both the groups. However, the increments were less in the experimental group than in the control group. Serum cortisol levels were also lower in the experimental group compared to the control group (P<0.01).Conclusions: Education based on the nursing process is a non-pharmaceutical and effective method to minimize changes in vital signs and decrease serum cortisol level in patients undergoing gynecological elective surgeries.

Background: Given the importance of the chronic obstructive pulmonary disease (COPD) and role of different factors in self-care behaviors of COPD patients, this study was conducted to determine the effect of self-efficacy program on self-care behaviors of COPD patients.Materials and Methods: In this semi-experimental study, 62 COPD patients were recruited in which 31 subjects were in control group and 31 were in experimental group. Subjects were selected based on purposive sampling from Imam Hospital affiliated to the Urmia University of Medical Sciences, Iran, in 2011. Two valid and reliable questionnaires were filled after completing informed consent form. A month later, and after implementing the planned intervention, the questionnaires were completed by the subjects again.Results: The mean standard deviation of age were 64.1 (9.1) years in the control group and 65.2 (8.0) years in the experimental group. There was a statistically significant difference between self-efficacy state before and after intervention. Self-care scores in the experimental group were significantly higher after intervention (t=25.18, P<0.0001).Conclusions: Given the high potency of self-efficacy factors on self-care behaviors of the COPD patients, enhancement of self-efficacy in these patients can be very effective in disease control, prevention of complications, reduction of hospitalization costs, and improve their quality of life. Hence, it is suggested that in empowerment programs of these patients, special emphasis will put on the strengthening of their self-efficacy.

Background: Unhealthy nutritional behaviors are a threat to adolescents. In this regard, we compared different training methods through a participatory interventional study.Materials and Methods: Through proportional random selection, 1823 female students were selected from 15 middle schools of Tehran. Following 2 years of intervention, nutritional habits of three different interventional groups were assessed.Results: Eating breakfast was significantly higher in the trained groups, and the use of weight loss diets was lower in them than in the control group. Also, satisfactory consumption of various kinds of nutrients in the trained groups was more than in the control group.Conclusion: Participatory health training, especially through parents, leads to adolescence nutritional health promotion.