Iranian Journal of Nursing and Midwifery Research
Year:2017 | Volume:22 | Issue:1|Papers Count:16

Introduction: Identifying what adolescents perceive as their lifestyle and exploring the factorspersuading their decisions to engage in or avoid healthy or unhealthy lifestyle behaviors couldimprove the ability of healthcare professionals to develop innovative preventive strategies andmodify negative health behaviors in adolescents. Hence, the literature on adolescent health‑relatedissues reported by adults showed a rarity of information from adolescents themselves.Materials and Methods: A qualitative study using the thematic analysis approach was conducted.Data were collected by semi‑structured, digitally recorded interviews from 32 male adolescents.Interviews were transcribed verbatim, and after collecting the data, the thematic analysis processwas started and conducted in six phases.Results: After data collection, the interview texts weretranscribed, and approximately 800 initial codes were extracted. The initial codes were reevaluatedto yield 48 main themes. Hence, the final thematic map was created as having 5 overarching themesand 12 subthemes, showing that interviewees emphasized unhealthy lifestyle. Conclusions: Thecomponents of unhealthy lifestyle seem important to them because they consider that they could leada healthy lifestyle through elimination of negative behaviors.

Introduction: Nurse–physician inter‑professional relationship is an important issue in health caresystem that can affect job satisfaction and patient care quality. The present study explores the majorissues of nurse–physician inter‑professional relationships in Iran. Materials and Methods: In thisin‑depth qualitative content analysis study conducted in 2014, 12 participants (5 physicians and7 nurses) were recruited from two educational hospitals. The data were collected from deep, open, and unstructured interviews, and analyzed based on content analysis.Results: The participants in thisstudy included 12 individuals, 6 females and 6 males, with the age ranging 27–48 years and tenureranging 4–17 years. Four themes were identified, namely, divergent attitudes, uneven distribution ofpower, mutual trust destructors, and prudence imposed on nurses. Conclusions: The results revealedsome major inter‑professional issues and challenges in nurse–physician relationships, some of whichare context‑specific whereas others should be regarded as universal. It is through a deep knowledgeof these issues that nurses and physicians can establish better collaborative inter‑professionalrelationships.

Introduction: Birth weight is one of the most important indicators of infant’s health and couldpredict their health condition in future. This study was conducted to determine and compare indicatorsof growth [weight, height, and body mass index (BMI)] and behavioral disorders in childrenwith normal, low, and very low birth weight at pre‑school age. Materials and Methods: In thisdescriptive analytical study, 236 children (126 with normal weight, 100 with low birth weight, and10 with very low birth weight) at pre‑school age were investigated in three groups. Data collectiontools were a two‑part questionnaire including the Rutter Children Behavior Questionnaire for parents, and parents’ and children’s demographic characteristics questionnaire, scale, and stadiometer. Datawere analyzed using descriptive statistics, variance analysis, Chi square, and Kruskal–Wallis tests.Results: The mean of weight, height, and BMI at pre‑school age in three groups had a significantdifference (P=0.009) and it was lower in the group with very low birth weight than the other twogroups; however, the difference between the group with normal birth weight and the group with lowbirth weight was not significant (P=0.10). The mean score of behavioral disorder had no significantdifference between groups (P=0.49). Conclusions: Results showed that children with very lowbirth weight grew less than the other two groups. Therefore, this group needs special attention andlong‑term follow‑up for taking care of them to ensure better growth. It is recommended to conductmore extended studies to evaluate behavioral disorders in these children.

Introduction: Understanding how academic dominant discourse is implicated in the shaping ofnursing identity, professional aspirations and socialization of nursing students is useful as it canlead to strategies that promote nursing profession. Materials and Methods: This is a qualitativeresearch conducted through discourse analysis approach. Semi‑structured interviews, focus group, and direct observation of undergraduate theoretical and clinical courses were used to collect thedata. Participants were 71 nursing students, 20 nursing educators, and 5 nursing board staffs fromfive universities in Iran.Results: Data analysis resulted in the development of four main themesthat represent essential discourses of nursing education. The discourses explored are theoretical andscientific nursing, domination of biomedical paradigm, caring as an empty signifier, and more thanexpected role of research in nursing education discourse. Conclusions: The results indicated thatacademics attempt to define itself based on “scientific knowledge” and faculties seek to socializestudents by emphasizing the scientific/theoretical basis of nursing and research, with the dominanceof biomedical discourse. It fails to conceptually grasp the reality of nursing practice, and the resultis an untested and impoverished theoretical discourse. The analysis highlights the need for theformation of a strong and new discourse, which contains articulation of signifiers extracted from thenature of the profession.

Introduction: Transcutaneous electrical nerve stimulation (TENS) through the skin is anonpharmacological method of pain relief. The present study aimed to compare TENS and lidocaineon episiotomy complication in primiparous women. Material and Methods: In a randomized, controlled clinical trial, 80 participants were included from March to July 2011 at the antenatal clinicand postdelivery ward in the Social Security Organization Hospital, Khorramabad, Lorestan, Iran.Data were collected using a demographic questionnaire, visual analog scale and redness, edema, ecchymosis, discharge, and approximation scales. The participants were randomized into two groupswith equal number of participants. All participants received 5 cc of local infiltration of 1% lidocainebefore episiotomy, and TENS electrodes were placed on He Gu and Shenmen points during thecrowning of fetal head. The TENS group received TENS with 100; 250 μs, the output range of15–20 mm amplifier from crowning of first stage of labor to the end of the episiotomy repairing.The lidocaine group received 10 cc of local infiltration of 1% lidocaine before episiotomy repairwhile did not receive TENS electrodes. The pain intensity during and after episiotomy repair wasrecorded.Results: TENS and lidocaine have similar effects on pain relief at the episiotomy cutting, the start of the episiotomy repair, and at end of the episiotomy repair; however, the pain relief ofboth the interventions was different during the episiotomy repair. The effect of TENS in reducingedema was statistically significant (P=0.001). Conclusions: TENS and lidocaine are effective forthe episiotomy complications during and after episiotomy repair.

Introduction: Ventilator‑associated pneumonia (VAP) is the most common infection in the intensivecare unit, and has many side effects such as increased mortality, increased length of hospital stay, and increased health costs. This study aimed to evaluate the compliance with the standards forprevention of VAP by nurses in the intensive care units. Materials and Methods: In this descriptivecross‑sectional study, 120 nurses in 11 intensive care units of hospitals affiliated to Isfahanuniversity of Medical Sciences, Iran, were assessed for 4 months from July to October 2014. Theimplementation of all measures for the prevention of VAP was investigated through observation andusing a checklist.Results: The mean compliance with the standards for the prevention of VAP in theintensive care unit by the nurses was 56.32%; analysis of variance test showed significant differencebetween the hospitals (P<0.001). Disposable ventilator circuit was performed for all patients; however, reviewing the patient readiness for separation from the ventilator was not conducted on adaily basis. Conclusions: Compliance with the standards for the prevention of VAP in the intensivecare units was relatively acceptable; however, it still requires serious attention by the officials withtraining and sensitization of nurses in implementing preventive measures, especially through theprovision of clinical guidelines and related protocols.

Introduction: Child’s hospitalization for surgery is a source of anxiety for the child and the familythat persists for a long time after discharge. Therefore, it is necessary to provide appropriate solutionsin this regard. This study aimed to investigate the effect of implementation of continuous care modelon anxiety in mothers of children discharged from pediatric units of educational hospitals of Isfahan University of Medical Sciences in 2016. Materials and Methods: In this quasi‑experimental study, 64 mothers of children hospitalized in surgical units were categorized in two groups (experimentaland control). The intervention was a continuous care model including orientation, sensitization, followup, and evaluation stages. We used Spielberg’s Anxiety Questionnaire to assess mothers’ anxietybefore, 1 week, and 1 month after the intervention. Data were analyzed using descriptive statistics, (t‑test and analysis of variance) using the Statistical Package for the Social Sciences version 16.Results: The results of the study showed that the mean anxiety scores of the experimental groupwere 58.9, 36, and 31.4, respectively, before, 1 week, and 1 month after the intervention (P<0.001).These scores were 57.5, 55.8, and 49.7, respectively, for the control group. t‑test results showed thatthe mean anxiety scores of the experimental group were significantly less than that of the controlgroup at 1 week and 1 month after the intervention. Conclusions: Based on the results, use of thecontinuous care model led to a decrease in mothers’ anxiety during their children’s discharge fromthe pediatric surgery units. Therefore, we suggest the implementation of this model in pediatric units.

Introduction: Development of nurse–patient empathic communication in the oncology ward isof great importance for the patients to relieve their psychological stress, however, nursing care ofcancer patients is accompanied with high stress and burnout. The present study aimed to definethe level of empathy and its association with burnout and some demographic characteristics ofoncology nurses. Materials and Methods: This descriptive/correlation study was conducted in aprofessional cancer treatment center in Isfahan. Through census sampling, 67 oncology nurses wereselected. The data collection tools were Jefferson Scale of Nursing Empathy, Maslach BurnoutInventory, and demographic characteristics questionnaire.Results: Mean nurses’ empathy andoverall burnout scores were 62.28 out of 100 and 38.8 out of 100, respectively. Score of empathyshowed an inverse correlation with overall burnout score (r=−0.189, P=0.04), depersonalization(r=−0.218, P=0.02), and personal accomplishment (r=−0.265, P=0.01). Multiple regression testwas used to detect which dimension of burnout was a better predictor for the reduction of empathyscore. Results showed that the best predictors were lack of personal accomplishment (P=0.02), depersonalization (P=0.04), and emotional exhaustion (P=0.14), respectively. The most influentialdemographic factor on empathy was work experience (r=0.304, P=0.004). One‑way analysis ofvariance showed that official staff had a higher empathy score (f=2.39, P=0.045) and their burnoutwas lower (f=2.56, P=0.04). Conclusions: Results showed a negative relationship betweenempathy and burnout in oncology nurses. Therefore, nursing support from managers to reduceburnout increases empathic behavior of nurses.

Introduction: Infertility in men is one of the current problems of human society. Some studiessuggest that the metabolic status of a man, including cholesterol intake, closely correlates withsperm function. The aim of this study was to evaluate the correlation between saturated fatintake and semen quality among men referring to the Isfahan Fertility and Infertility Center, Iran.Materials and Methods: This cross‑sectional study was conducted on all men who referred to theIsfahan Fertility and Infertility Center. The study population consisted of 120 men selected throughsimple random sampling. The data collection tool consisted of a two‑part questionnaire including ademographic and anthropometric characteristics form and the Food Frequency Questionnaire (FFQ).The FFQ consists of 168 items that assess food and nutrient intake for 3 months. The reliabilityand validity of the instruments were confirmed in previous studies. Semen analysis was performedusing computer‑aided semen analysis (CASA) method. Descriptive statistics and logistic regressiontest were used to analyze the data.Results: Results showed that the chances of having semenvolume of higher than 1.5 ml (normal volume) increased by 27.5% for every 1 g increasein total fat (CI: 1.11–1.46) (P=0.001) and reduced 38% for every 1 g increase in saturated fat(CI: 0.42–0.90, P=0.010). No association was found between semen quality and intake of dietaryfats. Conclusions: Based on the findings of this study and the prevalence of infertility in recentdecades, changes in diet and saturated fatty acids intake may improve semen quality.

Introduction: Improving the health of the elderly must be based on their special needs that canbe achieved through self‑needs assessments through education, which is one of the most importanttools in the field of health improvement. The aim of the present study was to evaluate the effect ofneed‑oriented educational interventions on the general health of the elderly living in nursing homes.Materials and Methods: The present study is a clinical trial conducted among the elderly livingat the Sadeghieh nursing home of Isfahan, Iran. Seventy elderly people who satisfied the inclusioncriteria were selected and divided into two groups of case and control. The case group went through8 sessions of group therapy for educating participants who were previously investigated throughneeds assessment. The control group received the usual health care. The general health level of theparticipants was evaluated before and 1 week and 1 month after the intervention using Goldberg’sgeneral health questionnaire. Data were analyzed using Chi‑square test, independent t‑test, pairedt‑test, Mann–Whitney test, and variance analysis.Results: The score of general health had nosignificant difference between both the groups before the intervention, however, the difference in thescore between both the groups 1 week and 1 month after the intervention was significant (1 weekafter the intervention, the scores were 15.6 and 30.3, and 1 month after the intervention, the scoreswere 16 and 32.2, respectively) (P<0.001). Conclusions: Need‑oriented educational intervention isan effective, safe, and inexpensive method for improving the general health of the elderly living innursing homes.

Introduction: Self‑efficacy is an essential factor for effective self‑management in chronic‑diseasepatients. Therefore, the measurement of self‑efficacy with a valid and reliable instrument is required.In this study, cultural adaptation and psychometric properties of the Persian version of “Self‑Efficacyfor Managing Chronic Disease” (SES6G) are illustrated in a sample of Iranian chronic‑diseasepatients. Materials and Methods: This was a cross‑sectional study in which translation andbackward translation was performed by bilingual translators. The final version of the Persian scalewas assessed to determine the content validity index (CVI) and the content validity ratio (CVR).A panel of experts reviewed items of the scale. Factor analysis was performed for the final versionof the Persian scale to assess internal consistency and construct validity among chronic‑diseasepatients attending government health care centers from March 2015 to June 2015 in Isfahan, Iran (n=483).Results: CVI and CVR scores were 0.87 and 0.89, respectively. There were noeliminated items in the cross‑cultural adaptation process. Internal consistency met the criterion fora reliable measure (Cronbach’s alpha=0.89). An initial factor analysis produced a one‑dimensionalscale (6 items) with Eigenvalues more than 1 that explained 69.49% of the extracted variance.Conclusions: The SES6G is a reliable and valid instrument to assess patients’ self‑efficacy formanaging chronic diseases in Persian language. Because the self‑efficacy score determines theeducational strategies to have effective educational programs, the use of this simple and brief scalecould be considered among Persian patients.

Introduction: One of the important tasks in managing labor is the protection of perineum. Animportant variable affecting this outcome is maternal pushing during the second stage of labor.This study was done to investigate the effect of breathing technique on perineal damage extentionin laboring Iranian women. Materials and Methods: This randomized clinical trial was performedon 166 nulliparous pregnant women who had reached full‑term pregnancy, had low risk pregnancy, and were candidates for vaginal delivery in two following groups: using breathing techniques (casegroup) and valsalva maneuver (control group). In the control group, pushing was done with holdingthe breath. In the case group, the women were asked to take 2 deep abdominal breaths at the onsetof pain, then take another deep breath, and push 4–5 seconds with the open mouth while controllingexhalation. From the crowning stage onward, the women were directed to control their pushing, anddo the blowing technique.Results: According to the results, intact perineum was more observed inthe case group (P=0.002). Posterior tears (Grade 1, 2, and 3) was considerably higher in the controlgroup (P=0.003). Anterior tears (labias) and episiotomy were not significantly different in the twogroups. Conclusions: It was concluded that breathing technique of blowing can be a good alternativeto Valsalva maneuver in order to reduce perineal damage in laboring women.

Introduction: Infantile colic is a painful condition in the first months of infancy. This study wascarried out with the aim of testing the hypothesis that massage treatment has a clinically relevanteffect on this condition. Materials and Methods: This randomized clinical trial was conductedamong 100 infants of<12 weeks of age with infantile colic. They were randomly assigned to eitherinfant massage (n=50) or rocking groups (n=50). In the massage group, trained individualstaught the parents of the infants the massage technique and gave them a brochure. Rocking groupparents was recommended to rock their infants three times a day for 1 week. Parents recordedthe pattern of crying (numbers, length, and severity of crying). After 1 week of intervention, data were analysed using t‑test, Chi square test, and repeated measurement analysis of variance(P<0.05).Results: Significant differences were not observed in infant and mother demographicinformation. Before intervention, the mean of total number, length, and severity of crying were6.12 (1.76) time/day, 4.97 (1.37) hour/day, and 6.60 (1.54) in the massage group and 6.96 (2.9)time/day, 3 (1.31) hour/day, and 5.98 (2.22) in the rocking group, respectively. After 1 week ofintervention, the mean difference of total number, length, and severity of crying were 4.08 (1.83)time/day, 2.81 (1.77) hour/day, and 2.9 (2.37) in the massage group and 0.56 (2.28) time/day, 0.27 (1.09) hour/day, and 0.02 (1.64) in the rocking group, respectively. Conclusions: This trial ofmassage treatment for infantile colic showed statistically significant or clinically relevant effect incomparison with the rocking group.

Introduction: Parental presence during induction of anesthesia (PPIA) has been a controversialissue, with some studies showing its effects on reducing anxiety. Hence, this study aimed toinvestigate the effects of PPIA on preoperative anxiety of children as well as their parents.Materials and Methods: This clinical trial was conducted among 60 children aged 2–10 yearsand their parents. Children were randomly assigned to intervention (n=30) and control (n=30)groups. Children in the control group were taken to the operating room (OR) alone, while those inthe intervention group were taken to the OR with one of their parents. When the anesthetic maskwas placed on the children’s face (induction), the children’s preoperative anxiety in both groupswas assessed using Modified‑Yale Preoperative Anxiety Scale (M‑YPAS), and after that the parentsin the intervention group were escorted to the waiting area. Parents’ anxiety in both the groups wasmeasured by the Spielberg State‑Trait Anxiety Inventory (STAI) in the waiting area. Data wereanalyzed using descriptive and inferential (independent t‑test and Chi‑square test) statistic methodsthrough the Statistical Package for the Social Sciences version 18 software.Results: Results showedno significant difference between children’s anxiety in the intervention (70.83) and control (70.39)groups in the preanesthetic period. In addition, no significant difference was seen between theintervention (79.23) and control (85.86) groups regarding total parents’ anxiety. Conclusions: PPIAwas not successful in reducing the children’s preoperative anxiety as well as parents’ anxiety. Futurestudies in this area are needed to clarify the effects of this intervention in pediatric populations.

Introduction: Nurses are trained with specific clinical skills, and objective structured clinicalexamination (OSCE) could be a better approach to assess clinical skills of nursing students.Materials and Methods: A comparative study was conducted by observational checklist regardingantenatal care and opinionnaire on the usefulness of OSCE and tradition evaluation method (TEM)was used to assess the clinical skills and to get opinion.Results: The mean score of OSCE wasmore than TEM and the difference was statistically significant (P<0.001). The opinion of studentsregarding the usefulness of OSCE was higher than TEM. Conclusions: The study concluded thatimplementing OSCE will overweigh the advantages of the TEM.

Dear Editor, Ensuring optimal maternal health has been identified asone of the most important global public health prioritiesfor many decades. [1] Nevertheless, even today, in excessof 800 women lose their lives each day across the globefrom avoidable factors related to pregnancy and childbirth, of which 99% are reported in developing nations. [1] Thisis an alarming concern, and remains a major challenge which the program managers need to respond to despite theestimated 44% reduction achieved under the MillenniumDevelopment Goals. [1, 2]