Iranian Journal of Nursing and Midwifery Research

Published by Medknow Publications
Print ISSN: 1735-9066
Publications
Labor pain is one of the most severe pains which has ever evaluated and its fear is one of the reasons women wouldn't go for natural delivery. Considering different factors which affect experiencing pain, this study aimed to explain women's experiences of pain during childbirth. This was a qualitative phenomenological study. The study population was composed of 14 women in 6 weeks post-partum period of natural delivery. The data were collected by interview. The data were analyzed by Colaizzi's seven-stage method. AFTER ANALYZING THE INTERVIEWS, FOUR MAIN CATEGORIES WERE EXTRACTED: the nature of delivery pain, the related factors in labor pain, the results of labor pain, and the perception of caseworkers. Assessing the women's experiences can be useful in giving better care. It helps understand the delivery pain phenomenon. Positive aspects of delivery pain must be strengthened and its negative aspects must be reduced as much as possible to create a suitable vision towards it.
 
Polycystic ovarian syndrome is one of the most common endocrine disorders with a prevalence of 5-10% in women. This syndrome is one of the major causes for menstrual disorders and is treated by medicational and non-medicational methods. This study aimed to define the effect of auriculotherapy on menstruation disorders in girls with polycystic ovarian syndrome. This is a clinical trial conducted on 60 single girls aged 18-35 years with clinical, laboratory, and sonography signs. The subjects were randomly assigned to two groups of auriculotherapy and medication, which underwent treatment for 2 and 3 months, respectively. Clinical signs were investigated in three steps in both groups. Data were collected through observation, laboratory tests, and sonography, and were analyzed by SPSS version 15. In 60 subjects, Chi-square test showed a significant difference in menstruation disorders in both groups 1 month after the start of intervention (P = 0.001); but 2 months after the start of intervention (P = 0.11) and immediately after the end of the intervention (P = 0.16), the difference was not significant. Three months after the end of the intervention, this variable showed a significant difference (P = 0.02). Medicational treatment and auriculotherapy are both effective on menstruation disorders, but auriculotherapy is more effective on reduction of menstruation disorders, compared to medicational therapy.
 
Mean and standard deviation of the weights of normal birth weight, low birth weight and very low birth weight children at 2, 4, 6, 9, 12, 15 and 18 months
Mean and standard deviation of the heights of normal birth weight, low birth weight and very low birth weight children at 2, 4, 6, 9, 12, 15 and 18 months
Mean and standard deviation of the head circumferences of normal birth weight, low birth weight and very low birth weight children at 2, 4, 6, 9, 12, 15 and 18 months
The frequency distribution of horizontal trend in growth curve of children with NBW, LBW and VLBW at 2, 4, 6, 9, 12, 15 and 18 months
Background: Birth weight is considered as the most important index of neonates’ growth as well as the most important determinant of infants’ mortality. This study was conducted to investigate the growth pattern in normal, low and very low birth weight neonates for 18 months in the health care centers of Isfahan, Iran. Materials and Methods: In a cross-sectional and retrospective study, 214 neonates (90 with normal, 90 with low and 34 with very low birth weights) were enrolled in the health care centers of Isfahan and their growth in the 2nd, 4th, 6th, 9th, 12th, 15th and 18th months were investigated. The data collection tool was a 3-part questionnaire which was validated using content validity. A part of data was completed based on the health file of the family. Findings: The mean of weight, height and head circumference in the months 2, 4, 6, 9, 12 and 15 in the three groups with normal, low and very low birth weights were significantly different. In the ages of 6, 15, 12 and 18 months, there was the highest frequency of horizontal trend in the growth pattern of children in the three groups. In the growth rate of neonates with low birth weight, there was the highest frequency of horizontal trend at the age of 12 months and there was the highest frequency of descending trend in the 15th months. Conclusions: The findings showed that according to National Center for Health Statistics (NCHS) percentiles, low and very low birth weight infants had lower growth in weight, length and head circumference compared to normal birth weight infants. Therefore, special attention should be given to healthcare and post-birth growth surveillance of these two groups to maintain and improve the health level of them.
 
Using blood and blood components is a common therapeutic procedure in hospitals. Nurses have an important role in a safe blood transfusion. Therefore, it is crucial for nurses to have sufficient knowledge of situations, amount and methods of using blood components, possible side effects and necessary cares. This study investigated nurses' knowledge of blood transfusion. This was a cross-sectional descriptive study on 117 nurses in medical training hospitals of Shahrekord University of Medical Sciences in 2004, aiming to evaluate their knowledge of blood transfusion. Data were collected using a questionnaire including 4 sections and 29 questions. Sections included demographic data, nurses' knowledge of blood components, nurses' knowledge of blood components infusion techniques, and nurses' knowledge of indication and side effects of blood components infusion. Knowledge scores were first coded and then categorized in three levels of good, average, and poor. Data were analyzed using SPSS software. The nurses' knowledge of blood and blood component, techniques of blood components infusion, and its indication and side effects was average (66.7%, 65.8% and 59%, respectively). The findings showed that the nurses' knowledge of blood and blood component was average and insufficient. Therefore, it is recommended to activate the blood transfusion committees in hospitals to increase the quality of this common procedure and prevent side effects by in-service trainings of nurses.
 
Interpersonal communication is considered as an important and effective factor of job satisfaction and efficiency and has special significance in nursing career because of the face to face relationship with patients. This study aimed to determine the association between head nurses' interpersonal communication and job satisfaction of nurses under their supervision. The study was conducted in educational hospitals of Isfahan University of Medical Sciences in 2006. This was a descriptive and analytical study on 203 nursing personnel working in educational hospitals of Isfahan University of Medical Sciences in 2006. Data were collected using Job Descriptive Index (JDI) developed by Smith and Kendall and interpersonal communication was measured using a researcher-made questionnaire. Data were analyzed using SPSS software and Pearson's test and presented in tables and diagrams. The majority of the participants (148 subjects, 73%) believed that head nurses' interpersonal communication was excellent and in general Pearson's test showed a significant association between head nurses' interpersonal communication and their personnel's job satisfaction (p < 0.011). Based on the results of this study on the relationship between interpersonal communication of the head nurses and job satisfaction of their personnel, we can improve the job satisfaction of nursing personnel as well as patients' satisfactory and level of services by developing educational courses and workshops on importance and effectiveness of interpersonal communication for head nurses.
 
Infant mortality rate was reported 3.18 in 1000 births in Iran. International organizations such as World Health Organization (WHO) and United Nations Children's Fund (UNICEF) consider applicable standards essential for providing effective health services in hospitals and health centers. Therefore, it is essential to create national care standards for neonatal intensive care units (NICU) in Iran. This was a multiple triangulation study conducted in 2007. In the first step, international standards were extracted from appropriate sites. Then, using Delphi method, as well as the viewpoints of 15 experts in clinical medical sciences, a set of suggested standards for intensive care unit was prepared. In the third step, 42 clinical science experts of Iran were selected, and their viewpoints on applicability of the suggested standards were investigated through a descriptive survey method. Data obtained in this step were analyzed using descriptive statistics. First, intensive care standards were extracted; then clinical science experts reviewed the suitability and applicability of suggested set of standards for Iran and finalized them. Finally, 386 standards for intensive care were drafted and approved by 77.5% to 100% desirability rate for NICUs of Iran. The findings of the study showed that most standards were either appropriate or fairly appropriate. So, necessary changes in final standards were made based on subjects, viewpoints and suggestions as well as the results of consulting with supervisors.
 
Comparing the mean of oxygen saturation before and during the intervention
Prematurity is the main cause of death in infants under one year of age and is the main reason for neonatal intensive care unit (NICU) hospitalization. The stressful environment of NICU exposes preterm infants to inappropriate stimuli. This study aimed to determine and compare the mean heart rate and oxygen saturation of premature infants before and during a designed program in NICU. In a clinical trial study (before-after intervention) on a single group, 31 hospitalized premature newborns in NICU of Al-Zahra Hospital in Isfahan were selected by simple continuous sampling method. Data were collected through interview, observation and checklist records. The data were analyzed using SPSS and descriptive and inferential statistics. Out of 31 premature infants in the study, 60% were boys and 35% were girls. The mean (standard deviation) of oxygen saturation before and during the designed program were 92.80 (2.54) and 94.22 (2.59) percent, respectively. The results of paired t test showed a significant difference between the means of oxygen saturation of the infants before and during the program (p = 0.048), but there was no significant difference between the mean of the infants' heart beat before and during the intervention. The findings showed that applying daily silence periods can greatly help to increase oxygen saturation and can improve the growth of premature infants. Therefore, by providing more facilities in clinical environments of NICU, conducting programs to reduce light and noise in these wards would be possible.
 
Old methods of administrating can't cover the rapid changes of today. These changes redounded new organizations like learning organizations to be formed. The purpose of this research was to study the relationship between learning organization and organizational commitment among nursing managers. This was a descriptive analytic survey. The population of study included 90 nursing managers of 9 educational hospitals. Data gathering was done via learning organizational (LO) and organizational commitment (OC) questionnaires. Data analysis was done using SPSS software. The mean score of LO was 56.9 ± 18.1 among nursing mangers, and the mean score of OC was 62.3 ± 10.1. In general, there was a significant relationship between LO and OC and there was a significant relationship between LO and job experience based on ANOVA test. In today's changing environment of very rapid changes which have been seen in different areas of science and technology and the increasing complexity and dynamics of environmental factors, only organizations with active adaptation (dynamic equilibrium) can survive and remain capable of growth. This aim can be fulfilled just in learning organizations.
 
Patients’ Characteristics
mean and standard deviation of Patients’ knowledge, awareness, attitude and practice score of HTN
correlation between Knowledge, Awareness, Attitudes and Practice about Hypertension in Hypertensive Patients
Hypertension is one of the most crucial health problems and most common chronic disease in developed and underdeveloped countries, which is called silent killer. Usually diagnosis happens suddenly. Despite this fact that is a preventable and treatable condition but without treatment it leads to serious and life threatening complications (such as heart, kidney and brain destruction), and in most cases these complications result in disability. It can be prevented by, increase knowledge and awareness, change attitude and practice. Prevention, plays significant role in controlling this disease. A cross-sectional, correlation-descriptive study was conducted in one stage, by one group. Two hundred thirty four (234) patients were recruited by random sampling among hypertensive patients referring to public health care centers in Khoor & Biabanak(an area in Isfahan Iran). Data gathering was carried out with a questionnaire. Data analysis was carried out SPSS software with descriptive and inferential statistics. Findings indicate that there is significant relationship between awareness and knowledge; awareness and attitude; awareness and practice. There is no significant relationship between knowledge and attitude; or knowledge and practice. In addition, there is significant relationship between attitude and practice. Although patients relatively had high awareness, knowledge, attitude and practice about their disease but still their hypertension was not under control. Several barriers are associated with uncontrolled hypertension particularly treatment-related barriers. Findings suggest further studies to determine new effective strategies to solve this problem.
 
Around 5% of the world populations are the carriers of the hepatitis B virus. Prevalence of carriers in many different areas of the world is various. Iran, including the rate of 2 to 3%, is among countries, which has the average prevalence. The aim of this study was to determine the prevalence of antigen HBs positive and associated factors in pregnant women who had referred to urban health centers of Isfahan Province in 2009. A descriptive study conducted on 1078 pregnant women who had referred to the urban health centers of Isfahan, Barkhovar, Meymeh, Khomeini Shahr, Lenjan and Najaf Abad in 2009 in order to register their physical condition and conducting pregnancy care. Random sampling method by quota was systematic. First, a questionnaire completed including demographic characteristics and records of high-risk behaviors in mothers and wives. Then, 4 cc of their blood drawn and evaluated the antigen surface in serum. Finally, the data were analyzed using SPSS15 software, Chi-square, Fisher and Logistic Regression tests. According to the findings, serum of 0.5% of pregnant women under the study was HBsAg-positive. The average age of subjects was 26.1 (4.9) years old and the average pregnancy number was 1.79 (1.0). Using Fisher's test as well as logistic regression test and based on the previous records of high-risk sexual behaviors and tattooing, a significant difference was observed in positive-HBsAg group in comparison with negative-HBsAg group (p ≤ 0.05). Instructing target groups and giving awareness in large-scale, close monitoring in high-risk centers such as beauty shops, tattooing centers and etc, and also staff training in how to use disposable and sterilized equipments have to be accomplished at the right time.
 
Characteristics of the 400 hospitalized older adult patients in the study according to sleep quality
The quality of sleep scores (mean ± SD) of hospitalized older adults according to medical disorder, type of sleep disorders and sociopersonal, physical, and environmental factors
Multiple logistic regression model for determining the predictors of sleep quality in hospitalized older adult patients
Sleep is an effective factor in the process recovery from diseases. Many variables affect the sleep quality of hospitalized older patients. This study was conducted to evaluate the quality of sleep and its related risk factors in hospitalized older patients in Kashan's hospitals, Iran 2009. Settings and design: a cross-sectional study was carried out on a sample of 400 hospitalized older adults in the hospital of Kashan, Iran. The Farsi Pittsburgh Sleep Quality Index (FPSQI) was used for gathering data. A global sum of 6 or greater indicates a poor quality of sleep. Statistical analysis used: data were analyzed using the Chi-square test, t-test, ANOVA, and binary logistic regression at the multivariate model. The overall quality of sleep of the patients in this study was poor. In the final regression model, sex (OR = 0.342), level of education (OR = 0.470), type of ward (OR = 0.592), previous hospitalization experience (OR = 2.336), and use of hypnotics in hospital (OR = 3.633) were the most important predictors of sleep quality. The most prevalent sleep disturbing factors were worries and anxiety, environmental noises and pain. However, the most negative effects on the PSQI mean score were reported to be from dyspnea, environmental lights, and changes in the sleep habits. Quality of sleep also had significant relationship with sleep latency (P = 0.001) and having a respiratory disorder. The knowledge of sleep disturbing factors in hospitalized older adults might help in planning preventive strategies to improve quality of sleep.
 
Relations between different variables and levels of psychosocial job stress
Characteristics of midwives in private and public hospitals and health centers of Mashhad (Iran)
Menstrual patterns of participating midwives (N=150)
Prevalence, odds ratios (OR) and 95% confidence interval (CI) of psychosocial work conditions according to Karasek's model
Relations between different variables and levels of psychosocial job stress
According to the biopsychosocial model, menstrual symptoms are caused not only by a combination of biological factors such as hormonal disorders and lifestyle, but also by psychological and social factors such as working environment. This study aimed to determine the relation between occupational stress and dysmenorrhea in Iranian midwives. This prospective correlational study was performed on 150 midwives at public and private hospitals and health care centers of Mashhad, Iran. The subjects were selected through two-stage cluster sampling during 2010-2011. At the beginning of the study, participants completed questionnaires containing demographic information, work circumstances, the 21-item Depression, Anxiety, and Stress Scale, and the Job Content Questionnaire. They then completed the short form of daily Menstrual Distress Questionnaire during three consecutive menstrual cycles. Independent Student's t-test, one-way analysis of variance, Kruskal-Wallis, Mann-Whitney, and chi-square tests, correlation coefficients, and linear regression analysis were used to analyze the data collected data in SPSS11.5. Dysmenorrhea was observed in 63.3% of the participants. Among these individuals, 15.7%, 45.2%, and 38.9% had mild, moderate, and severe symptoms, respectively. Moreover, 59.3% of the studied midwives had severe occupational stress. There was a significant positive correlation between occupational stress and severity of dysmenorrhea (P = 0.002, r = 0.82). Occupational stress is associated with increased risk of severe dysmenorrhea. This finding can be used to guide preventive measures to eliminate or decrease occupational stress and dysmenorrhea among Iranian midwives. However, identification of sources of occupational stress and related workloads is necessary.
 
Comparison of mean pre-test post-test scores of sleep quality and its sub-scales in intervention and control groups
Comparison of pre-test post-test mean scores of sleep quality its sub scales in intervention group
Comparison of pre-test mean scores of sleep quality and its sub-scales in control group
Studies showed that poor quality of sleep is a common problem among the elderly. Because of drug complications and side effects such as drug dependency and resistance and decrease of sleep depth in long-term intake of sleep medication, cognitive-behavior therapy including sleep restriction therapy which does not cause these problems is more considered. This is a quasi-experimental study on 38 elderly who were members of jahandidegan canter in Shiraz. The subjects were selected according to the inclusion criteria and were divided into experimental and control groups. The Pittsburgh Sleep Quality Index (PSQI) was used for evaluation of sleep quality. A 4 week sleep restriction therapy was implemented for experimental group and finally both groups were compared. The data were analyzed by Kolmogorov-Smirnov test, independent and dependent t-tests in significance level of 0.05. Mean sleep quality decreased from 14.21 to 11.26 after the intervention in the experimental group while it was 13 before intervention and decreased to 12.78 after the intervention in the control group. Independent t-test showed a significant difference after the intervention (P = 0.038). Mean of sleep medication intake and daytime dysfunction after intervention were 0.947, 1.94 in experimental group and 0.894, 1.63 in control group respectively, which showed no significant difference (P = 0.903, P = 0.272). This study indicated that sleep restriction therapy can improve quality of sleep, but the amount of sleep medication intake and daytime dysfunction did not show a significant difference after intervention.
 
Comparison of PB based on various levels of qualitative variables
Comparison of mean and SD of quantitative variables in two groups of nurses with and without PB
Multiple analysis of PB related factors in working nurses in hospitals in Tabriz
Burnout is a syndrome containing three dimensions of emotional exhaustion, depersonalization, and reduction of personal accomplishment. Nurses are exposed to professional burnout (PB) due to their exposure to physical, mental, and emotional stressors, which can lead to numerous complications in their personal, social, and organizational life. This study aimed to define the prevalence of PB amongst nurses working in hospitals in Tabriz and to detect its related effective factors in 2010. This is a cross-sectional analytical study conducted on all selected nurses working in hospitals in Tabriz. The questionnaires were filled and returned by 712 subjects after taking their consent. The data were collected by a questionnaire including questions on demographic characteristics and Maslach Burnout Inventory (MBI). Independent t-test was employed to compare mean quantitative variables in two groups of individuals with and without PB. Chi-square test was also adopted to compare the prevalence of PB in levels of qualitative variables. Logistic regression test was employed for multiple analyses of PB related factors. In this analysis, variables in level of 0.2 which had an association with PB as a single variable were entered to the model. Among the nurses taking part in the study, 156 (21.9%, CI 95%: 19.0-25.1) suffered from PB based on its definition. The risk of burnout is increased by 1.12-folds for each overwork night shift. Higher education increases professional burnout by 3.17-folds. The prevalence of burnout among nurses in Tabriz was revealed. Night shift and education level were shown to have an association with professional burnout.
 
Comparing mean acute physiology and chronic health evaluation II (APACHE II) scores of the control and intervention groups
Comparing mean scores of clinical pulmonary infection scale in the intervention and control groups before and after the intervention
Oral care plays an inevitable role in health and well-being of patients in intensive care units (ICUs). Poor oral care causes colonization of respiratory pathogens and secondary respiratory infections. Ventilator-associated pneumonia occurs in patients on mechanical ventilation for more than 48 hours. It results in prolonged duration of mechanical ventilation, mortality and health expenses. The present study aimed to review the effects of an oral care practice on the incidence of ventilator-associated pneumonia in patients on mechanical ventilation admitted in ICUs. This was a clinical trial study conducted in the ICUs of selected hospitals in Isfahan during 2010. We randomly divided 54 patients into the intervention and control groups. Intubation was performed during the 48 hours before the study. The intervention group received an oral care practice along with brushing and the control group received routine oral care twice daily. The incidence of ventilator-associated pneumonia was diagnosed through clinical pulmonary infection score (CPIS). The two groups were compared in terms of underlying criteria (APACHE-II). The incidence of ventilator-associated pneumonia did not statistically differ between the intervention and control groups (37% vs. 48.1%; p = 0.41). The results of the present study showed that brushing and standard oral care practice had no effects on ventilator-associated pneumonia. Therefore, the incidence of such complication might be affected by many different factors.
 
Schedule of home visits
How information resources to enhance the self-efficacy have been operationalized as an intervention in the home visits steps
Average elderly's scores in self-care self-efficacy before and after intervention
Perceived self-efficacy is a strong predictor for behavior. Considering the importance of health-promoting self-care behaviors in increasing quality of life in the elderly, this study was aimed at defining the effect of nurse home visits on self-care self-efficacy of the elderly in rural areas. This is a pre and post quasi-experimental study conducted on 33 older adults randomly selected from five villages in Falavarjan province in Iran. Intervention program was in the direction of self-care self-efficacy in four domains including nutrition, health practice, physical activity, and well-being in the form of five home visit programs and one group session by a nurse during 6 weeks, and included two different sections of education and nursing interventions administered based on needs assessment and determination of the tasks for the clients and their families. Theoretical framework of this study was supported by Bandura's self-efficacy, Orem's self-care theory, and Pender's revised health promotion model. The data were collected by self-care self-efficacy and demographic information questionnaire before and after the intervention. Data were analyzed by descriptive statistics and paired t-test. The mean elderly score in the four aforementioned domains increased after the home visit program. A significant difference was seen in the mean total scores of self-care self-efficacy and its subscales by paired t-test before and after intervention (P < 0.001). It was observed that home visit program, integrated with the theories, had a positive influence on improving self-care self-efficacy of the elderly, and was supported by Bandura's theory of self-efficacy suggesting four sources of performance accomplishment, vicarious experience, verbal persuasion, and emotional arousal. With regard to the importance of self-care behavior in health promotion of the elderly, multifaceted low-cost interventions with the highest effect seem essential.
 
The association between the received O2 during transportation and hypoxia
The association between patients’ hypothermia and keeping them warm during transportation
The association between received fluid and urine output
Burn is an irreparable event, which results in numerous physical, psychological, social, and economic complications. The burned patients should be merely treated in a professional burn center due to vast clinical range of these patients. Since, a percentage of mortality in burned patients is for the patients' transportation from other centers; this study has aimed to investigate the manner of their transportation to Imam Mosa Kazem Hospital. This is a descriptive cross-sectional study on 98 subjects selected through sequential sampling from thermally burned patients being referred to Isfahan burn emergency center by ambulance from August 2011 to November 2011. The data including demographic information and event details, burned surface, burning grade and the province of origin were collected by a questionnaire, as well as a checklist related to caring team standards, transportation team, transportation equipment, and outcomes. The data were analyzed by descriptive statistical tests. Based on the findings, the longest transportation time was 6.35 (4.30) hours. There was no significant association between patients' O2intake and hypoxemia. There was no association between patients' hypothermia and cooling the burn in the patients at the event location. There was a significant association between intake of fluid within transportation and urine output and hypovolemia (P = 0.00). Most of the defects of treatment were related to the equipments and infection control devices. The findings showed that burned patients' transportation is so far from standards in Iran, and the authorities' should pay specific attention to that in form of vast national investigations.
 
Role of nurses in some organizations
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. 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. 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. 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.
 
Oral contraceptive pills are among the most popular contraceptive methods, but the fear of cancer and cardiovascular disease overshadows its continuous use among women. This study aimed to define the association between consumption patterns of combined oral contraceptives among women with breast cancer. This is an analytical case-control study conducted on 175 women with breast cancer, referring to Seyed al Shohada Medical Center and private clinics in Isfahan to be treated and followed up in 2011, as well as 350 healthy women who were identical with the subjects in the study group regarding age and residential location. The data were collected using a researcher-made questionnaire. Content validity and Cronbach's alpha were employed to confirm validity and scientific reliability of the questionnaire, respectively. The data were analyzed by descriptive and analytical statistical methods through SPSS. The findings showed that there was a significant association between history of contraceptive pills' consumption and incidence of breast cancer (P < 0.001). It was shown that the risk of developing breast cancer is increased by 2.27-fold among those with pills' consumption compared to those with no history of that. It was also shown that pills' consumption for 36-72 months increased the risk of breast cancer by 2.18-fold, the age of the first use being less than 20 years increased the risk by 3.28-fold, and time since the last use of less than 25 years increased the risk by 2.63-fold. There was no significant association between duration of use, age of the first and last use, and time since the first and last use in the study and control groups. The results showed that history of pills' consumption is associated with incidence of breast cancer regardless of the consumption pattern. Use of oral contraceptives pills at any age and for any duration can increase the risk of breast cancer.
 
Types of surgery in experimental and control groups
Comparing pain intensity mean differences before surgery and 12–24 h following surgery between the 2 groups
One of the most frequent issues nurses encounter with after or during cancer-related surgeries is pain. For postoperative pain relief, different nonpharmacologic interventions, such as nurse-patient communication, mental support, preoperative education, and consultation can be used. Doing such interventions may decrease postoperative pain. However, the research results regarding the effect of such measurements on pain intensity is contradictory. So in this research study the effect of a pain management plan on pain intensity after cancer surgery was assessed. The present study is a pre- and posttest case and control clinical trial, which was conducted in Sayyed-Al-Shohada Hospital of Isfahan University of Medical Sciences in 2011. Care program consisted of pain education, communication with the patient, and pain measurement. Seventy patients were sampled based on the inclusion criteria and randomly assigned in 2 groups. Data were collected using American Pain Society-patient outcome questionnaire, which measured pain intensity. In the experimental group, the mean score of pain intensity before surgery and in the first 12-24 h after surgery was less than the control group. Also comparing pain intensity mean differences before and in the first 12 h, before and in the first 24 h indicated that the experimental group had lower scores than the control group, but these differences were not statistically significant. In both the groups, in the first 24 h following surgery the mean score of pain intensity decreased significantly. Results of the present research study suggested that a nursing pain management program consisting consultation, education, and pain assessment may have a clinical effect on cancer patient pain intensity following surgery. However, these results were not statistically significant. This might be due to the limited sample size as well as conducting the program in a short period of time. It is recommended that effects of such a program on the pain intensity will be examined further with a larger sample and in a longer period of time.
 
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. 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. 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). 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.
 
Frequency distribution and percentage of head nurses and staff nurses based on personal and social characteristics 
Mean and SD of head nurses' time management based on head nurses' and staff nurses' personal and social characteristics 
Effective time management is considered important for managers for achieving the goals in an organization. Head nurses can improve their efficiency and performance with effective use of time. There has always been a lot of disagreement in understanding time management behaviors of head nurses; therefore, the present study was conducted with an aim to compare the understanding of head nurses and staff nurses of the time management behaviors of head nurses employed in Social Security Hospitals in Tehran, Iran in 2011. This was a comparative descriptive study in which 85 head nurses were selected through census and 170 staff nurses were also selected through simple random sampling method from hospitals covered by the Social Security. Data collection was done through a standard inventory with high validity and reliability, which consisted of two parts: Socio-demographic characteristics and time management inventory. The obtained data were analyzed by descriptive and inferential statistics through SPSS software version 13. Mean score of time management in head nurses' viewpoint was 143.22 (±18.66) and in staff nurses' viewpoint was 136.04 (±21.45). There was a significant correlation between the mean scores of head nurses' time management and some of their socio-demographic characteristics such as gender, clinical experience, passing a time management course, and book reading (P < 0.05). There was a significant correlation between the mean scores of staff nurses' time management and their clinical working experience, education, using time management approach, and type of hospital (P < 0.05). The majority of head nurses (52.9%) believed that their time management was in a high level; besides, most of the staff nurses also (40%) believed that time management of their head nurses was high. However, there was a significant difference between the perceptions of both groups on using Mann-Whitney test (P < 0.05). With regard to the importance of time management and its vital role in the quality of nursing care for clients, and also the fact that head nurses believed more in their time management behaviors, they are expected to improve organization's goals and developments in order to modify the weaknesses and shortages and promote the skills and capabilities of their staffs and also resolve the disagreement on the understanding of time management. Moreover, effective time management training programs can be an important step for staff nurses and their head nurses.
 
Hemodialysis, as the main remedy of chronic renal failure, can cause mental problems among patients receiving this treatment. These clients face depression because of being treated long-term and invasive therapeutically methods. This is a descriptive-analytical study in which 171 patients receiving hemodialysis. They were divided in to those ones suffering from syndrome and the second group without syndrome. The results showed that the depression average grade was 47.31 ± 11.60 and 43.15 ± 10.3, in the first and the second group. This was a significant relation. Being high level of depression among these patients who suffering from restless leg syndrome, its suggested monitoring depression level intermittently. vital signs and decrease serum cortisol level in patients undergoing gynecological elective surgeries.
 
Frequency distributions (%) of the responses to viewpoint surrey in managers, staffs and clients based on organizational and structural obstacles
Frequency distribution of viewpoint scores in three groups of managers, staffs and clients in relation with organizational and structural obstacles in family planning counseling
Organizational and structural obstacles are a group of major obstacles in achievement of appropriate family planning counseling. Detection of these obstacles from the viewpoint of managers, staffs and clients who are key members in health services providing system is a major step toward appropriate planning to modify or delete this group of obstacles. The present study was conducted with the goal of comparing managers', staffs' and clients' viewpoints about organizational and structural obstacles in family planning counseling in health-care centers in Isfahan in 2012. This is a cross-sectional one-step three-group comparative descriptive study conducted on 295 subjects including 59 managers, 110 staffs and 126 clients in medical health-care centers in Isfahan in 2012. Managers and the staffs were selected by census sampling and the clients were recruited through convenient random sampling. The date collection tool was a researcher made questionnaire, which was designed in two sections of fertility and personal characteristics and viewpoint measurement. Descriptive and inferential statistical test were used to analyze the data. The obtained results showed no significant difference between mean scores of viewpoints in three groups of managers, staffs and clients concerning organizational and structural obstacles in family planning counseling (P = 0.677). In addition, most of the managers, staffs and clients reported organizational and structural obstacles as the obstacles in the process of family planning in moderate level. The results showed the necessity of health services managers' planning to modify or delete organizational and structural obstacles especially the agreed obstacles from the viewpoint of managers, staffs and clients.
 
Family intervention sessions schedule
Subjects’ variables in caregiving family members of the patients undergoing coronary bypass surgery in the study and control groups
Total mean caring burden scores and subscales’ mean scores of patients’ family members’ burden before and after the intervention in the study and control groups
Comparison of total mean caring burden and subscales’ scores changes of patients’ family members after the intervention in the study and control groups
Family burden is defined as the problems, concerns, and unpleasant events affecting the patients undergoing coronary arteries' surgery, and is associated with these patients physical and psychological improvement. Nurses are in a good position to provide appropriate intervention. This study aimed to investigate the effect of family-focused nursing interventions on the burden of the family members of the patients undergoing coronary bypass surgery. This is a clinical trial conducted on 50 family members of the patients undergoing coronary bypass surgery in Isfahan Shahid Chamran hospital. Caregivers were selected by convenient sampling and were randomly assigned to two groups of study and control. Caregivers in the study group attended a three-interventional session program during their hospitalization time, while the subjects in control group did not. Data collection tool was Novak and Guest caring burden inventory (CBI). Data were analyzed by SPSS. Means and SDs of caring burden before and after the intervention were 30.08 (14.03) and 19.2 (10) in the study group, respectively, and 30.16 (12.62) and 35.44 (10.42) in the control group, respectively. Changes of total scores of caring burden showed a significant difference after the intervention in the study and control groups (P < 0.001). Score changes of subscales of time dependence (P < 0.001), developmental (P < 0.001), physical (P < 0.001), and emotional caring burden (P = 0.007) were also significant. Results showed that family-focused nursing interventions were effective in reducing the family burden of the patients undergoing coronary bypass surgery. Nurses can administrate family-focused nursing interventions to reduce the caregiver burden.
 
Quality of life scores before and 1 and 2 months after intervention in pregnant women 
Background: About 79% of pregnant women in the world suffer from sleep disorders. These disorders result from physiological changes during pregnancy, originate from different factors, and can affect pregnant women's quality of life before, during, and after delivery. This study aimed to investigate the effect of sleep healthy behavior education on the quality of life among pregnant women with sleep disorders in the second trimester. Materials and Methods: This is a clinical trial conducted on 112 pregnant women with sleep disorders referring to two selected health care centers in Makou affiliated to Urmia University of Medical Sciences during June-Oct 2012. Data collection tools included demographic characteristics questionnaire, Pittsburgh Standard Sleep Quality questionnaire, and World Health Organization, Quality of Life (WHOQOL-BREF) WHOQOL-BREEF questionnaire. Sampling was done by convenient sampling. Firstly, Pittsburg Standard Sleep Quality Questionnaire was completed and the pregnant women with sleep disorders were selected as the subjects. After completion of sampling, the subjects were randomly assigned to two groups of study and control. Education of sleep health behavior was provided in the study group by the researcher during four 1-h sessions. Then, WHOQOL-BREEF and Pittsburg Standard Sleep Quality questionnaire were completed again in two groups in the first follow-up session (1 month after educational intervention) and in the second follow-up session (2 months after educational intervention) held by the researcher. Control group only received conventional prenatal care. The obtained data were analyzed by Chi-square test, independent t-test, Fisher's exact and repeated measure tests through SPSS 18. Results: Mean scores of quality of life showed an increase in 1 and 2 months after intervention in the study group compared to the control group. A significant difference was observed in the QOL in the two groups, 1 month (P < 0.000) and 2 months (P < 0.001) after intervention. Conclusions: Education of sleep healthy behaviors was effective on the QOL of pregnant women with sleep disorders. The results obtained in the present study can be used to support the pregnant women with sleep disorders and sleep disorders clinics, as well as for administration of prenatal care.
 
Patients' and caregivers' demographic characteristics in the study and control groups 
The family of cancer patients experience burden of care because of their caring role. Therefore, appropriate and effective interventions are essential in order to decrease burden. The goal of the present research was to determine the effect of a family need-based program on the burden of care in caregivers of leukemia patients. In this clinical research, 70 caregivers of leukemia patients who referred to Sayed Al-Shohada Medical Center in Isfahan, Iran were chosen and divided, through convenient sampling method and using table of random numbers, into two groups, experimental and control. Caregivers of the experimental group attended five training sessions. The data collection tool of this study was the Zarit Burden Scale. It was completed by members of both groups before, immediately after, and 1 month after the intervention. The data obtained were analyzed with SPSS software. During the study period, burden slowly decreased in the experimental group and increased in the control group. Mean burden of care score before, immediately after, and 1 month after the intervention was 63.6, 30.4, and 23.03, respectively, in the experimental group and 62.5, 67.3, and 68.8, respectively, in the control group. In addition, the mean burden score in the experimental group significantly decreased in comparison with the control group (P < 0.001). This family need-based program can decrease burden in caregivers of leukemia patients and may potentially improve the quality of life of both patients and caregivers.
 
In nursing, self-efficacy is quite critical for skill performance. Some factors might influence and predict self-efficacy in nurses. Thus, the present study aimed to investigate self-efficacy and the factors predicting nurses' self-efficacy in clinical setting. In this cross-sectional study, 264 nurses were selected from five hospitals affiliated to Shiraz University of Medical Sciences by stratified random sampling. General Self-efficacy Scale (GSE) was used to assess a general sense of perceived self-efficacy. The data were analyzed using one-way analysis of variance (ANOVA) and multiple regression analysis. The mean of self-efficacy in all the nurses was 29.78 [Standard Deviation (SD) = 5.82]. Moreover, the self-efficacy of the nurses with diploma, bachelor's, and master's degrees was 32.22 (SD = 6.21), 29.33 (SD = 5.68), and 32.00 (SD = 6.00), respectively. In addition, a significant difference was found between the nurses with bachelor's and diploma degrees regarding their self-efficacy (P = 0.01). Also, a significant relationship was found between self-efficacy and willingness to work in the nursing unit (F = 3.31, P = 0.01) and interest in the nursing field (F = 2.43, P = 0.04). The nurses who had more than 16 years of working experience in the field of nursing reported a better self-efficacy score. Overall, self-efficacy was predicted by the years of experience in the field of nursing (β =0.25, P = 0.009) and the interest in the nursing field (β = -0.15, P = 0.02). This study indicated that the nurses with diploma degrees gained higher self-efficacy scores compared to those with bachelor's degrees. Changing the nursing curriculum and increasing the motivation in the nursing context might enhance the interest in the nursing field as well as the nurses' self-efficacy. Of course, other studies are recommended to be conducted to improve the nurses' self-efficacy.
 
Fertility rate apparently is a non-interventional behavior, but in practice, it is influenced by social values and norms in which culture and traditional beliefs play a significant role. In this regard, some studies have shown that gender roles can be associated with reproductive behaviors. With regard to the importance of annual reduction of population growth rate and its outcomes, the present study was performed to determine the relationship between gender role attitude and fertility rate in women referring to Mashhad health centers in 2013. The present study is an analytical cross-sectional and multistage sampling study performed on 712 women. Data were collected by a questionnaire consisting of two sections: Personal information and gender role attitude questionnaire that contained two dimensions, i.e. gender stereotypes and gender egalitarianism. Its validity was determined by content validity and its reliability by internal consistency (r = 0.77). Data were analyzed by SPSS software version 16. Initial analysis of the data indicated that there was a significant relationship between acceptance of gender stereotypes (P = 0.008) and gender egalitarianism (P < 0.001), and fertility. There was also a direct association between acceptance of gender stereotypes and fertility rate (r = 0.13) and an indirect association between egalitarianism and fertility rate (r = -0.15). The results of the present study indicate that there is an association between gender role attitude and fertility. Paying attention to women's attitude is very important for successful planning in the improvement of fertility rate and population policy.
 
Mean characteristics of the three groups
Infants' feeding is one of the critical periods in women's health that can influence their life. The purpose of this study was to investigate the relationship between infants' feeding patterns and mothers' physical and psychological dimensions of quality of life. In this cross-sectional study, 189 mothers were selected by convenience sampling (n = 63 in each group of infant feeding pattern) from Isfahan in 2013. Demographic and World Health Organization's WHOQOL-BREF Quality of Life questionnaires were completed. Data were analyzed by descriptive and inferential statistical methods through SPSS. There was no significant difference in demographic characteristics and the mean total score of quality of life between groups (breastfeeding = 85.7, formula = 83.9, and combination feeding of breast milk and formula = 82.1). Mean scores of physical dimension of quality of life were significantly different between groups (breastfeeding = 24.7, formula = 23.7, and combination feeding of breast milk and formula = 22.7). Mean scores of psychological dimension were not significantly different between groups (breastfeeding = 21.3, formula = 20.6, and combination feeding of breast milk and formula = 20.4). The results of this study showed that mothers in breastfeeding group have higher score in quality of life and physical and psychological dimensions, compared to the other two groups. We can increase mothers' health and quality of life and the rate of breastfeeding with wide planning and supportive intervention by the families and society.
 
Pain is the common complication after a surgery. The aim of this study was to evaluate the effect of aromatherapy with Rosa damascena Mill. on the postoperative pain in children. In a double-blind, placebo-controlled clinical trial, we selected 64 children of 3-6 years of age through convenient sampling and divided them randomly into two groups. Patients in group A were given inhalation aromatherapy with R. damascena Mill., and in group B, the patients were given almond oil as a placebo. Inhalation aromatherapy was used at the first time of subjects' arrival to the ward and then at 3, 6, 9, and 12 h afterward. Common palliative treatments to relieve pain were used in both groups. Thirty minutes after aromatherapy, the postoperative pain in children was evaluated with the Toddler Preschooler Postoperative Pain Scale (TPPPS). Data were statistically analyzed using Chi-square test, one-way analysis of variance (ANOVA), and repeated measures ANOVA. There was no significant difference in pain scores at the first time of subjects' arrival to the ward (before receiving any aromatherapy or palliative care) between the two groups. After each time of aromatherapy and at the end of treatment, the pain score was significantly reduced in the aromatherapy group with R. damascena Mill. compared to the placebo group. According to our results, aromatherapy with R. damascena Mill. can be used in postoperative pain in children, together with other common treatments without any significant side effects.
 
Gestational diabetes is the second common disorder in pregnancy period, which is detected in 24-28 weeks of gestational age through screening tests in low-risk women. The women with gestational diabetes are prone to prenatal mortality and development of future diabetes. Therefore, detection of these individuals in the first trimester and conducting preventive interventions is of great importance. This study aimed to define the predictive value of fasting plasma glucose (FPG) and fasting plasma insulin (FPI) test in first trimester concerning the positive result of oral glucose challenge test (OGCT). This is a prospective and observational study conducted on 88 pregnant women in Tehran. After FPG and FPI measurements in these women in the first trimester, a screening test of GCT with 50 g oral glucose was conducted in 24-28 weeks of gestational age. Diagnostic value of FPG and in these two groups of positive and normal GCT results was evaluated through receiver operator characteristic (ROC) curve. P < 0.05 was considered significant. In this study, 15 subjects (17%) were detected with a positive GCT result. The sub-curve area of ROC diagram for FPG and FPI was calculated to be 0.573and 0.592, respectively, which reveals that FPG and FPI cannot have a proper predictive value for the positive result of GCT. Based on the results, the best cutoff points for FPG and FPI are 79.5 mg/dl and 7.55 μIU/ml, with accuracy of 60-67% and specificity of 45.2-47%. Only higher fasting glucose levels in early pregnancy, within the normoglycemic range, would predict the development of glucose intolerance with limited sensitivity and specificity.
 
Patients' baseline characteristics and group matching (the results of Kruskal-Wallis and Chi-square test)
Comparison of the pain intensity (mean±SD) among the three groups at different times after cardiac radiofrequency ablation
After radiofrequency catheter ablation of arrhythmias, patients have to bed rest for 4-6 h to prevent bleeding and hematoma. However, such a rest may cause back pain in the patients. The aim of this study was to determine the effects of continuous change in body position during and after the radiofrequency ablation on the back pain. In a quasi-experimental design 75 patients referring to university-affiliated hospitals were randomly assigned to a control group, receiving no change in body position, group A subjected to changes in body position during and after ablation, and group B subjected to changes in body position during ablation. The intensity of pain, blood pressure, heart rate, and extent of bleeding and hematoma were measured. The groups were not significantly different in terms of demographic characteristics, blood pressure, heart rate, overall bleeding, or hematoma at the entry into the coronary care unit. While not significantly different from each other, the intensity of back pain between group A and B were significantly lower than that of group C. Compared to group C, group A and B had a significantly lower pain score up to 6 and 4 h after the procedure, respectively. Group B had a significantly higher pain score at 2, 4, and 6 h post ablation than group A. The findings show that changing the body position during and after the ablation procedure would reduce or prevent the back pain without increasing the chance of bleeding and hematoma.
 
Quality of self-care in patients with arteriovenous fistula
Vascular access complications
Nursing technique
Vascular access complications are a major cause of excessive morbidity and mortality in the dialysis population. Moreover, there is not sufficient research regarding the factors correlated with vascular access complications among hemodialysis patients. This study aimed to evaluate the vascular access complications and their related factors such as nursing techniques and self-care in hemodialysis patients. A cross-sectional study was performed on 110 patients undergoing hemodialysis in Isfahan Aliasghar hospital during 9 months from July 2010 to March 2011. The data collection tools were a demographic questionnaire and three checklists designed to assess the complications of vascular access and care techniques. Data were collected by observations and interviews with the patients. Fisher's exact test, chi-square test, Pearson correlation coefficient, and descriptive statistics were used to analyze the data through SPSS 16. Among 110 subjects, there were 63 male and 47 female subjects. Subjects' mean age was 55.88 (15.51) years. There were 72 patients undergoing hemodialysis through arteriovenous fistula and 38 through permanent intra-jugular catheters. Insufficient blood flow in the catheter was the most common complication in patients with jugular catheters. Also, aneurysm was the most prevalent complication in patients with arteriovenous fistula. Low self-care of patients and needling into the aneurysm were correlated with aneurysm size. Presence of underlying diseases was related to ischemia. Nursing techniques and self-care of patients were correlated with the occurrence of complications. Therefore, it draws the attention of the nurses toward continuing professional education and patients' education, which can increase the longevity of vascular access.
 
C, intertrochanteric; F, Breisky pelvimeter; OP, transverse diagonal of the Michaelis sacral rhomboid area; CD, vertical diagonal of the Michaelis sacral rhomboid area
Mean of maternal anthropometric measurements in the two groups, normal delivery and dystocia
Diagnostic values of maternal anthropometric measurements for dystocia prediction
Diagnostic values of combining of maternal height with other maternal anthropometric measurements
Diagnostic values of combining different deciles and percentiles of maternal height with pelvic diameters and pelvic diameters with each other by the highest validity
Dystocia is one of the important causes of maternal morbidity and mortality in low-income countries. This study was aimed to determine the diagnostic accuracy of maternal anthropometric measurements as predictors for dystocia in nulliparous women. This prospective cohort study was conducted on 447 nulliparous women who referred to Omolbanin hospital. Several maternal anthropometric measurements such as height, transverse and vertical diameters of Michaelis sacral rhomboid area, foot length, head circumference, vertebral and lower limb length, symphysio-fundal height, and abdominal girth were taken in cervical dilatation ≤ 5 cm. Labor progression was controlled by a researcher blind to these measurements. After delivery, the accuracy of individual and combined measurements in prediction of dystocia was analyzed. Dystocia was defined as cesarean section and vacuum or forceps delivery for abnormal progress of labor (cervical dilatation less than 1 cm/h in the active phase for 2 h, and during the second stage, beyond 2 h or fetal head descend less than 1 cm/h). Among the different anthropometric measurements, transverse diameter of the Michaelis sacral rhomboid area ≤9.6 cm, maternal height ≤ 155 cm, height to symphysio-fundal height ratio ≤4.7, lower limb length ≤78 cm, and head circumference to height ratio ≥ 35.05 with accuracy of 81.2%, 68.2%, 65.5%, 63.3%, and 61.5%, respectively, were better predictors. The best predictor was obtained by combination of maternal height ≤155 cm or the transverse diameter of the Michaelis sacral rhomboid area ≤9.6 cm and Johnson's formula estimated fetal weight ≥3255 g, with an accuracy of 90.5%, sensitivity of 70%, and specificity of 93.7%. Combination of other anthropometric measurements and estimated fetal weight with maternal height in comparison to maternal height alone leads to a better predictor for dystocia.
 
Comparing mean satisfaction total score in the study subjects of the three groups
Comparing mean score of satisfaction factors in the three groups
Irregular population growth is considered as a serious threat to the international community and is also a major obstacle for nations' social and economic development. Thus, one of the ways to have a healthy community is to control the population and provide safe and effective contraceptive methods. Hormonal contraceptives are the most effective method of birth spacing. The present study aimed to determine and compare satisfaction from hormonal contraceptives including depot medroxyprogesterone acetate (DMPA), Cyclofem and LD in women referred to selected health care centers of Isfahan in 2010. This was a descriptive-comparative study with cross-sectional data collection method from 26 April 2010 to 28 October 2010. Simple non-probability sampling was used to select 150 individuals (divided into three groups of 50) among the females who referred to 8 selected health care centers in Isfahan to receive DMPA, Cyclofem, or LD for the first time, and/or those who had used contraceptives for three months. To assess satisfaction rate and its related factors, the standard ORTHO Birth Control Satisfaction Assessment Tool (BC-SAT) was completed three months after medicine consumption through interviewing. Data was analyzed using descriptive and inferential statistics (Fisher's exact, chi-square, ANOVA, and LSD tests). There were no significant differences in terms of mean score of satisfaction between the three groups. Cyclofem (192.2) and DMPA (188.1) gained the highest and lowest mean satisfaction scores, respectively. Although the mean satisfaction score in areas of ease of use/appropriateness, interference in menstruation pattern, acceptance and continuation of the method had significant differences in three groups, no statistically significant difference was observed in lifestyle, confidence to the method, side effects, concerns about future pregnancies and total satisfaction. Generally, there was no difference in satisfaction from the three studied hormonal contraceptives.
 
Considering the school nursing standards, which is the most important and vital element of the school health team, can be a fundamental step toward solving the current and future problems of the school and society health. The present research was done with the goal of determining the current situation of the standard of the school health nursing process in elementary schools of Kerman, Iran. The present research is a quantitative, descriptive study and was done between the years 2009 and 2010 through conducting an opinion poll. In this study, first the international standards of school nursing were searched and extracted from informational sources. Then, a questionnaire was designed based on the standards of the school nursing process and its related indicators in 6 areas. This questionnaire had two parts. The first part had the respondents' demographic information, answering was optional, and the second part of the poll was about each of the indicators. After preparing the questionnaire and determining its validity and reliability, it was distributed among the 120 samples (60 health trainers and 60 of Kerman's elementary school staff), and their opinions were gathered and analyzed through statistical-descriptive analysis. The results of this research demonstrate that approximately all the above mentioned standard areas in the country were applied (98%). The rate of acquiring the standard of nursing process was high (90%) in some areas (Investigative area) and low (30%) in some other areas (diagnosis area). In total, the rate of acquiring the majority of indicators of nursing process standards has an average percentage. It is suggested to use schools health professionals to raise the indicators of the standard of the school nursing process (the indicators which had low or average acquiring rate), and to raise the performance quality.
 
Mean basic fetal heart rate in both groups before and after intervention
Frequency distribution of fetal nonstress test reactive result in both groups before and after intervention
Mean time of onset of the second acceleration in fetal heart rate in both groups before and after intervention
The primary goal of antenatal testing is to identify fetuses at risk of intrauterine neurologic injury or death so that these adverse outcomes can be prevented. We want to assess nonstress test (NST) results and some parameters before and after vibro-acoustic stimulation and acupressure. We did a randomized controlled clinical trial in Shahid-Beheshti Hospital in Isfahan in 2011. A total of 64 pregnant women (32-36 weeks) in prenatal care unit were selected for vibro-acoustic stimulation (n = 32) and acupressure (n = 32) during the second NST. The statistical processing was performed by descriptive, paired t-test, analysis of variance (ANOVA), chi-square, and McNemar test through SPSS version 20. The mean baseline fetal heart rate (FHR) in vibro-acoustic and acupressure groups before and after stimulations did not differ significantly. The mean time of first acceleration in vibro-acoustic group was decreased after stimulations significantly, but in the acupressure group it did not differ statistically. The numbers of accelerations in both groups did not differ significantly before and after stimulation. The mean time of second acceleration in the vibro-acoustic group was 6.7 min before stimulation and 3.9 min after stimulation. This decrease was significant. The mean time of second acceleration after stimulation was lower than before significantly in the acupressure group. The frequency of reactive NST was same in both groups, before and after stimulation. Vibro-acoustic stimulation and acupressure of acupoint BL67 did not change FHR parameters but they could decrease the time of reactive result of NST.
 
Determining the mean scores of the individual and family characteristics
Determining the mean scores of the individual and family characteristics
Determination and comparison of mean score of the social adjustment in the intervention and control groups before and after the intervention
Life skills have different effects on various aspects of the mental health. Social adjustment prepares adolescents for entering to the adulthood. On the other hand, humor and joking in the education is considered as a stress reducer and learning increaser. Therefore, the present study conducted aimed to determine the effect of acquiring life skills through humor on the social adjustment rate of the high school girls. This was a two-group semi-experimental study including three phases. The study population included 69 first year high school female students of Isfahan Department of Education district 3 who were selected in simple random sampling. First of all, the social adjustment rate was measured using California Personality Inventory. Thereafter, life skills education was conducted using humor during five sessions. Finally, a test was taken in order to assess the acquisition of the life skills in which passing score was required for re-completing the questionnaire. The data were analyzed using software SPSS(10) and independent and paired t-tests. The findings of the study indicated that the mean score of the social adjustment statistically had a significant difference in the intervention group before and after the intervention. Furthermore, statistically, there was a significant difference between mean score of the social adjustment in the control group and test group after conducting the intervention. The findings of the study indicated that life skills education has been increased through humor on the social adjustment rate of the high school girl students. Considering the efficacy of learning life skills on the social adjustment and results of the other studies which were in accordance with the present study, implementing such trainings with a new method comprehensively is recommended in the schools.
 
There are two types of primary dysmenorrhea (spasmodic and congestive) which differ from each other in terms of the occurrence time in menstrual cycle, pain quality and other symptoms. The present study aimed to determine the effect of acupressure at the Sanyinjiao point (SP-6) on severity of menstrual symptoms (primary outcome) and the duration of resting time as well as the number of ibuprofen consumption (secondary outcome) in the two types of primary dysmenorrhea. This was a clustered randomized controlled trial on 72 eligible students residing in dormitories of public universities of Tabriz, Iran. Determining the type of primary dysmenorrhea using a Menstrual symptoms questionnaire (MSQ), 36 participants which suffered from each type of dysmenorrhea were enrolled from the four dormitories. The dormitories were randomly divided into intervention and control groups. No intervention was carried out at the first cycle. During the two next cycles, Sanyinjiao point of the subjects in the intervention group was pressed for twenty minutes at the time of pain. The subjects in both groups were allowed to consume ibuprofen, if needed. During these three cycles, the participants recorded and reported menstrual symptoms severity, duration of resting time and the number of the used ibuprofen. The severity of menstrual symptoms and duration of resting time in the 2 and 3 cycles were significantly reduced more than control groups for both spasmodic and congestive types of primary dysmenorrhea. In addition, the aver-age numbers of ibuprofen pills taken by both intervention groups was significantly less than the control groups. There was no significant difference between the two intervention groups in terms of any of the outcomes. Acupressure is effective on lowering the symptoms of dysmenorrhea and duration of resting time almost equally in both spasmodic and congestive types. Therefore, using this method either alone or along with other methods is recommended to treat dysmenorrhea.
 
Breast milk is the main food source for infants' growth and development. Insufficient milk is one of the obstacles to the adequate use of this substance. One of the treatments to help this issue is acupressure. Therefore, the present study was designed to determine the effect of acupressure on maternal milk volume. This study is a randomized clinical trial in which 60 breastfeeding mothers complaining of hypogalactia and meeting the inclusion criteria were studied. In addition to providing routine education, bilateral acupressure was performed for 12 consequentia l days on the acupoints of SI1, LI4, and GB21 in the intervention group, as three sessions per week with each session conducted 2-5 times. The control group received only routine education. In both groups, breast milk volume before intervention and 2 and 4 weeks after intervention was evaluated by an electric pump. Data were analyzed by descriptive and inferential statistical analysis through SPSS. The t-test showed no significant difference in the mean volume of milk in the two groups (P = 0.543). Mean volumes of milk before and 2 and 4 weeks after the intervention were 10.5 (8.3), 33 (13.44), and 36.2 (12.8), respectively, in the acupressure group and 9.5 (7.7), 17.7 (9.4), 18 (9.5), respectively, in the control group. Analysis of variance (ANOVA) test showed a significant difference in the mean volume of milk at 2 and 4 weeks after the intervention (P < 0.001). Both acupressure and general education methods were effective on the milk volume of breastfeeding mothers. Acupressure method was more effective than the other method. Therefore, application of acupressure as a method of alternative medicine to increase breastfeeding is suggested.
 
Comparison of total mean scores of fatigue, behavioral, emotional, sensory, and cognitive dimensions before and after intervention in the three groups of study, placebo, and control
Comparison of fatigue score changes and dimensions of piper fatigue scale after intervention in the three groups of study, placebo, and control
Fatigue is considered as a major problem in hemodialysis patients and can impair their quality of life. The purpose of this study was to investigate the effectiveness of acupressure on fatigue in hemodialysis patients. This is a clinical trial study in which 96 hemodialysis patients participated. Patients were randomly assigned into acupressure, placebo, and control groups (32 subjects fulfilling the inclusion criteria assigned to each group). The measures included the form of demographic characteristics, visual analog scale of fatigue, and Piper Fatigue Scale. Patients in the acupressure and placebo groups received acupressure intervention during the early 2 h of dialysis on six acupoints with massage for 20 min/day, 3 days per week for 4 weeks. In the placebo group, acupressure intervention was performed as mentioned above with a distance of 1 cm away from the actual intervention site. Patients in the control group received routine unit care only. Chi- quare test, Kruskal-Wallis, paired t-test, one-way analysis of variance (ANOVA), and Duncan test were used for data analysis. One-way ANOVA tests showed significant differences in the total mean score of fatigue and fatigue mean scores in the behavioral, emotional, sensory, and cognitive dimensions in the acupressure, placebo, and control groups. The results of this study showed that acupressure may reduce fatigue in hemodialysis patients, and use of this non-pharmacologic technique for hemodialysis nurses is suggested.
 
Mother's position. (Reference: www.childbirthconnection. org/pdfs/comfort-in-labor-simkin.pdf)  
Acupressure point. (Reference: http://acupunctureschoolonline. com/bl-31%E2%80%93bl-34-eight-liao-baliao-acupuncture-points.html)  
Natural delivery is distressing and the mother's severe pain and anxiety in this condition can have negative impacts on the fetus, mother, and the delivery process. Yet, pain and anxiety can be reduced by supporting the mother by a doula. Thus, the present study aims to compare the effects of doula supportive care and acupressure at the BL32 point on the mother's anxiety level and delivery outcome. The present clinical trial was conducted on 150 pregnant women who had referred to the Shoushtari Hospital, Shiraz, Iran for delivery in 2012. The subjects were randomly divided into two intervention groups (supportive care and acupressure) and a control group (hospital routine care). The mothers' anxiety score was assessed before and after the intervention, using the Spielberger questionnaire. The delivery outcomes were evaluated, as well. Subsequently, the data were entered into the SPSS statistical software (Ver. 16) and analyzed using the analysis of variance (ANOVA), Chi-square test, correlation coefficient, and logistic regression analysis. After the intervention, the highest and lowest mean scores of the state and trait anxieties were compared with the control and the supportive care groups, respectively, and the difference was statistically significant (P < 0.001). A significant relationship was found between the labor length and mother's anxiety score after the intervention in the supportive care (P 0.001) and the control group (P = 0.006). However, this relationship was not significant in the acupressure group (P = 0.425). Also, a significant difference was observed among the three groups regarding the mothers' anxiety level (P = 0.009). The study results showed that doula supportive care and acupressure at the BL32 point reduced the mother's anxiety as well as the labor length. Therefore, non-pharmacological methods are recommended to be used during labor for improving birth outcomes and creating a positive birth experience.
 
Location of UB32 (Ciliao); adapted from http://www.acupuncture.com[13]
Frequency distribution of research participants according to BMI
Mean of pain severity in acupressure group according to BMI
Comparison of mean and SD of age, BMI, and pain in the two groups
Pain originating from intramuscular (IM) injection should not be underestimated, because it can damage the nurse-patient relationship. This research aimed at answering two main questions, whether acupressure is effective on pain severity due to IM injection or not and whether pain severity in two groups is different or not. This research was performed in government-affiliated hospitals of Ilam. The patients were 15-55 years old. Subjects were individually asked to participate in the research, and an informed consent was obtained from them. Before injection, the patients were asked to lie in prone position and the acupressure point UB32 was found. It was pressed for 1 min circularly. Then, the acupressure point was pressed directly (pressure equal to 4.5 kg/cm(2)) by thumb three times sequentially. After acupressure, 3 ml penicillin 6.3.3 was injected to buttock muscle. In the control group was injected only penicillin 6.3.3 by the conventional method. Collected data were analyzed by SPSS 16 version. Means of pain intensity in the acupressure group according to body mass index values (BMIs) were 1.50 ± 0.75 in thin, 1.64 ± 0.72 in normal, 1.38 ± 0.60 in overweight, 1.40 ± 0.54 in obese, and 1 ± 0.0 in severely obese subjects, with a total score of 1.53 ± 0.68. Analysis of variance (ANOVA) showed no significant difference between mean pain intensities based on BMI. There was no significant difference in the two groups concerning BMI and age (age: 30.24 ± 10.98 vs. 29.26 ± 10.07; BMI: 23.74 ± 4.45 vs. 23.88 ± 5.74), but the difference between them in terms of pain intensity mean was statistically significant. It is concluded that acupressure in UB32 is effective on reducing the pain severity. Pain severity mean in the acupressure group was lesser than in the other group, and t-test showed a significant difference between the two groups.
 
Comparison of quality of life scores’ average before and after conducting the self-care training program in the experiment group
Comparison of quality of life score shift average before and after the self care in both experiment and control groups
Acute lymphocytic leukemia is one of the common cancers of childhood and currently, 80 percent of these children survive more than 5 years by getting the right treatment. Since long-term treatment is painful and invasive, preventing the side effects and their influence on quality of life is an important issue which introduces consideration for self-care. Consequently, the present study was conducted in 2007-2008 about the effects of self-care on the lives of children suffering from acute lymphocytic leukemia, referring to treatment centers in Isfahan City. The present study was a two-staged, two-group clinical trial. 48 children aging 5-18 and suffering from acute lymphocytic leukemia were selected through convenient sampling method and the training program was administered before them and afterwards, they were divided randomly into two groups of experiment (n = 24) and control (n = 24). The General Scale and Cancer Scale Quality of Life Identification Questionnaires were used to define the quality of life of the children. The validity and reliability of the questionnaire were in turn defined by content validity method and Cronbach's alpha test. The experiment group received the self-care checklist after training and was controlled and examined for 3 months. The pre-and-post self care Quality of Life Questionnaire were both filled out in both groups and accordingly, the SPSS software, independent t test, chi-square and paired t tests were used to analyze the data. The findings of the study showed that both groups were homogeneous by virtue of influential factors on quality of life, like age, gender, type, stage and duration of treatment (p > 0.05). There was no significant difference between the experiment and control groups' quality of life average scores before administering the self-care training program. The results of paired-t test in the experiment group after administering the self-care program showed a significant difference in General and Cancer Scale Questionnaires Quality of Life with that before administering the program, while no significant difference was observed in the control group. Also, the independent t-test showed a significant difference in the average of quality of life score shift after administering the self care between the experiment and control groups. Quality of life improved after administering self-care training program in the experiment group while it did not improve in the control group and even the increase in average score of quality of life in Cancer Scale in this group was an indicator of an increase in problems related to disease, treatment and care. The results of this study showed the positive effects of administering self-care on the quality of life of children suffering from acute lymphocytic leukemia.
 
Bruising is an unpleasant result of subcutaneous injection of Enoxaparin, which causes physical discomfort, limitation of injection site, patient's refusal of treatment, and distrust in nurses' ability. The application of techniques which reduce patients' fear, anxiety, and physical damage is one of the tasks of nurses. This clinical trial investigated the effect of duration of subcutaneous Enoxaparin injection on the bruising size in acute coronary syndrome patients. Seventy 35-75-year-old acute coronary syndrome patients hospitalized in Coronary Care Units were selected randomly. Each subject received 10- and 30-sec duration of injections by a single researcher on both sides of the abdomen in 12-h intervals. The bruising size was measured using a transparent millimeter measuring paper, 24 and 48 h after each injection. Data were gathered by a data recording form (demographic and measurements data) and analyzed by descriptive statistics and non-parametric tests through SPSS. Results showed that the mean bruising sizes at 24 h after 10- and 30-sec injection were 33.26 mm(2) (72.77) and 48.96 mm(2) (99.91), respectively, and at 48 h were 15.61 mm(2) (142.02) and 52.48 mm(2) (143), respectively. There was no significant relationship between the two techniques (P > 0.05), although the effect of age on bruising size was significant (P = 0.01). According to the findings of the present study, length of Enoxaparin subcutaneous injection has no effect on the bruising size.
 
Comparing the performance score of nurses from their own viewpoint before and after the intervention
Despite many progresses in the improvement of care status and the management of acute coronary syndrome, cares quality is far from the desirable conditions. Today, due to the great emphasis on resources management, costs control, the effectiveness of patient care, improving quality and responsibility, the good patient care is necessary. Two dimensions are referred for improving the quality: process (standard- based and safe services) and resultant (client satisfaction). The present study, aimed at determining the impact of Synergy Model on nurses' performance and the satisfaction of the patients with acute coronary syndrome. In a quasi- experimental study in a two-group and two-step form, a sample of 22 nurses and 64 patients with acute coronary syndrome in cardiac intensive care units of some university hospitals in 2010-2011 were recruited. Synergy Model was explained and carried out for the studied groups in a workshop and its impact on nurses performance in different areas and patients' satisfaction was examined by using two checklists: examining the nurses' performance quality and examining the patients satisfaction. Differences between the mean scores of the nurses in communicative, supportive, care and educational domains and total performance were statistically significant before and after the intervention (p < 0.001). However, in therapeutic domain, changes were not significant. There was a statistically significant difference between the average satisfaction score of the two groups (p < 0.001). Applying Synergy Model as a basis for receiving nursing cares was effective in increasing patient satisfaction and in the performance of nurses of cardiac intensive care units.
 
Adolescents’ social adaptability according to parenting style categorization
Social adaptability is an important requirement of the social life of adolescents, which can be affected by their mother's parenting style (PS). The purpose of this study is to compare the social adaptability in four parenting styles (authoritative, authoritarian, permissive and neglectful) through which mothers interact with their adolescent girls. This survey is a cross-sectional and analytical study on 737 adolescents that study in the all girls junior high schools in Isfahan. Data collection was done with a questionnaire. The questionnaires were completed by the adolescents. After data collection, the parenting styles were determined and the social adaptability of the four groups was compared. The mean social adaptability in adolescents who their mothers have the authoritative parenting style was 49.6 ± 6.1, in the permissive parenting style 50.1 ± 5.8, the authoritarian parenting style 44.2 ± 6.5 and in the neglectful parenting style was 42.2 ± 7.5. The social adaptability of the four groups was significantly different (p < 0.001). This study shows that the permissive parenting style and after that authoritative parenting style were followed by higher social adaptability in adolescent girls.
 
Stroke is a stressful event with several functional, physical, psychological, social, and economic problems that affect individuals' different living balances. With coping strategies, patients try to control these problems and return to their natural life. The aim of this study is to investigate the effect of a care plan based on Roy adaptation model biological dimension on stroke patients' physiologic adaptation level. This study is a clinical trial in which 50 patients, affected by brain stroke and being admitted in the neurology ward of Kashani and Alzahra hospitals, were randomly assigned to control and study groups in Isfahan in 2013. Roy adaptation model care plan was administered in biological dimension in the form of four sessions and phone call follow-ups for 1 month. The forms related to Roy adaptation model were completed before and after intervention in the two groups. Chi-square test and t-test were used to analyze the data through SPSS 18. There was a significant difference in mean score of adaptation in physiological dimension in the study group after intervention (P < 0.001) compared to before intervention. Comparison of the mean scores of changes of adaptation in the patients affected by brain stroke in the study and control groups showed a significant increase in physiological dimension in the study group by 47.30 after intervention (P < 0.001). The results of study showed that Roy adaptation model biological dimension care plan can result in an increase in adaptation in patients with stroke in physiological dimension. Nurses can use this model for increasing patients' adaptation.
 
Top-cited authors
Masoud Bahrami
  • Isfahan University of Medical Sciences
Mahboubeh Valiani
  • Isfahan University of Medical Sciences
Mahin Moeini
  • Isfahan University of Medical Sciences
Nahid Shahgholian
  • Isfahan University of Medical Sciences
Fariba Taleghani
  • Isfahan University of Medical Sciences