Showing papers in "Advances in Nursing & Midwifery in 2009"

Reasons for medication errors in nurses’ views

Abstract: Background Medication error in nursing is one of the most common errors of healthcare systems (over 78%) with detrimental outcomes. Different reasons have been suggested in this regard and it seems that further investigations are still needed. Purpose This descriptive study was conducted to identify the reasons for medication errors in nurses’ views. Methods 100 nurses from different wards at several hospitals completed a 3-part questionnaire including demographic, occupational and medication error questions. Content and test-retest methods were used for validity and reliability of the questionnaire respectively. Different tests were used for statistical analysis of data. Results 53% of the subjects reported medication errors at least 1 time in their work experience. The most common ones were wrong dose (27%), drug neglect (22%) and wrong time (18%) respectively. Most errors were made by nurses between 25 and 30 (51%), at neonatal and pediatric wards (60%) and mainly in morning shifts (65%). The most common reasons included heavy workload (70%), shortage of staff (62%), physical and emotional fatigue (59%) and lengthy working hours (58%). Conclusion It can be concluded that the 3 reasons for making errors refer to organizational-humanistic factors. In fact, insufficiency in healthcare system leads to increased medication errors. Identification of these factors can help both healthcare system and nurses to eliminate them and decrease the errors resulting in improved quality care and patient’s safety. Keywords: Medication errors, Nurses, Reasons.

Effects of education via Health Belief Model on knowledge and attitude of voluntary health workers regarding Pap smear in urban centers of Qazvin

Abstract: Background Cervical cancer is the second common cancer after breast cancer in the world. It accounts for 18% of total deaths among women. Purpose This quasi-experimental before-after study was conducted to determine the effects of education based on Health Belief Model (HBM) on knowledge and attitude of voluntary health workers regarding Pap smear in urban centers of Qazvin. Methods 120 health workers took part in the study. A questionnaire completed by the subjects was used for data collection. Different statistical tests including Qui-square, ANOVA, coefficient of correlation etc. were used for data analysis. Results Mean scores of knowledge and elements of HBM (perceived sensitivity, benefits, barriers and severity) about Pap smear test in the subjects before and after intervention and within the elements showed a significant correlation. No significant relationship was found between the elements and such variables as the age and number of children of the workers. A significant relationship was found between the elements (perceived sensitivity and benefits) and educational level of the subjects before the intervention and also (perceived sensitivity and barriers) after that. Conclusion Instructing prevention based on HBM can increase knowledge and make attitude positive in voluntary health workers. Keywords: Health Belief Model (HBM), Knowledge, Attitude, Pap smear.

Knowledge and attitude of pregnant women regarding mode of delivery in women referring to Dezful health centers

Abstract: Background The significant increase in Cesarean delivery around the world turns this issue to a major health concern. In Iran, Cesarean rate is 3 to 4 times higher than what is recommended by WHO. Determining knowledge and attitude of people is the first step in developing and enacting educational programs for health promotion. Purpose This descriptive study was performed to determine knowledge and attitude of pregnant women referring to Dezful health centers regarding mode of delivery in 2008. Methods 120 women selected via quota sampling method participated in the study. A questionnaire completed by interviewing regarding demographic characteristics, knowledge about modes of delivery and attitude toward normal vaginal delivery (NVD) was used for data collection. Content and test-retest methods were used for its validity and reliability. Results Most subjects (54.2%) had moderate knowledge regarding mode of delivery. Their attitude (56.7%) toward NVD was neutral. Conclusion Since the majority of cases had moderate knowledge about modes of delivery and neutral attitude toward NVD, holding prenatal educational classes in this regard and supervision as well as follow-up for them are recommended. Keywords: Knowledge, Attitude, Modes of delivery.

Association between clinical competency and patient's satisfaction from nursing care

Abstract: BackgroundQuality care has always been the concern of nursing managers Characteristics of care givers may affect on the quality On the other hand, clients’ views in this regard is considered as a quality measurePurposeThis descriptive correlational study was conducted to determine the relationship between clinical competency and patient's satisfaction from nursing care in hospitals affiliated to Zahedan Medical UniversityMethods47 nurses and 141 patients were randomly selected The nurses provided direct care to 3 patients at least for 3 days The patients were asked on discharge A questionnaire was used for demographic data collection and completed by interview Another tool was used for measuring clinical competency with 62 questions regarding managerial, professional, communicational and educational skills, which was applied by head nurses, supervisors, and researchers Patients’ satisfaction was measured by a 37-item questionnaire concerning physiologic, security and social needs completed by interview Different statistical tests were used for data analysisResults Mean age of nurses and patients were 373±107 and 307±49 respectively 745% of nurses as well as 532% of patients were female Clinical competency of 17%, 755% and 255% of nurses was less than expected, in the expected range and more than expected respectively 92%, 61% and 298% of patients were dissatisfied, relatively satisfied and completely satisfied with nursing care Regression test showed a significant, linear and positive correlation between clinical competence and patient satisfaction Two-way ANOWA showed a significant relationship between clinical competence, sex, education as well as marital status of patients and their satisfactionConclusion It seems that the more the clinical competency is, the more the quality care would be and this results in increased patient satisfaction Therefore, by increasing clinical competence or applying more competent nurses, healthcare system can provide more satisfaction for the clients Keywords: Clinical competence, Patients’ satisfaction, Nursing care

Malnutrition in children under five in iran

Abstract: Background Children make a significant proportion of human population and their healthy growth and development ensure the future health of society. Childhood is considered as one of the most significant life stages for growth and health at other stages. Due to specific nutritional need, children are prone to food insufficiency. Accordingly, nutritional condition of children under 5 is an appropriate measure for evaluating the condition of health in a society. Purpose This study was intended to report malnutrition condition of Iranian children under 5 by reviewing related studies. Methods Different Iranian and international databases including Iran Medex, Irandoc and Pubmed were searched. Results Studies found that the prevalence of malnutrition in children under 5 was different at regions of the country and between 8.6% and 34%. The least amount (8.6%) was seen in Gilan province and the highest in Sistan and Baloochestan province. Risk factors in this regard were low-birth-weight, poor family planning, lack of consumption of complementary food, lack of mother’s knowledge regarding the proper time to start complementary nutrition and low level of mother’s education. Keywords: Malnutrition, Children under five, Nutritional state.

Psychometric evaluation of Anger Rumination Scale

Abstract: Background and aim Anger rumination is an inevitable, repetitive and cognitive process which occurs during anger experience, continues after it and increases its duration and severity. Anger rumination is associated with a wide range of psychological disorders, especially emotional ones. The main purpose of this study was to examine the validity and reliability of Anger Rumination Scale (ARS) as an important tool in health studies. Materials and methods 384 students (211 girls and 173 boys) of Tehran University took part in the study by completing Anger Rumination Scale (ARS), Tehran Multidimensional Anger Scale (TMAS), and Mental Health Inventory (MHI). The scale was validated with content, convergent and discriminant validity. Its reliability was measured by test-retest and internal consistency methods. Findings Reliability scores of the scale were satisfactory. Its content validity was calculated with a significant result according to Kendall's coefficients of concordance for its subscales including angry afterthoughts, thoughts of revenge, angry memories and understanding of causes as well as its total score after reviewing by 10 psychology specialists. The convergent and discriminant validities of the scale were measured based on an expected pattern of correlations between it and the measures of trait-anger, state-anger, anger-in, anger-out, anger-control in, anger-control out, psychological well-being, and psychological distress with significant results. Conclusion It can be concluded that Anger Rumination Scale (ARS) is a valid and reliable scale to measure anger rumination. Keywords: Anger Rumination Scale, Validity, Reliability. * Corresponding Author: Dr. Besharat; Professor of Clinical Psychology, Tehran University, Tehran, Iran. E-mail: besharat@ut.ac.ir

Effects of kangaroo and routine care on physiologic parameters of low-birth-weight infants

Abstract: Background and aim Low birth weight (LBW) is the most important indicator of mortality in children. These infants cannot tolerate physiologic stresses; therefore, they are isolated from their mothers to be put in incubators. This isolation put them at numerous risks. This clinical trial was conducted to compare the effects of kangaroo with routine care on physiologic parameters of low-birth-weight infants at NICUs in 2008. Materials and methods 80 LBW infants were randomly divided into 2 equal experimental and control groups. In kangaroo-care group, the infants were removed from incubator for 1 hour and put on the chest of their mothers. The control group was provided care routinely. Physiologic parameters including pulse rate, oxygenation of arterial blood, temperature and respiratory rate were checked at 30 and 50 minutes after the return of infants to their incubators. Data collection form was validated by content method and validities of instruments were checked by choosing standard and authorized devices. Reliability was achieved by inter-rater method (r=0.87). Findings No significant difference was found between the 2 methods during care in terms of the parameters (P>0.05). However, a significant difference was found between pulse rate as well as oxygenation changes 5 and 50 minutes after care delivery (P=0.01, P=0.02 and P=0.03) with no difference in temperature (P=0.48). Conclusion Findings showed that Kangaroo care is as effective as routine care in stability of physiologic parameters. Therefore, developing educational programs for healthcare personnel, nurses and mothers can facilitate the provision of this type of care. Keywords: Physiologic parameters, Low-birth-weight infants, Kangaroo care, Routine care, Neonatal intensive care units (NICUs). * Corresponding Author: Nurian, M; Dept. of Pediatrics, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences . Tehran, Iran. E-mail: Manighea@yahoo.com

Degree and types of domestic abuse in the elderly referring to

Abstract: Background Aging has always been concerned throughout history. The second half of the 20 th century has been referred as population graying due to increased number of elderly people. Of related familial and social outcomes is the upsurge of antisocial behaviors and violence. Domestic elder mistreatment or abuse as a major health problem is a type of familial violence with a significantly increasing incidence in the last 2 decades. Since there is no specific organization to be responsible for this problem in developing countries like Iran, no information or evidence is available and limited studies are only limited to developed countries. Purpose This descriptive study was conducted to determine the degree and types of domestic abuse in the elderly referring to parks of Tehran. Methods 400 elders 60 years and over including men and women from all parts of Tehran took part in the study. A questionnaire in 3 parts including demographics, types of abuse and open questions was used for data collection. The tool was validated by face and content methods and made reliable by internal consistency as well as test-retest methods. The questionnaire was completed by the researcher through interviewing the subjects. Results Findings showed that 28% of the elderly was between 70 and 74, 38.2% had secondary education, 65.1% was married and 32.9% lived with their spouses. 87.8% of them experienced at least 1 type of abuse, 12.2% no abuse and 24.9% all 4 types of abuse. 84.8% experienced emotional abuse; 68.3%, neglect; 40.1%, financial exploitation; and 35.2%, physical abuse. A positive correlation was found between age and abuse. In contrast, no relationship was found between abuse and sex, educational level, marital status, living condition as well as geographic area. Conclusion It can be concluded that domestic abuse is a widespread social problem which requires urgent, continuous and fundamental interventions. Clarification of the issue from different aspects, identification of predisposing and preventive factors and recognition of at-risk elderly are of high priorities in this regard. Keywords: Elderly, Domestic abuse, Parks.

Self-efficacy in hemodialysis patients and its related factors

Abstract: BackgroundEnd-stage-renal-disease (ESRD) patients treated by hemodialysis require major lifestyle changes and self-efficacy in the treatment regimen to comply with their chronic illness. Clients’ perception of being self-efficient results in increased self-care activities and adherence to medical regimen. Although client’s self-efficiency can affect on outcomes of the disease, few study is available in this regard. Purpose This descriptive correlational study was carried out to identify self-efficacy of hemodialysis patients and its related factors. Methods200 patients referring to healthcare setting affiliated with Iran Medical University were selected by convenience sampling method. A tool, Guidelines for Health Promotion, was used to assess self-efficacy in the treatment regimen. The tool was made reliable by test-retest method. ResultsFindings showed that self-efficacy was correlated with educational level, dialysis duration and weight difference between 2 dialysis sessions. In contrast, no correlation was found between self-efficacy and age as well as sex. Conclusion The study showed a significant relationship between self-efficacy and some personal characteristics of patients. Thus, it is necessary for nurses to assess self-efficacy of their patients. In addition, nurses are in a key position to influence on self-efficacy of their patients and improve self-care activities of them. To achieve these, they can provide necessary instructions for their clients to control stress and emotional as well as physical stimulations. Keywords: Self-efficacy, Chronic renal disease, Hemodialysis, Nursing.

Measurement of “behavior” or “intention to behaviors” in MS theses of Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences

Abstract: Background and aim Behavior and performance are investigated in different studies, which yields significant information to researchers leading to discovery of weak and strong points of behavior. This plays an important role in reaching to research goals. This review study was carried out to identify methods in the measurement of behaviors and application of them in MS theses of students in faculty of nursing and midwifery of Shahid Beheshti Medical University. Materials and methods 526 MS theses of students were investigated in terms of the methods for measurement or evaluation of behaviors. Findings Of the 526 theses, 22 were related to the measurement of behavior. Behaviors were measured by self-report questionnaires, checklist and no tool in 12, 8 and 2 theses respectively. Conclusion Findings showed that behavior is mostly measured by questionnaire and less by observation which yields more complete information. Keywords: Behaviour measurement, Reasoned Action Theory, Questionnaire, Observation. * Corresponding Author: Dr. Yaghmaei; Dept. of Community Health Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences , Shariati, Tehran, Iran. E-mail: Farideh_y2002@yahoo.com

Demographic features affecting on postpartum depression

Abstract: BackgroundPostpartum depression is a common disorder affecting on maternal-neonatal bonding. PurposeThis analytical study was performed to identify demographic features influencing on postpartum depression in 2007. Methods246 women having normal vaginal delivery with no history of physical and mental disorders during pregnancy or earlier were selected in a healthcare setting affiliated to Hormozgan Medical University. They were assessed on day 40 after delivery with 2 demographic and Edinburg’s questionnaires in terms of parity, educational level of spouses, neonatal disorders, sex of neonate, occupation of spouse, family planning, and decision for abortion, marital satisfaction, and history of stillborn babies. ResultsA significant difference was found between the groups in terms of marital relationships, level of education, sex of neonate, decision for abortion and unwanted pregnancy while there was no difference in parity, occupation of spouse and age. ConclusionIt can be concluded that women having unwanted pregnancies with lower educational level, unsatisfactory relationship with their spouses and undesired sex of their babies should receive more help in preventive programs for postpartum depression. Keywords: Postpartum depression, Edinburg’s depression test, Demographic characteristics.

Relationship of chemotherapeutic agents with menstrual disorders in nursing staff

Abstract: Background Occupational contact with chemotherapeutic drugs is considered as a potential threat for health. These agents may cause menstrual disorders according to many studies regarding the effects of long-term contact of the agents with health personnel. Oncology nurses involved in the preparation and administration of these drugs may be prone to many threats and complications. Purpose This retrospective study was conducted to detect menstrual disorders in nursing staff with or without contact with chemotherapeutic agents at Namazi Hospital in Shiraz. Methods Nurses from chemotherapy, hematology, pediatrics, Eastern 3 as well as bone marrow transplantation wards in case group and from internal general, internal women, internal men as well as Western 3 in control group (totally 94 subjects) was selected. A questionnaire in 4 parts including demographic, past medical history, menstrual disorders and contact with the agents was used for data collection. Pelvic sonography and hormonal tests were also checked. Results 61.1% of nurses in the case group suffered from menstrual disorders in comparison with 53.3% of subjects in the control group. TSH, FSH, and LH levels were higher and prolactin level was lower in the case group. Most nurses in the case group experienced the disorders in the last 6 months. No significant relationship was found between menstrual disorders and application of protective devices. Conclusion Because of potential effects of contact with chemotherapeutic agents on reproductive system, involved staff should use available protective devices to prevent infertility and menstrual disorders. Keywords: Menstrual disorders, Occupational contact, Chemotherapeutic agents.

Snack of students in secondary schools and their buffet conditions in tehran: a qualitative study

Abstract: Background School buffets are considered as important facilities in providing snacks for students. In addition, the consumption of junk and unhealthy foods in the snacks is prevalent. Purpose This qualitative study was carried out to identify the views and performance of students concerning having breakfast as well as snacks and assessing school buffets in Tehran in 2006. Methods 240 students from 12 secondary schools in district 4 of Tehran were selected by purposive sampling method. 24 focus group discussion sessions, each lasted 60 minutes with 8-10 students were held and recorded for each group. All session notes were compared and controlled by recorded files for identifying the main themes to be encoded, classified and analyzed. Results More than half of the students ate snacks to reduce lack of energy and satisfy hunger. About 50% of girls took cake, waffle and milk while some boys ate fruits, sandwich and cake. Most students believed that buffet is necessary at school and considered its condition from moderate to bad. More than half of them stated that the snacks and foods in buffets were invariable, expensive, unhealthy and nonnutritive. Conclusion With respect to undesirable snack patterns of students, improving the condition of school buffets to have more nutritious foods is a significant step in altering eating habits of them. Keywords: Adolescent, Snack, Buffet, Focus group discussion (FGD)

Educational needs of patients with multiple sclerosis (MS)

Abstract: Background With respect to different problems and complications of patients with multiple sclerosis (MS), appropriate educational programs and interventions should be performed for them to promote their quality of life. Purpose This descriptive study was conducted to identify educational needs of patients who were the members of Iranian MS Society in 2007. Methods 174 subjects referring to the society were selected with convenience sampling method. A questionnaire in 4 parts was used for data collection. Results Most subjects (26.4%) were between 32-39, women (71%) as well as married (59.8%) and history of the disease less than 3 years (27.7%). 39.1% was in great need of education, 0.6% of disease nature, 94% of sexual disorders and 64.8% of administrative problems. A significant relationship was found between educational needs concerning physical issues and education (P=0.027) and also these needs and times of hospitalization (P=0.004). Conclusion It can be concluded that the most urgent educational needs were about sexual problems, mobility problems and administrative problems and the lowest need for education was about elimination problems. Keywords: Educational needs, Multiple sclerosis, Iranian Multiple Sclerosis Society. Physical needs.

Risk factor frequencies in ischemic and hemorrhagic stroke

Abstract: Background Stroke is the most common neurologic disorder and the third leading cause of death in many countries. It has two types: ischemic and hemorrhagic. The latter has more complications and is lethal. Some risk factors of stroke include diabetes, hypertension, smoking and hyperlipidemia. Purpose This cross-sectional study was conducted to compare the frequencies of risk factors in patients with ischemic and hemorrhagic stroke, hospitalized at Hazrat-e-Rasoul Hospital in 2007. Methods 100 patients were randomly selected in an every other manner for each type of stroke and assessed as well as compared in terms of most significant risk factors. A form for recording age, sex, type of stroke and related risk factors was used to collect data from medical records. Results 74% and 26% of the patients suffered from ischemic and hemorrhagic stroke respectively. Mean ages of the first and second group were 68.3 ± 16.56 and 61.9 ± 13.69. The frequencies of risk factor in ischemic stroke were 64.86% for diabetes, 56.75% for hypertension, 21.62% for smoking and 13.51% for hyperlipidemia. The corresponding figures for hemorrhagic stroke were 65.38%, 61.53%, 3.8% and 3.8%. A significant difference was found between the frequencies of smoking (P=0.048) and hyperlipidemia (P=0.000) in ischemic and hemorrhagic stroke. Conclusion With respect to high frequencies of the above risk factors, controlling them in a better and more accurate manner, increasing public awareness and modifying life style are valuable in primary and secondary prevention of stroke and its complications. Keywords: Stroke, Ischemic stroke, Hemorrhagic stroke, Risk factors, Diabetes, Hypertension, Smoking, Hyperlipidemia.

Risk factors of cardiac diseases in faculty members and educational staff

Abstract: Background In spite of different studies for identifying risk factors in cardiovascular diseases, mortality rate resulted from them is worrying. It is estimated that by the year 2020, the rate will reach to 75%. At present, such risk factors as urban lifestyle, stress, diabetes, obesity, immobility, smoking, increased lipids, BUN, creatinine, hypertension etc. have been identified and are under investigation. Purpose This cross-sectional study was carried out to determine identified and probably unknown risk factors in the faculty and educational staff of Islamic Azad University in Karaj city. Methods 242 subjects including 81 (33.5%) faculty members and 161 persons (66.5%) from educational staff were randomly selected. A questionnaire in 2 parts and some clinical as well as paraclinical tests were used for data collection. All data were gathered between 8 AM and 12 MD during heavy workload. Results It was revealed that 44% of the faculty and 46% of the staff had marginal body mass index (BMI). In addition, 14% as well as 26% of the subjects had abnormally higher BMI respectively. In both groups, 63% had higher BMI than normal. Waist circumferences of 62% of the faculty and 76% of the staff were 80 cm or more. 65% had normal blood pressure while it was more than 140/80 mm Hg in 22%. However, in 9% of the faculty and 4% of the staff, the pressure was 100/50 mm Hg. 96% and 91% of both groups did not smoke and fell within normal ranges for blood sugar and urine. The amount of urea and creatinine showed a significant difference between the groups (P=0.000, P=0.009). Conclusion Some known risk factors such as blood sugar and lipids were controlled in the groups but some of them have not been identified as risk factors for cardiac diseases, e.g. BMI, waist circumference, urea and creatinine. A significant relationship exists between blood pressure and job stress as well as coping strategies. This denotes that educational authorities and administrators should modify their plans to control stress and risk factors. Keywords: Cardiac risk factors, Stress, Faculty members, Educational staff.

Sexual satisfaction in postmenopausal women

Abstract: Background and aim One of aspects in marital satisfaction is sexual. It has a significant role in mental health of families. With respect to increasing age and life expectancy of Iranian women, studying about sexual aspects of postmenopausal women can promote their health and quality of life. This descriptive study was conducted to determine sexual satisfaction of postmenopausal women referring to healthcare clinics affiliated to Medical Universities in Tehran in 2008. Materials and methods 270 women were selected by convenience sampling method. A questionnaire completed by interview was used for data collection. It included 2 parts: demographic and sexual satisfaction items. Different statistical tests were used for data analysis. Findings Mean age of women was 52.49 ± 4.93. Their sexual satisfaction was desired (58.9%) but their sexual drive was undesired (66.3%). All sexual aspects had a significant relationship with the satisfaction of women from sexual activities (P Conclusion Although postmenopausal stage is associated with decreased level of sexual hormones and drive, intimate relationship with spouse, increased educational level leading to increased knowledge, adaptation with menopause, hormone therapy and decreased stress as well as complications of chronic diseases can increase sexual satisfaction. Keywords: Postmenopausal women, Sexual satisfaction. *Corresponding Author: Lecturer, Dept. of Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences . Tehran, Iran.E-mail: zsheikhan@gmail.com .