Advances in Nursing & Midwifery

Concept of health in the view of diabetic patients: A qualitative study

Valiee, S. ¹ * (MSN); Moridi, G. ²(MSN); Fathi, M. ³ (MSN); Nikbakht Nasrabadi, A. R. ⁴ (PhD); Rezaei Farimani, M.⁵ (BSN)

1. Lecturer, Dept. Medical Surgical, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Kurdistan, Iran. PhD candidate, Faculty of  Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

2. Lecturer, Dept. Pediatric, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Kurdistan, Iran.

3. Lecturer, Dept. Medical Surgical, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Kurdistan, Iran

4. Associated Professor, Dept. Medical Surgical, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran

5. Lecturer, Dept. Medical Surgical, Faculty of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Background and aim

Feeling of health is subjective and unique and health criterion varies in different age, cultural and socioeconomic groups. Illness can have a great effect on individual’s feeling and definition of health and well being. The aim of this study was to explore the meaning of health concept in the view of diabetic patients.

Materials and methods

This study was qualitative, semi structured interviews were conducted with 20 diabetic patients who attended to the diabetes clinic of Sanandaj Tohid Hospital. Interviews were transcribed and analyzed using conventional content analysis, and codes and themes were derived from participant’s responses.

Findings

Based on the findings of study five major themes about health emerged: intact body and happiness, life without any limits, peace of mind, spirituality and absence of complications.  

Conclusion

Health definition based on specific conditions of any culture and group that affect health behavioral. Based on emerged themes, health care providers must consider these themes and seek ways to achieve health in diabetic patients and use them in care plans.

Keywords: Health, Diabetes, Qualitative study, Conventional content analysis, Nursing.

^*Corresponding Author: Sina Valiee, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Pasdaran St, Kurdistan, Iran. E-mail: valiee@muk.ac.ir

Effect of cardiac rehabilitation on quality of life in myocardial infarction patients in Zanjan

Sadegh Zadeh V (MSN) ¹, Moshtagh Eshgh Z (MSN) ²

1. Lecturer, Dept. Surgical, midwifery Dept, Islamic Azad University, Zanjan Branch, Zanjan, Iran

2. Lecturer, Dept. of Nursing, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background and aim

Acute heart diseases cause limitation in physical activity and problems in quality of life. The aim of this study was to determine the effect of cardiac rehabilitation on quality of life in myocardial infarction patients in Zanjan.

Materials and methods

The current study is a two group and a pre & post test experimental study. 60 patients were selected and randomly assigned in two groups, control group and experimental group. For data collection, demographic questionnaire and Nottingham Health Profile (NHP) were used. Content validity of questionnaire was measured by content validity and reliability by Test-re-Test (r=0.82). Intervention program included, individual training, nutrition and mental counseling and exercise program. From each of the two groups control and experimental pre-test and post-test examinations were taken. Data were analyzed by SPSS v16 and descriptive and analytical statistics (T test, repeated measurement ANOVA) were used.

Findings

The results show a significant difference in the quality of life scores of the control and experimental groups (P=0.001 Mean=1.55 S.E=0.41, P=0.000 Mean=2/71 S.E=0.59, respectively). Thus, cardiac rehabilitation program is effective on quality of life of MI patients in the experimental group. According to results, the average score of the eight week (experimental: P=0.000 Mean=0/64 S.D=1.42 control: P=0.001 Mean=2.27 S.D=2.20) was better than that of the third week (experimental: P=0.000 Mean=3.35 S.D=2.73 control: P=0.001 Mean= 3.82 S.D=2.13) for both groups. This is more drastic in the experimental group. Furthermore, results showed no significant difference between the quality of life scores of men and women.    

Conclusion

The cardiac rehabilitation program can affect and improve the quality of life. Providing rehabilitation centers, gives the patients the chance to use these programs and gives them a better chance of independence life.                                                                                    

Keywords: Cardiac rehabilitation, Myocardial infarction, Quality of life, Exercise.       

^*Corresponding Author: Vida Sadeghzadeh. Department of Nursing, Zanjan Branch, Islamic Azad University, Zanjan, Iran. E-mail: vidasadegh@yahoo.com

Correlation between anthropometric indices at birth and developmental delay in children 4-60 months

Amir Ali Akbari, S.^1* (MSM); Torabi, F.² (MSM); Soleimani, F.³ (MD); Alavi Majd, H.⁴ (PhD)

1. Lecturer, Dept. of Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2. Alumnus, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

3. Pediatrician, Administrator of Pediatrics Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.

4. Associate Professor, Dept. of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Background and aim

Advancements in medical knowledge and treatment modalities have resulted in increasing the survival rate of high risk infants. This increased number of survivors call attention to future development of these children. After infection and trauma, developmental and behavioral problems are the most common children medical problems. The aim of this study was to determine correlation between anthropometric indices at birth and developmental delay in children 4-60 months that were visited in health services centers affiliated to University of Medical Sciences in 2010.

Materials and methods

In this descriptive-corrolational study, 401 children 60-4 months that were visited in health services centers affiliated to University of Medical Sciences in 2010 were selected by multistage method. Anthropometric indices of children at birth were collected from their health care records and development status of children was measured by "Ages and Stages Questionnaire". Validity of 0/84 and reliability 0/94 were obtained from pervious study. Data were analyzed by SPPS v 18.

Findings

The results showed that the average age of children in normal group was 17/33±13/18 month and in developmental delay group was 29/92±19/19 month. Most gender in normal group was female (%56) developmental delay group was male (%55/2).

In addition, there were no correlation between height and head circumference at birth and developmental delay. However, birth weight of children with developmental delay were four times lower than  birth weight of normal developmental children (p = 0.004, OR = 4).

Conclusion

Factors that lead to intrauterine growth reduction will create many problems in the neonatal period. On the other hand, staying these infants in NICU is longer and lead to presenting disorders in child developmental process.

Keywords: Anthropometric indices, Developmental delay, Child

^*Corresponding Author: Sedigheh, Amir AliAkbari. Lecturer, Dept. of Midwifery, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

E-mail: asa_akbari@yahoo.com

Factors contributing to readmission of congestive heart failure  patients admitted in internal ward of Hospitals of Shahid Beheshti University of Medical Sciences in Tehran

Ashktorab, T.¹*(PhD); Bathaei, S A.² (MSN); Zohari Anbuhi, S.³ (MSN); Alavi Majd, H.⁴ (PhD);

Ezati, J.⁵ (MSN)

1. Associate  Professor, Dept. of Medical-Surgical, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences. Tehran. Iran

2. Alumnus, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences. Tehran. Iran.

3. Lecturer, Dept. of Medical-Surgical, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences. Tehran. Iran.

4. Associate Professor, , Dept. of  Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences. Tehran. Iran.

5. Lecturer, Dept. of Medical-Surgical, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences. Tehran. Iran.

Abstract

Background and aim

The prevalence of congestive heart failure (CHF) continues to rise and nearly 5 million people in the United States have CHF, with more than one-half million new cases diagnosed each year. The readmission rate within 3-6 months after discharge in these patients is 10-50 percent. The aim of this study was to determine factors contributing to readmission of patients with congestive heart failure (class 2 and 3) who were admitted in internal ward of Hospitals of Shahid Beheshti University of Medical Sciences in Tehran 2009.

Materials and methods

In this correlation -descriptive study, 110 patients with congestive heart failure based on 2 and 3 New York Heart Association Classification (NYHA) were included. Subjects were selected by quota purposive sampling and were divided into two groups (readmission and no readmission). Data were collected by a questionnaire. Content validity of the questionnaire was assessed by 10 nursing experts, 5 persons with congestive heart failure and 2 cardiologists. Reliability was measured by ted-retest (0/86). Data were analyzed by SPSS 15.

Findings

Results showed that, % 61.8 of samples was readmitted to the hospital during the previous 6 months period.  In addition, two individual factors (age and literacy level) and two disease related factors (NYHA class and having other disease) contributed to readmissions. Therefore, age and higher NYHA class and having co morbidities had direct and also literacy level indirect relationship with readmissions.

Conclusion

The readmission rate of patients with congestive heart failure in this study was high. Therefore, attention to contributing factors is needed.

Keywords: Congestive heart failure, Readmission, Factors.

^*Corresponding Author: Dr Ashktorab; Assistant Professor, Dept. of Medical-Surgical, Faculty of Nursing and Midwifery, Shaheed Beheshti Medical University, Shariati, Tehran, Iran. E-mail: t_ashktorab@sbmu.ac.ir

Effect of therapeutic play on postoperative pain of hospitalized school age children in pediatric surgical ward

Baratee F¹ (MSM); Dabirian A^2* (MSM); Yoldashkhan M³ (MD); Zaree F⁴ (PhD); Rasouli M

1. Alumnus, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2. Lecturer, Dept. of Pediatric, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

3. Lecturer, Dept. of Anestisiology, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4. Assistant Professor, Dept. of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran

5. Assistant Professor, Dept. of pediatric, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background and aim

A majority of children experience moderate to severe postoperative pain. To ensure adequate pain relief in pediatric patients, non pharmacological techniques are needed for use in conjunction with pain medication. The aim of this study was to determine the effect of therapeutic play on postoperative pain of hospitalized school age children in surgical ward of Sheikh’s Pediatric Hospital affiliated to Mashhad Medical University in 2009-2010.

Materials and methods

In this randomized clinical trial, 40 hospitalized children in surgical ward between the age of 8 and 12 years old were selected and randomly assigned to the experimental group who participated in a session of therapeutic play that lasted between 30 and 45 minutes whereas those in the control group received routine care. Data collection tools included demographic questionnaire and Objective Numeric Pain Scales. The intensity of pain was assessed before (Phase1), immediately after (Phase2), and 15 minutes after (Phase3) intervention or routine care. The validity of ’Objective Pain Scales’ and ‘Numeric Pain Scales’ were determined by concurrent validity (0/89) and between ‘Objective Pain Scales’ and ‘Face pain Scale’ (0/95). Reliability of ‘Objective Pain Scales’ was measured by inter -rater reliability (0/95). Data were analyzed by SPSS v16.

Findings

The results showed that children in the experimental group reported having significantly less pain (p<0/001) than the control group based on a comparison pain scores in Phases 1 and 2 and 3.

Conclusion

The findings of this study have shown the positive effect of therapeutic play on postoperative pain of hospitalized school age children.

Keywords: Postoperative pain, Therapeutic play, School age children.

Corresponding Author: Akram Dabirian, Dept. of Pediatric, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran. E-mail: a.dabirian@yahoo.com

Needs of family caregivers of the patients with Alzheimer disease: Analyzing of family caregivers experiences

Mohammadi F ¹ (PhD), Fallahi khoshknab M ² (PhD), khanke H³ (PhD)

1. Assistant Professor, Dept of Gerontology & Research Center on Aging, Social Welfare and Rehabilitation Sciences University, Tehran, Iran.

2. Assistant Professor, Dept of Nursing, Social Welfare and Rehabilitation Sciences University, Tehran, Iran.

3. Assistant Professor, Dept of Nursing,  Social Welfare and Rehabilitation Sciences University, Tehran, Iran.   

Abstract

Background and aim

With the increasing elder population, providing effective family care is turning to be the most important challenge in health and welfare of elder people. The aim of this study was to explore needs of family caregivers of the patients with Alzheimer disease by analyzing of family caregivers experiences

Materials and methods

This qualitative study was conducted by latent conventional content analysis. 35 family caregivers of elder patients with Alzheimer disease participated in the study. Participants were selected based on purposive sampling.  Sources of information included documents of  participant's diaries, about their problematic and complicated days of caring. Data were analyzed through reading and rereading documents, determining meaning units, extracting of codes and categorizing of them.

Findings

Most of participants (80%) were female, with mean age of 56/2 and literate (under diploma level). The findings generated 794 initial codes, which were grouped in 7 categories of: need to knowledge, receiving help from other family members in caring, modification of the home environment, self caring of caregivers, need "to be visible", compatible and complimentary health care system and caring equipments.

Conclusion

Regarding to Global expansion of Alzheimer disease, considering the family care giving issue of elders with Alzheimer disease is essential. Therefore, providing suitable information, establishing education for caregivers related to disease and patient care management, management of caregivers’ health, psych–social support and establishing of appropriate complimentary health care system for elderly patients should be considered. These   strategies would facilitate the family care giving and support the caregivers on their journey.

Keywords: Elderly, Alzheimer, Need, Family caregiver

^*Corresponding Author: Farahnaz Mohammadi, Assistant Professor at Social Welfare and Rehabilitation Sciences University, Department of gerontology & Research center on Aging.

 E-mail: f.mohammadi@uswr.ac.ir

Incidence of intradialytic complications and their risk factors in patients undergoing hemodialysis in hospitals affiliated to Medical University of Hamadan Iran

Ghahri Sarabi, AR.¹ (MSN); Torabi, M.² (MSN); Abed Saeedi, Zh.³ (PhD); Akbarzadeh Baghban, A.⁴ (PhD)

1. Lecture, Dept. of Medical Surgical, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran. Iran.

2. Alumnus, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences. Tehran. Iran

3. Assistant Professor, Dept. of Medical Surgical, Faculty of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

4. Assistant Professor, Dept. of Biostatistics. Faculty of Paramedical, Shahid Beheshti  University of Medical Sciences, Tehran, Iran.

Abstract

Background and aim

Hemodialysis is one the most common renal replacement therapies in end stage renal disease. Despite progress in dialysis technology, intradialytic complications occur frequently. The aim of this study was to determine the rate of intradialytic complications and their risk factors in patients undergoing hemodialysis in hospitals affiliated to Medical University of Hamedan Iran in 2009.

Materials and methods

192 patients undergoing hemodialysis participated in this descriptive correlational study. These patients were included in the study using census method. Data were collected by1- a questionnaire which consisted of 3 sections (demographic information, person – related factors and  therapy- related factors),2-a check list and  clinical examination ( blood pressure and weight measurement). Content validity of the questionnaire was assessed by 10 nursing experts, 5 staff of hemodialysis wards and 2 nephrologists. Reliability of check list was measured using inter-rater reliability (r=0.98). Data were collected by the second author. Data were analyzed by SPSS 15.

Findings

Findings showed that the most frequent complications include: hypotension (%15.1), muscle cramp(%11.5), nausea(%9.4), headache(%7.8), angina(%2.6), vomiting (%2.1) and itching(%1.6) respectively. Logistic regression analysis, showed a significant correlation between age and cramp (person – related causes) and a significant correlation between hypotension, cramp with vomiting and headache. Moreover, findings showed a significant correlation between nausea with eating  during dialysis (patient- related causes); and between hypotension with dialysis solution (therapy- related causes).

Conclusion

Based on the results of this study, most of intradialytic complications can be prevented. Use of these findings can improve the process of dialysis.

Keywords: Hemodialysis, Intradialytic hemodialysis complications

^*Corresponding Author: Alireza Ghahri Sarabi, department of Medical-Surgical nursing, school of nursing and midwifery, Shahid beheshti University of Medical Sciences and Health Services, Tehran, Iran. E-mail: ARGS1340@yahoo.com

Basic requirements for implementation of total quality management in Centers of Emergency Medical Services in Iran according EFQM model

Abedsaeedi, Z¹. (PhD); Mozafari,M².*((PhD); Pazargadi,M.³(PhD);  Alavi majd, H.⁴ (PhD)

1. Assistant Professor, Dept of Medical Surgical, Faculty of  Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

2. PhD Student, Dept of Nursing, Faculty of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Lecturer, Ilam University of Medical Sciences, Ilam, Iran

3. Associate Professor, Dept. of Management, Faculty of Nursing & Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran

4. Associate Professor, Dept. of Biostatistics. Faculty of Paramedicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

Background and aim

Successful implementation of TQM requires a committed leadership, customer – based approaches, process management, efficient communication, knowledge management, empowerment and involvement of staff and an organizational culture for continuous quality improvement. The aim of this study was to assess basic requirements for implementation TQM in Centers of Emergency Medical Services in Iran according EFQM model.

Materials and methods

In this descriptive study, all of operational and official stations of Medical Emergency services  in Ilam, Bushehr, Mazandaran, Ardebil, West Azerbaijan and Yazd province, one half of operational stations in city of Tehran, Sistan–Baluchestan, Khorasan-razavi and Isfahan, were included. All senior managers  and personnel of these centers  and a random sample   of 3246 customers who have  received  care during the last 6 months were selected. By using a 189 –item’s rating scale and 4 questionnaires; leadership style, job and patients satisfaction and state of organizational empowering, according to 5 enabler criteria, from  EFQM  model was assessed. Validity of instruments by measuring content validity and reliability by internal consistency and test-retest confirmed. Descriptive and inferential statistics used for analyzing data.

Findings

The overall mean score was 168.4±34.6 out of 500; therefore, the selected divisions were labeled as drifters organizations which were in early stage of quality improvement road. In comparison, the Tehran, Isfahan and Khorasan-razavi centers with more score labeled as improver’s organizations. At the entire, leadership criterion obtained minimum (26.6%) and people criterion obtained maximum (39%) mean scores.

Conclusion

Results showed that enabler criteria of the EMS centers in Iran need to reinforcement. It is essential enhancing the knowledge and attitude of managers and personnel about quality improvement principles. Additionally, establishing the management by process, creating customer focused approach and culture of continuous improvement, empowering employees and constituting quality circles are appropriate interventions that should be considered

Keywords: European Foundation for Quality Management (EFQM), Total Quality Management (TQM), Center for Management of Accidents and Emergencies, Emergency System, Enabler criteria.

^*Corresponding Author: Mosayeb, Mozafari. Dept of Nursing. Faculty of Nursing & Midwifery, Ilam University of Medical Sciences, Ilam, Iran, Banganjab.

E-mail: Mozafaric@yahoo.com