Advances in Nursing & Midwifery

Background and aim
Family structure indicates the way in which the related components of the family are organized as a
whole family. Family structure is important to the outcomes of family and has main effect on family
function and relationships. Circumplex Model of Marital and Family Systems (Olson) evaluates
family structures and divided them to three category balanced, middle range and unbalanced
families. The aim of this study was to compare the perceived family structure of mothers with a
disable boy and mothers with a boy without disabilities upon circumplex model in Tehran in 1390.
Materials and methods
The present study is a comparative descriptive study. Data were gathered from 100 mothers who
had a boy with disability and 100 mothers who had a boy without disability .The participants were
included in the study from exceptional and normal elementary governmental schools in Tehran by
multi-stage cluster sampling method. Data were collected by a questionnaire, which consist of two
parts, demographics variables and Family Adaptability Cohesion Evaluation Scale (FACES-III)
(Olson 1986) . This questionnaire has acceptable validity and reliability. This scale position the
families in three type of family structures balanced, middle range and unbalanced. Data were
analyzed by SPSS 16 and descriptive and analytics methods such as t- test and chi square.
Findings
Most of the perceived family structured in two groups were balanced and middle-range. Mothers
with disable boy perceived their family structures balance and middle range less than and perceived
their family structure unbalance more than the other group. Perceived family structure in two
groups were not statistical significant (p>0/05).
Conclusion
There weren’t relationship between presences of disable child or form of disability with mother's
perceived family structure, and mothers in two groups perceive their family structure similar to each
other’s. So conclusion is that family structure isn’t affected by disability of the child.
Keywords
Circumplex Model of Marital and Family System, Perceived family structure, mothers, disable boy,
boy without disabilities

Background and aim: Kidney transplantation is the best treatment for patients with end stage renal
disease. Living donor kidney transplantation is increasingly performed in Iran. Since the quality of
life of live kidney donors has been subjected to little investigation, the present study was conducted
to investigate the quality of life of live kidney donors in Tehran in 2012-2013.
Materials and methods: This is a descriptive study conducted on 45 donors living in Tehran in 2012-
2013. Sample selection was started by recruiting convenient samples following by snow ball
sampling. Data were collected by a questionnaire consisting of as a three sections: demographic
information, SF-36 quality of life questionnaire and researcher made questionnaire .The data were
analyzed by SPSS 19 .
Results: Mean age of the donors was 34/4 year. 62/2 % of the donors were men. The quality of life
of 66/7 % of donors in physical, 60 % in mental and 48/9 % in social domain were classified as
moderate (score:34-66). The mean score of quality of life of donors was 59. 59.58 % of the
participants donated their kidney for financial reasons and there was no significant correlation
between the quality of life scores and reason for donation. 31 % of the donors regretted the
donation.68/8% of donors do not encourage donation and recommend it to others and the average
score of these donors is less than the donors who recommend donation(p <0/001)
Conclusion: The quality of life of kidney donors in this study was moderate. It is worthwhile to
follow up the donors and to assess physical and mental problem of donors after donation in order to
reduce subjective outcomes and regret in donors. There is a need for financial support of kidney
donors.
Key words: Quality of life , Kidney donation, Live donor

Abstract
Background and aim: Every year many women lose their lives because of postpartum bleeding in
developing countries including Iran. Inaccurate assessment of postpartum bleeding can cause delay in
treatment and further loss of blood. This study designed to investigate the methods of assessment of
postpartum bleeding in Iran
Materials and methods: This survey is cross sectional study that conducted in 129 obstetric units in 23
provinces in 213. To select centers, to cluster sampling, 23 of the 31 provinces in the country were enrolled.
In the Provinces ,Centers of public hospitals, educational , private and obstetric centers were selected
randomly. A questionnaire consisting of two sections for vaginal delivery and cesarean section was used for
data collection. data analyzed by SPSS software version 19 and Descriptive statistics.
Findings: Most and least used method for assessing blood loss in normal vaginal delivery was, clinical
estimate (93%) and special bag for collecting blood (3/9%). Also in Cesarean delivery , Clinical estimation
(81/8%) and transparent bags of blood collection (3/03%) were the least way.
Conclusion :The visual estimation is the most widely method for estimation of blood loss after birth
Key words: postpartum hemorrhage assessment methods, third stage of labor, postpartum hemorrhage

Abstract
Background and aim: Despite the recognition of the clinical instructor impact on quality of nursing students'learning, recent research indicate many problems in nursing instructors' performance. Many factors
contribute to effective clinical teaching and the instructors' clinical experience may affect their teaching quality. The aim of this study was to explore student nurses' experiences regarding their clinical teachers' experiences in nursing practice .
Method and materials: A qualitative approach was used for the study. The study protocol was approved by research committee of the school of medical education. A purposive sample of undergraduate nursing students at their internship placements participated in the study. Data were collected by semi structured interviews. Interviews were recorded and transcribed verbatim. A conventional content analysis approach was used for data analysis. Data saturation was reached by 12th interview .
Results: After coding and clustering the data 6 themes emerged. These themes were as below: 1- peace of mind 2- getting interested in nursing 3- effective clinical learning (impact of working with an instructor who has clinical experience) and 4-anxiety 5-no interest in nursing 6- ineffective clinical teaching ( working with instructors without any clinical experience).
Conclusion: The clinical background and nursing skills of clinical teachers is a major factor for effective teaching in clinicalsettings.

Abstract
Backgroun and aim: Self-esteem is the basic structure and essence of self-assessment and positive selfperception
as one of the potential variables of job satisfaction. Employees’ job satisfaction is a career
attitude, is an important variable for providing better services. The aim of this study is the determination the
correlation between nurses’ self-esteem and job satisfaction in teaching Khorramabad , Iran in 2014.
Method and Materials: This descriptive study was carried out in Khorramabad, Iranr in 2014. A
convenient sample of 170 nurses participated in the study . Data were collected by 3
questionnaires : demographic characteristics of participants, Cooper-Smith Self-Esteem Inventory,
and Wysocki & Chrome Job Satisfaction Scheme. ،The validity of questionnaires was assured by
content validity method. The reliability of the instruments was determined by computing
Chronbach's Alpha . The questionnaires were distributed to nurses working in different shift works,
which were completed and returned . Data were analyzed using SPSS 18 software.
Results: Considering the self s steem scores of nurses , 25.9% were classified , as being at low self
esteem level, 55. 9% at the average level and 18. 2% at the high self esteem level, while 23. 5%
were at the low job satisfaction level, 64. 7% were at the average job satisfaction level and 11. 8%
in were at the high job satisfaction level. Spearman correlation coefficients for correlation between
self-esteem and job satisfaction was(r = 0. 381) (p = 0. 001) ,which shows a significant correlation
between self-esteem and job satisfaction. The spearman correlation coefficients for age/work
experience and self-esteem were (r = 0. 132) and (r = 0. 154), respectively, (p = 0. 086) and (p = 0.
045), respectively. There is a significant correlation between self-esteem and work experience, yet
there is no significant correlation between self-esteem and age. The spearman correlation
coefficients between ,work experience and job satisfaction were (r = 0. 278) and (r = 0. 274),
respectively, (p = 0. 001). The correlation between age and job satisfaction is significant.
Conclusion: According to the research results, it could be mentioned that there is a relationship
between both variables of self-esteem and job satisfaction among the nurses. It is recommended to
consider self-esteem and its promotion methods as a strategy to increase nurses’ job satisfaction.
Keywords: self Esteem, job satisfaction, nurses.

Abstract
Background and Aim: Studies have shown erectile dysfunction is a common problem in men which
has negative impact on both man and his partner. This dysfunction causes sexual and marital
relationship difficulties. Efforts are not effective until relationship has not been improved. Thus the
purpose of this study is to design a model for improving relationship of wives with men with
erectile dysfunction.
Materials and Methods: This is a qualitative study; data collecting method was unstructured
interview with 16 female partners of men with erectile dysfunction. Field notes were also used as
data. Constant comparison analysis was done simultaneously using Strauss and Corbin method.
Sexuality in female partners of men with erectile dysfunction was explained using grounded theory.
The model which improves the relationship between wives and men with erectile dysfunction was
composed using the findings of grounded theory and literature review based on the Walker and
Avant theory synthesis method.
Findings: results of this grounded theory indicted that loss of intimacy was the main concern of
female partners of men with erectile dysfunction. And main strategy in facing with sexuality was
preserving the family unity. In this model, unlike the existing models, the starting point for sexual
dysfunction treatment is the female partner. This model designed through three phases: first phase
was aimed to identify the status of marital relationship, second phase was aimed to empower
women participation of spouses, and third phase was aimed to perform holistic interventions to
stabilize desirable marital relationship.
Conclusion: Using this model, in sexual problem condition, at first woman, then couple will be
empowered. Thus the overall marital relationship will not be damaged or the intensity of damage
will be reduced.
Key word: Erectile dysfunction, Sexual problem, Sexual relationship, Marital relationship, Mod

Background& aim: Ensuring the patient safety is the first step for quality improvement in health
care systems. Clinical governance model , with a systemic approach, a framework for quality
assurance. Implementation of clinical governance requires managers and staff contribution. The aim
of this study was to compare the manager's and employees's views about the effect of clinical
governance on patient safety in hospitals of Alborz university of medical sciences .
Materials and Methods: A descriptive - comparative ,design was used. The sample of the study
consisted of 129 managers and 251 employees. The entire population of managers were included
in the study. The employees were included in the study by using quota sampling method. Data were
collected by a questionnaire. The questionnaire consisted of demographic information and questions
regarding the seven components of clinical governance. The validity of the questionnaire was
assured by computing CVI (0.85). The reliability of the questionnaire was assessed by internal
consistency (α=0.98) and test re test .Data were analyzed by SPSS 16 software.
Results: Almost all managers ( 96.9%) and majority of employees (92.4%) strongly agreed with the
significant impact of clinical governance on patient safety. There was no significant difference
between managers' and employees' views
Conclusion: The managers and employees had a positive view on clinical governance and its effect
on patient safety. This finding shows that there is a willingness and readiness for implementation of
clinical governance in hospitals of Alborz university of medical sciences.
Keywords: Clinical governance, Patient, Perspective, Hospital

Abstract
Background and aim: Seasonal variations in incidence of diseases can be reason of effect of
environmental factors on health. Since the seasonal pattern in preterm birth varies across countries
and because of importance of preterm births and unknown causes of it, this study was designed to
investigate the frequency of preterm births in different seasons.
Materials and Methods: This cross-sectional study used data of all 5,860 infants born in the
Rafsanjan Nik-Nafs hospital in 2011-2012. Inclusion criteria included live birth more than 20 weeks
gestational age and birth weight more than 500 grams. Gestational age was determined according to
mother's last menstrual period date. The criterion for preterm birth was gestational age less than 37
weeks gestation. Data was collected through delivery records of hospital medical documentary unit.
For data analysis, chi-square and Fisher's exact tests was used.
Results: The prevalence of preterm birth in this study was 6.96% (408 cases). The highest and the
lowest frequency of preterm births were in January and February, respectively (P=0.031). Also,
preterm births was most frequent in spring (8.4%) and it was least frequent in winter (4.9%)
(P=0.002). The difference in frequency of preterm births in varying seasons across natural
deliveries, Afghan race and boys was found statistically significant (P<0.05).
Conclusion: The results of our study showed that preterm birth increase in the warm seasons of the
year and it is necessary for health care systems, as well as nursing and midwifery services to take
appropriate action in these circumstances.
Keywords: Preterm birth, Season, Month, Race, Rafsanjan