[Blood loss and need for transfusion assessment in open reduction and internal fixation of femoral shaft fractures]

Background and Objective: A high percentage of patients with multiple traumas sustained at least from an orthopedic problem. One of the high frequent lesions was femoral shaft fracture. The aim of this study was to determine the amount of bleeding and the need for blood transfusion in femoral shaft fractures and risk factors

Methods: This descriptive, retrospective study was done on 84 patients with femoral shaft fractures whom were operated in Imam Khomeini Hospital in, Sari, in northern Iran during 2012-15. Age, sex, comorbidities, type of fracture, hospitalization period, pre and post-operative hemoglobin and blood unit's loss were recorded for each patient

Results: In 43 patients [51.19%] plate and in 41 patients [48.80%] intramedullary naling were used for treatment of fractures.13 [15.47%], 33 [39.28%] and 37[44.04%] of patients were received one, two and three blood units, respectively. There was no significant relationship between energy intensity and age. There was significant relationship between the intensity and the type of fracture [P<0.05]. A significant correlation existed between blood unit transfusion with sex, fracture type, hemoglobin before surgery and fracture energy intensity [P<0.05]

Conclusion: Based on the results of this study, it is recommended for hip fracture at least 3 units of blood should be reserved

[ effect of Family Centered Empowerment Model on mothers' QOL of girls under six years old with UTI]

Introduction: Urinary tract infection is the most common chronic childhood disease, especially in girls under 6 years old. This chronic disease reduces quality of life of mothers. This study aimed to determine the effect of Family Centered Empowerment Model on mothers? QOL [physical dimension] with daughter of urinary tract infection.

Materials and Methods: This quasi experimental study was conducted in Motahari Hospital between 1991-1992 year, with 60 mothers whom were eligible for entry into the study in two control and intervention groups. Research instrument consisted of "Perceived Threat", "Self-Efficacy", "Mother Efficacy", "Self-Control", "Locus of Control", "Cooper Smith Self-Esteem" and "SF36 Quality of Life Questionnaire". Content Validity Index, Content Validity Ratio and reliability with Cranach's alpha coefficients calculation were measured for instruments. Data were collected for mothers in intervention group in three phase [before, after and during the model performing] and four stages in intervention time. The mother's quality of life was assessed before, one and three months after empowering the mothers in intervention group. Data was analyzed by SPSS/18.

Findings: There was not significant differences in the empowerment and quality of life scores before intervention [P<0.05]. There was a significant difference between the two groups [intervention and control] after family centered empowerment model accomplishment [P<0.05].

Conclusion: Family Centered Empowerment Model could increase quality of life scores of mothers. It is suggested that this model use clinically for families with children with other chronic illnesses.

[Comparison of viewpoint of nurses and women with cancer undergoing chemotherapy about preview of counsulting role playing obstacles of nurses practitioner in chemotherapy units]

The low level of life quality in the patients is related to low educational levels of the patient and her family and As the nurses are in contact with the women with cancer and their families more than in the clinics and hospitals, they could have effective role in developing patient and family situation and increasing their knowledge and information to partnership in treatment decision and control their health in which field one of the most suitable nursing interference to increase women acknowledgment and their support is consulting. In spite of this, most nurses have not necessary alertness to do the role. So the goal of the study preview of counsulting role playing obstacles of nurses in related to women with cancer underging chemotherapy. The study is Analytical-Descriptive-Cross sectional study that has done in four education hospitals related to Iran Medical University. The study samples have chosen from 42 nurses and 50 women with cancer underging chemotherapy. The data are collected from questionnaires completion related to demographic data and questionnaires completion related to nurses and women visions. After collecting information, data was analyzed using SPSS version 15. In related to data demografic analyziz, mean and deviation and for other questionnare data, answers frequency to each question was analyzed. The findings show the nurses have recognized that non-having enough time to consult, non-sufficient reach to up-date scientific resources about cancer and chemotherapy, high job stress to counsult with patients are as the main obstacles in individual-nurse, environment, management, individual-patient respectively and the patients announced that non-having enough time of nurses for counsulting, non-east reach to hospital, unsuitable care persistent in home, non-recognition from consulting role of nurses, respectively are the main reasons. The study showed that there are unanimous votes and differences among nurses and patients views from point of priority. So, the managers of treatment section shall concentrate their essays to omit or adjust the announced factors from two groups and specially common cases

[ effect of self care program education by group discussion method on self concept in diabetic adolescent girls reffered to Iranian diabetes society]

Diabetes is a chronic illness which needs the self care behaviors up to the end of life. If this illness attends with adolescence because of the nature and properties of the adolescence creates problems of adapting to the illness and doing self care behaviors for adolescent and his/her family. On the other hand studies have shown that in chronic illnesses such as diabetes, self care interacts with self concept. How ever diabetes adolescents affiliating has problem for self concept and since adolescence the effect of self care on self concept has important value. So this study has been done to assess the effect of self care program with group discussion on self concept of diabetic young girls. This research is a semi experimental study has been done in 2008- 2009 with 80 diabetic adolescent girls between 15-19 [40 as test group and 40 as evidence group] in Iranian Diabetes Society. After data collection result in pre intervention stage with knowledge, practice and self concept questionnaire and need measuring in each group, self care program was designed and then self care program was discussed in 6 sessions for test group. Then immediately and after one month of intervention again the same questionnaire completed for test and evidence group of diabetic adolescent girls. Results after data analysis showed that test and evidence group were same for independent sample t test and chi-square test for demographic information [age, height, weight, fathers job...]. In test group in comparison among before, immediately after and after one month of intervention there was significant difference in increasing score of knowledge, practice and self concept [P<0.0001]. But this difference was not significant in evidence group [P>0.05] and independent t-test [P>0.05] showed no significant difference in knowledge, practice and self concept between test group, and evidence group before intervention. Immediately and after one month of intervention between two groups with independent t-test, was seen significant difference in mean score of knowledge, practice and self concept [P<0.05]. Generally results of the research showed that performing the self care program by group discussion was effective in increasing self concept of diabetic adolescent girls and it is suggested that teaching self care behavior by group discussion is used as a effective method to improve self concept in other adolescents with chronic disease

[Elder abuse by family members: an exploration in the lived experiences of older people]

Elder abuse by family members particularly where family provides care to an aging relative has been addressed as a serious problem by most societies. Considering the importance and prevalence of the issue, exploring lived experiences of elders in this regards is necessary to have a better understanding of elder abuse phenomenon. The study aimed to explore experiences and perceptions of elders regarding their abuse by family members. A qualitative study using hermeneutic phenomenological approach was employed to conduct the study. Unstructured interviews were undertaken with fourteen elderly community dwellers of Tehran city. In-depth interviews were taped and transcribed verbatim and analyzed using van Manen method. Four themes were identified including: 'being deprived of human rights and dignities', 'smashed up integrity', 'silent suffering' and 'painful ending'. The lived experience of the older adults evidenced elder abuse as a deprivation from the human rights and dignity which could result in negative physical, psychological, and socio- economical consequences, decreased quality of life and tough ending which they bear it in silence. The findings reveal significant concepts in providing care to elders and could contribute in increasing capabilities of healthcare workers specially nurses to assess, intervene and prevent it appropriately

[Barriers to employing participative management in nursing units of Arak educational hospitals]

Without any doubt, one of the most important factors to achieve the goals in organization is employing right management methods. According to many experts, management of health care settings is considered as an important teamwork, nowadays. Therefore, providing an appropriate ground in health care settings for participation demands identifying the barriers to participation and the ways to overcome them. This study aimed at assessing the barriers to employing participative management in nursing units of Arak educational hospitals in 2007. In this descriptive study, 26 nurse managers and 87 nurses working in one of three educational hospitals in Arak, were given a questionnaire to complete. The data were analyzed by descriptive statistics. It was revealed that 56/99% of the participants identified organizational factors as the most important barriers to employing participative management. In addition, most of participants [84/1%] hadn't passed any course on participative management, and 76/1% of them reported their agreement with participative atmosphere in organization and the rest agreed to some extent. In another words, there was no objection regarding this issue. The study indicated that the most important barrier to employing participative management was organizational factors. The next important barriers were personnel' cultural, individual-managerial and personal- staff barriers. Managers' development for competency-oriented management, not only can help to get ride of the barriers, but also results in employing participative management or choosing an appropriate management style in organization

Pain management: patients' perspective

Pain relief is an integral part of nursing care and an appreciated outcome of nursing actions. Pain is one of the most common problems in postoperative period. This article is part of a larger study which aimed to explore patients' perspective of pain and pain management. Annually, more than hundreds of million people undergo surgical operations experiencing postoperative pain. Although a number of researches and discussion papers have explored the issue, the current study has explored patients' perspective about postoperative pain management, a subject that have rarely been studied. A qualitative approach was adopted. Data was collected via semi- structured interviews and participations' observations. A purposive sample of ten surgical patients and four companions [relatives] were selected from two educational health centers. Data analysis uncovered a number of themes. The themes related to patients' perspective about pain management is subject of this paper. The other five themes of pain management were: watching over by personnel and availability, humanistic approach, presenting information and patient education, communication and patient's participation, considering patient integrity, and ambivalence between expression of pain and reluctance. The findings of this study help personnel to know the patients and their needs better and to find what pain management means to them. Consequently, nurses can plan, imply and evaluate nursing interventions most appropriately

[ effect of participation of girl students on consumption of fruit and vegetable in family]

Evidence indicates that they may help to prevent major diseases such as heart diseases, some types of cancers, type 2 diabetes mellitus, stroke and etc. The aim of the study was to investigate the effect of girl students' participation on consumption of fruit and vegetables in the family. Fruits and vegetables are essential part of healthy diets. Increasing groups [experimental and control] and was carried out in 10 middle- schools in Tabriz during the year 2006. A number of 200 students participated in this study. The students in the experimental group [n=100] taught to research objectives [healthy diets, fruit and vegetable consumption, the methods of washing and disinfecting fruit and vegetables, importance of fruit and vegetables and the role of students in planning of fruit and vegetable consumption in the family]. Then they began to assess and evaluate the amount of fruit and vegetable consumption in their family and encouraged their family members to increase or correct of fruit and vegetable consumption patterns. Questionnaires and checklists were data collecting tools, which were completed 2 times by students: before and 1 month after intervention. This study had a quasi-experimental research design with two consumption of fruits and vegetables [P < 0.001]. Findings showed that girl students' participation made an increase in their family girl Students' participation can increase fruit and vegetable consumption in the family.: Based on these findings, the research hypothesis was supported. It means that girl students' paticipation can increase fruit and vegetable consumption in the family

[ effect of self-care education on quality of life in patients with esophageal cancer following esophagectomy]

Physical complications following esophageal cancer are known as factors that affect the patrent's quality of life. These symptoms affect the mental, social and emotional aspects of patient's life adversely. This study was carried out to investigate the effect of self-care education on life quality of patients suffering from esophageal cancer following esophagectomy in selected hospitals of Tehran University of medical sciences. In this quasi-experimental study 77 patients treatment and control groups with esophageal cancer were selected non-randomly regarding their characteristics [35 years old and over, and transhiatal esophagectomy]. Three half-hour face-to-face education sessions were held for 40 patients and their families, while 37 patients were regarded as control group. Quality of life of patients undergoing esophagectomy and the number of problems in both groups were measured through SF36 checklist in two stages: before education and esophagectomy and one month after education and esophagectomy. Finally, life quality and the number of complications were compared in both groups. Independent t-test revealed that total life quality score before intervention in two groups was not significantly different [p=0.53]. Moreover, the same test showed no significant difference in two groups after intervention [P=46]. However, paired t-test revealed that total life quality score in treatment group differed significantly before and after intervention [p=0.035]. In addition the same test showed a significant difference in control group before and after intervention [p=0.009]. Pearson correlation coefficient indicated that there was no significant difference between demographic variables and total life quality score [p>0.05]. Paired t-test showed that the number of patient's complications decreased following the education. Self-care education following esophagectomy improves the life quality of patients and reduces the complications. Thus, regarding the follow-up period [one month] sample volume, and efficacy of the intervention more comprehensive studies using laryer sample volumes with longer follow-ups are recommended

effect of designed home visit program on promoting cutaneous leishmaniasis preventive behaviors

Cutaneous Leishmaniasis is the second common parasitic disease in Iran. According to several studies, insufficient knowledge of mothers about the prevention strategies related to occurrence of the disease in their children are significant. Therefor, educating of the rural families by home visit program could be effective approach to prevent Cutaneous Leishmaniasis. The objective of the present study was to determine the effect of designed home visit program on promoting preventive behaviors regarding Cutaneous Leishmaniasis in rural families of Tang Hanna district in Neyriz. The study was a quasi-experiemental desing which 60 families with at least one child [with 6-12 years old] were randomly selected, with [no Cutaneous Leishmaniasis] from seven rural areas and assigned to two groups of experimental and control groups and matched to demographic indicators [age, education, income...]. Data collection tools included a questionnaire and observational- interviewing checklist about preventive behaviors. The Pretest phase was performed in two groups during 3 meetings. Then, home visit program was performed in experimental group for 4-5 meetings. The duration of each meeting was about 45 minutes for the period of one month and half. Then the post test phase was performed in the two groups, after intervention. According to the results, independent t- test and Chi-squire test indicated that there was no significant difference between experimental group and control group [in demographic variables such as: age, sex, education, ...] before the intervention. The t-test and Chi-square test indicated that there as not any significant differences between experimental and control group [P > 0.05]. Paired t-test and independent t- test indicated that there was a significant difference between before and after intervention about families performance in the experimental group [P < 0.001] compared to the control group. Also Independent t-test indicated that there was a significant difference between experimental group and control group after intervention in some preventive behaviors regarding Cutaneous Leishmaniasis [P < 0.001]. According to the findings, it can be claimed that using a designed home visit program could be an effective approach in the promoting of preventive behaviors about Cutaneous Leishmaniasis in the subjects. Moreover the results indicate that home-visit programs seem appropriate strategy for improving families performance in order to prevent Cutaneous Leishmaniasis

Pathology of patient education: a qualitative study

Patient education by nurses can be one of the best strategies for optimum self- care at home. The objective of this study is pathologic study of patient education process and answering to these questions :1- What is the process of patient education? 2- What are the pathogens of correct implementation of patient education? This was a qualitative research with using content analysis method. Sample size included twenty B.S nurses, three MS nurses, ten nurse students and ten hospitalized patients. The setting of the study was schools of Nursing and Midwifery and 2 general hospitals of Arak University of Medical Sciences. Data gathering method was semi - structured interview. Analysis of data was done based on content analysis method. The study Findings showed that factors related to: 1- Curriculum planning, in Schools of Nursing and Midwifery 2- Patient education courses 3- Insufficient attention to nurses conditions 4- Insufficient attention to educational, cultural and habitual needs of patients and their families 5- Educational management 6- Attitude of participants to patient education, were key issues in the process of patient education that was related to inappropriate implementation of patient education in clinical settings. Patient education and nurses' role in this regard were significant factors to be considered. The pathogens which were effective on incorrect implementation of patient education, decrease the quality of care nursing. Applying the new curriculum planning can empower nurses on patient education. Providing in service training for clinical nurses and patient education follow up by clinical and educational managers can lead patient health promotion

Needlestick injuries reporting among clinical nurses

Exposure to blood-borne pathogens by needlestick injuries [NSIs] continues to pose significant risks to healthcare workers [HCW]. The number of contaminated NSIs sustained by HCW primarily due to underreporting, is still unclear. Therefore the objective of this study was to investigate the Needlestick Injuries and the rate of reporting among Clinical Nurses. This cross-sectional study was conducted among nurses in one teaching hospital and one nonteaching hospital in Tehran. To investigate the causes of these injuries 111 nurses with using purposive sampling method, were contributed and voluntarily and anonymously filled in a questionnaire on the demographic and professional characteristics. In this study, data regarding the frequency of contaminated needlestick and the rate of reporting the injuries and the reasons for not reporting such injuries, were collected. According to the findings, 54.1% [n = 60] of the subjects had no contaminated injuries and 45.9% [n = 51] had experienced at least one contaminated NSI in their period of clinical practices. Thirty-four percent of the nurses experienced 58 contaminated needlestick injuries in the past 12 months [Crude Incidence Rate: 0.52 NSI/nurse/year]. Only 36.8% [n=14] of the nurses who had experienced NSIs in the previous year, were reported all exposures to the needlestiks. The reasons for not reporting injuries consisted of dissatisfaction with follow up [33.3%], low probabilities of the infection risk of the injury source [29.2%], to be busy [12.5%], not familiar with reporting process [16.7%] and low perception of risks [8.3%]. This study suggests that the ferequency of NSIs and the rate of underreporting among Iranian nurses are considerable and it needs to be further investigated. Interventions such as continous training of nursing staff about standard reporting protocols and precautions of the post-exposure procedures might improve reporting of such injuries among nurses

Barriers to and support for physical activity in overweight and obese compared with normal weight adolescents

As the prevalence of overweight increases among adolescents, thus factors that may influence children's participation in weight-related health behaviors need to be examied. This study examined barriers to and support for physical activity in overweight and obese adolescents compared with normal weight adolescents. In this cross-sectional study, sample included 279 male students studying in two secondary schools in Tehran. Of all students, 179 [64.2%] were within normal weight range, 49[17.6%] were obese and 51[18.3%] were overweight. A questionnaire comprising demographic characteristics, and barriers to and support for physical activity, and also, a checklist of physical activity within current week were distributed to be filled out by students. Data were analyzed using One-Way ANOVA and Tukey's test. According to finding, adolescents with normal weight had significantly higher moderate and vigorous physical activity than obese adolescents and the time of TV watching were significantly more among overweight and obese adolescents than adolescents with normal weight. Body-related, social and fitness barriers were the most predominant ones among obese adolescents. There was no statistically significant difference between mean score of convenience and resource barriers among different weight groups. Obese adolescents also reported significantly lower levels of adult and peer support for physical activity. Obese adolescents may be particularly vulnerable to body-related, social and fitness barriers to physical activity. Reducing these barriers may be helpful, as physical activity intervention is most relevant for overweight youth. Interventions should be implemented for reducing barriers to physical activity and also enhancing parents and peers support for physical activity among obese adolescents

Survey of predisposing causes of working errors in nursing cares from perspective of nurses and their mangers perspectives

Working errors are inevitable in every profession including health care professions, but in nursing it is of greater importance, because of its inalienable damages to patients. Study of predisposing factors of these errors is the first step to control and decrease errors during nursing care. The purpose of this study was to survey predisposing causes of working errors in nursing cares from perspectives of nurses and their managers and also to examine the importance of different predisposing domains in different wards in year 2007. This research is a descriptive study in which cluster random sampling method was used. Ninety six nurses and nursing managers from 3 selected educational hospitals in Tehran participated in this study. Data were collected by a questionnaire and analyzed by descriptive and inferential statistics. From perspective of nurses and nursing managers, different factors in domains of management, environment, and care and nursing were considered as predisposing factors to nursing errors. Also, there were a statistically significant difference between wards in terms of predisposing causes of working errors [P < 0.001]. Regarding impossibility of absolute suppression of nursing errors, struggle for controlling and decreasing nursing errors depends on using a systematic approach with emphasis on management, environment, care and nursing domains when assessing predisposing factors and planning appropriate intervention

effect of adolescents' participation on drinking water consumption habits in the rural area of Rostam Abad

Water - related diseases are among the most important public health problems in developing countries and providing the people with safe water is a key factor in health promotion. Thus, the present study was conducted to investigate the effect of adolescents' participation on drinking water habits of Rostam Abad village in Bouin Zahra in 2004. This research is a quasi - experimental study with 36 adolescent cases who covered 102 families. At first, training sessions were held for the adolescents and then each of them took charge of a few families [average 3 families] for education and control. Ultimately, the percentage of rural families who used healthy water [chlorinated or boiled] before and after adolescents' participation was compared. To compare the mean consumption of safe water pre and post intervention t - test was used. The results showed that none of the rural families consumed healthy water before intervention. However, 68.8% of the families used healthy water after intervention. Paired t-test showed a significant difference between mean consumption of safe water pre and post intervention [P=0.001]. Adolescent participation affects the index of providing and consumption of healthy water in rural areas. Thus, it is suggested that this approach be applied as a practical means to increase the healthy water consumption in rural areas