[Comparison of occupational stress among female nurses and female members of the medical group in chosen training hospitals in Isfahan]

Introduction: Job stress is one of the most important factors in physical and psychological conditions in workers and reduces their efficiency. Job stress may affect physicians and nurses as major components of the healthcare system and therefore the quality of healthcare might be affected. Moreover, women are a vulnerable group in society. Therefore, this study aimed to compare job stress in female nurses and female members of the medical group in selected educational hospitals

Methods: In this comparative study, 130 nurses and 70 female members of the medical group of the two teaching hospitals of Isfahan city [Alzahra, Noor and Ali Asghar] were randomly recruited. Inclusion criteria included being female, aged between 22 to 50 years, nurses with bachelor's degrees or higher, interns, residents and general practitioners [Specialist physicians are not included in the study]. Data collection tools included hospital stress questionnaire [HSS] and demographic data form. Data analysis was performed using SPSS16 software. Descriptive statistics, Spearman correlation coefficient, Mann-Whitney U and Chi-Square testes were used

Results: the mean stress score was 3.027 +/- 0.453 in female physicians and 2.923 +/- 0.326 in nurses, respectively [p=0.037]. Mean scores of all stress subscales were significantly different in the two groups except for the three subscales of incompetence, role duality and relations with colleagues. In female nurses the biological agents subscale had the highest mean score [4.223 +/- 0.833], while the shift working obtained the highest mean score in the medical group [3.893 +/- 0.951]

Conclusion: This study shows that the mean of overall job stress score were significantly different among female nurses and female physicians. Moreover, mean scores of all stress subscales were significantly different in the two groups except for the subscales of incompetence, role duality and relations with colleagues

[ relationship between sleep quality and quality of life in older adults]

Introduction: Assessing the elders' quality of life [QOL] and its affecting factors such as sleep quality, is a useful method for detecting their health and determining the efficacy of delivered health care. This study aimed to evaluate the association between QOL and sleep quality in elderly people

Methods: This cross-sectional study was conducted on 370 elderly people in Kashan in 2013. Data was collected using a three part questionnaire including: demographics, the European Quality of Life-5 Dimensions [EQ5D] questionnaire and the Pittsburg Sleep Quality Index [PSQI]. Statistical analysis was performed using SPSS software, version 16

Results: The QOL was moderate and poor in more than a fifth of the elderly. The highest mean score of the QOL was in the area of self-care, and the lowest mean score of QOL was in the area of pain and discomfort. Moreover, the sleep quality was poor in 27.8% of the elderly. The Spearman correlation coefficient showed a significant reverse correlation between the PSQI scores and QOL scores in elderly people [p= 0.001, r=-0.489]

Conclusion: This study showed the elderly with higher PSQI scores had lower levels of QOL scores. It seems that lower levels of sleep quality can decrease the elders' QOL. Then, training the elderly people on the sleep quality may lead them to a higher level of QOL

[ effect of massage therapy by a nurse and the patient's companion on the anxiety of male patients hospitalized in CCU: a clinical trial]

Anxiety can change the heart rate and also increase the myocardial oxygen demand and the risk of mortality in patients with heart diseases. This study aims to examine the effects of massage therapy by a nurse or the patient's companion on anxiety of the male patients admitted in coronary care unit. An RCT was conducted on three randomly allocated groups [massage by a nurse, massage by a patient's companion, and control group] of male patients admitted to coronary care units of Kashan's Shahid Beheshti hospital [n=30]. In the intervention groups, total body massage was done for 60 minutes. The third group [control] did not receive any intervention. Data was collected using Spillberger anxiety inventory and was analyzed by SPSS-PC [v.11.5], using independent t-test, paired t test, One-way ANOVA, Tukey test, Chi-square, and Fisher exact test. The mean scores for the Stat and Trait anxiety of the two intervention groups were significantly decreased after the massage therapy sessions [p<0.001]. However, no significant differences were found between the mean scores of stat or trait anxiety of the groups who received massage by a nurse or by the patients' companion [P.0.05]. However, significant differences were found between the mean scores of stat or trait anxiety of the two intervention groups and the control group [P<0.05]. Considering the effect of massage therapy on decreasing the level of anxiety and finding no difference between the effect of massage by nurses and patients' companions, massage therapy by the patients' companions can be used as an anxiolytic method in CCU patients

[Oral care in ICU patients: a review of research evidence]

Considering the importance of oral care in the ICU and the lack of comprehensive protocols for oral care, the present study was conducted to review the available literature on oral care and to present an evidence-based protocol for oral care in ICU patients. Fifty-four full-texts original articles, systematic reviews and metaanalysis papers on mouth care in ICU patients published from 2001 to the end of 2010 in English and indexed in the Pubmed, Ovid, Elsevier, and ProQuest databases were searched by using the relative key-words [e.g. oral care, mouth care, critical care, and intensive care] in the title or abstract and then evaluated. ICU patients are prone to dental plaque and VAP due to conditions such as impaired immunological deficiency, the presence of an endotracheal tube, drug side effects, and difficulty with swallowing food and fluids. Due to the lack of a standard protocol for oral care in ICU, oral cares haven't properly done in ICU wards. Studies have shown that some oral care interventions [e.g. tooth brushing with toothpaste, brushing all surfaces of teeth, tongue and palate, and also the use of chlorhexidine solution] have largely reduced the incidence of VAP in ICU patients. The results revealed that the oral hygiene may reduce the incidence of VAP. Hence assessing patients, implementing mechanical and pharmaceutical interventions are important in oral care and applying the protocol presented in this study can improve the oral health of patients in the ICU

Evaluation of old-age disability and related factors among an Iranian elderly population

Old-age disability has become a public health concern. This study was conducted to evaluate the prevalence of disability and its related factors among the elderly population in Kashan city, Islamic Republic of Iran. A cross-sectional study was conducted on a multistage random sample of 350 elderly people. The World Health Organization Disability Assessment Schedule II was used as the disability measure. Overall, 37.1% had mild ageing disability, 38.6% moderate, 20.0% severe and 4.3% extreme disability. Significant relationships were observed between disability and sex, age, living status, needing help, marital status, urban/rural residence, drug addiction, duration of addiction, employment status, having regular physical activity, level of education, health perception, history of hospitalization in the last year and having multiple diseases. Considering the rapid increase in the aged population in Islamic Republic of Iran, more attention should be paid to the health of elderly people

[Seeking treatment behaviors for acute myocardial infarction symptoms in patients referred to Kashan Shahid Beheshti Hospital 2006-7]

Background: The time spend for prehospital action and the type of seeking treatment behaviors of MI patients are important. The present study was conducted to answer seeking treatment behaviors at patients with myocardial infarction [MI] in Kashan Shahid Beheshti Hospital

Materials and Methods: A cross-sectional case study was conducted on 280 patients with MI during 2006-7. Data were gathered using a questionnaire including 7 questions related to the demographic characteristics of subjects, the time of manifestation of symptoms, the hospitalization history, the initial perception of symptoms, the patient's seeking treatment behaviors and methods using to come to the hospital. The patient's behaviors were categorized in two groups of appropriate and inappropriate

Results: From a total of 280 samples 73.8% were men [mean age: 61.37+/-13.34 years] and 26.4% were female [mean age: 67.21+/-9.97 years]. The most revealed behaviors were rest [42.5%], self medication [34.3%] and calling the Emergency Medical Service [22.85%], using sublingual TNG [20.5%], respectively. Only 107 patients had appropriate seeking treatment behaviors. On the other hand, 60 patients displayed inappropriate treatment behaviors. A combination of appropriate and inappropriate seeking treatment behaviors have also reported by 113 patients

Conclusion: A considerable number of the patients with MI demonstrated inappropriate seeking treatment behavior. Public education would be helpful to reduce the prevalence of the inappropriate behaviors

[Nurses perception of professional support]

Background: Professional support has frequently been mentioned as one of the basic prerequisite for nurses' job satisfaction and, creativity and quality in nursing care. However, perception of a professional support to this job has not been studied adequately. The present study was made to clarify the concept and the process to professional support in nursing

Materials and Methods: this qualitative study was conducted using the grounded theory method during 2005-9. The research question was that of what experiences and perceptions the nurses have of the concept of professional support, 29 nurses were interviewed semistructurally in several educational hospitals in Tehran and Kashan. Data were analyzed using Straus and Corbin's method

Results: Seven categories were emerged from data including the concept of support, feeling of being sheltrles, decreased self-confidence, decreased quality of care, avoidance, decreased professional unity and legitimate support. Participants defined professional support as any material or spiritual backing to strengthen their capabilities in nursing care. They believed that professional support increases capabilities of nurses to make clinical decisions. However, feeling to be unsupported made them to be indifferent, low in self-expression, distrusted them to their managers, powerlessness and shortcoming in conflicts. Lack of legitimate support decreases the nurses' decision-making power and made them to avoid of autonomous intervention. Nurse managers had also a sense of lacking legitimate support

Conclusions: Although, the professional support enable nurses to offer a good care for their clients, however, sometimes they feel left unsupported. Developing the legitimate support may decrease the nurses feeling of being unsupported

[ severity of old age disability and its related factors]

Background: although the assessment of old age disability and its related factors can help us to plan programs to support the elderly people and prevent the disability of this group, such studies were mostly conducted in developing countries. This study was designed to evaluate the severity of disability and its related factors among the elderly population in Kashan, Iran during 2006-7

Materials and Methods: a cross-sectional analytical study was conducted on a two-stage clustered sample of 350 elderly cases in Kashan [65 years and older]. The data collection tools were demographic and also WHO-DAS-II questionnaires. Chi-square, Fisher Exact test, Spearman correlation coefficient and ANCOVA were used to analyze the data

Results: among the studied samples, 75.7% had no or low level disability and only 4.3% had sever one. A Significant relationship was observed between disability and variables such as sex, need to help, place of residency, addiction, regular physical activity, marriage, level of education, lifestyle and previous job. In addition, a positive correlation was observed between disability and sex. Among the variables studied, gender, marriage, need to help, place of residency, regular physical activity and previous job had the most significant correlation with disability

Conclusions: the severity of studied population disability was lower than that in the other countries. Considering the more prevalence of disability among females, the findings indicate the necessity of paying more attention to the elderly population, especially the female one

Factors influencing evidence-based nursing: a qualitative study

Nursing profession efforts is to establish the practice on evidence-based research. There has been a wide gap between the practice-based nursing and research-based nursing evidence in Iran. However, there is lack of research on the factors influencing evidence-based nursing and its barriers in Iran. This study was conducted to investigate the factors as facilitators and inhibitors of Evidence Based Nursing [EBN]. Grounded theory methodology was used for analyzing the participants' experiences and their viewpoints regarding Evidence-Based Nursing and the related factors. Semi-structured interviews and observation were conducted in the hospitals of Kashan University of Medical Sciences to gather the data until data saturation. Constant comparative analysis method was used to analyze the data. Twenty one participants including nurses, head nurses, matrons and nurse educators were interviewed. The mean of the participants' occupation service experience was 4.71-9.9 years. Two main categories emerged from the data; as [the meaning of EBN,] and [factors affecting EBN.] From the participants' perspective, EBN was defined as [caring the patients based on the nurse's professional knowledge to respond the patients' needs instead of physicians orders.] The second category consisted of six subcategories including [possessing professional knowledge and skills,] [time availability and opportunity,] [become accustomed to,] [self-confidence,] [the process of nursing education,] and [the work environment.]. Although the nurses professional knowledge, self-confidence and the process of their education influence on the manner of nurses functioning, however, the work environment and its induced expectations were emerged as the most important variables affecting EBN. Although professional knowledge and self-confidence of the nurses with the process of nursing education system influence on nursing care quality; but the work environment and its induced expectations, are the most important factors that influence on evidence-based nursing. Therefore, it is necessary to modify the work environment and the nursing education system to develop an organizational personal expectations for creating an opportunity of caring based on the best research-based professional knowledge