[Nurses' knowledge regarding evidence-based guidelines for preventing ventilator-associated pneumonia]

Introduction: Ventilator-associated pneumonia [VAP] is a subset of hospital infections occurring 24 hours after intubation or mechanical ventilation. Considering the outcome of VAP, prevention is of a high importance in the care of patients who are being treated by mechanical ventilation. Thus, evidence-based guidelines have been published by researchers to prevent ventilator-associated pneumonia and can effectively reduce its incidence

Objective: The purpose of this study was to review the knowledge on these evidence-based guidelines in prevention of ventilator-associated pneumonia

Method: This is a descriptive -analytical, cross-sectional study which used census sampling method. 171 nurses with bachelor and master degree participated in the study. To determine their knowledge of evidence-based guidelines for prevention of ventilator-associated pneumonia, a two-part questionnaire was used. The first part included demographic information including age, sex, nursing position title, university degree, working experience and years in the intensive care unit as well as ICU specifications such as type and number of beds and internet access. The second part had Labeau et al. questionnaire that consisted of 9 multiple-choice questions. Questionnaires were given to the participants during morning, afternoon and night shifts by a researcher in each ward. The response time was 15 minutes. After collecting the questionnaires, correct responses were calculated in percentage and the mean of total score was determined. In this study, evaluations and judgments were based on the mean of score. In order to analyze the data, descriptive statistics were used to estimate the frequency. Chi-square, t-test and ANOVA were used to examine the relationship between level of knowledge, demographic variables and characteristics of intensive care unit

Results: 171 of 219 ICU nurses participated in this study and 48 patients were excluded due to vaccation at the time of sampling or unwillingness. Most of the study population was women [93.6%] with a Bachelor's Degree [94.7%] and nurse position title [89.5%].In this study, 59.9% of the nurses had not passed any ICU-specific training course. 42.7% of them were in ICU with more than 8 beds. The majority of them [40.4%] had between 1-5 years of working experience. Furthermore, the mean score of nine one-score questions equaled 4.63 +/- 1.708. The most wrong answers belonged to the questions about "ventilator set's replacement frequency" and "the moisturizer's replacement period". The most correct answers were about "choosing a semi-sitting position for reducing VAP". Mean of scores obtained by women was higher than men. The independent t-test showed no significant difference between the two groups [P=0.721]. The mean score was higher in nurses with master degree and the ones who had passed specific ICU nursing courses than the ones who did not. Independent t-test manifested no significant difference [P=0.189, P=0.204] in this regard. Among the participants who had replacement nurse position, nurses working in ICUs with more than 8 beds and nurses with more than 10 years of experience had a higher mean score. Yet, ANOVA showed no significant difference among these groups [P =0.168, P=0.882, P=0.327]

Conclusion: This results in more attention to training purposes in some parts of the guidelines. Lack of nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia is one of the potential barriers and increasing the awareness level will be the first step in a successful training program. The findings seem to highlight the importance of specific parts of the guidelines that should be considered in trainings. Lack of nurses' knowledge of evidence-based guidelines for preventing ventilator-associated pneumonia is one of the potential barriers. Increasing their awareness will be the first step for a successful training program on VAP prevention

[Status of self- care ability of patients with Rheumatoid Arthritis]

Introduction: today medical world is facing the increase of chronic diseases. Rheumatoid Arthritis as a chronic disease causes pain, fatigue, limited mobility and daily activity, physical function disorder and disability. An important part of controlling chronic illnesses such as rheumatoid arthritis is enabling patients to conduct self-care and adjusting to condition of chronic disease

Objective: present study aims to determine self-care ability of patients with rheumatoid arthritis

Methods: this is a cross sectional descriptive study which surveyed the level of self-care of 326 patients with rheumatoid arthritis referring to Rheumatology clinic of Razi educational center in Rasht. Data were collected using Health Assessment Questionnaire in order to determine the disability rate and Self-Care Inventory in order to determine the Self-Care ability rate through interview. Data were analyzed by descriptive and analytical statistical tests [Kruskal Wallis, Mann Whitney and Multiple linear regressions]

Results: the mean self-care ability of patients was 57.65+/-2.32 which was at a good level. Sex [P<0.0016]], age [P<0.001] marital status [P<0.001], education [P<0.001], jobs [P<0.001], income [P<0.004], duration of illness [P<0.000] and co morbidities [P<0.001] were significantly associated with self-care ability

Conclusion: study findings indicate that baseline factors are effective in controlling rheumatoid arthritis disease; therefore it is necessary for nurses to determine self-care needs considering effective related factors to develop and implement training programs in order to improve patients' empowerment

[Assessment of psychometric properties [validity and reliability] of safety climate questionnaire: factor analysis application]

Safety climate has shown its ability to predict important safety results, such as perceived risk, accidents and injuries. It is important to understand the psychometric properties of instruments used to measure safety climate before they are used in the setting of factories and workplaces. We explore the reliability and validity of safety climate questionnaire in Qazvin industries. Furthermore, correlations between accident rate and safety climate factors were explored. A study using a questionnaire was conducted on 380 employees in eight major companies in Qazvin, Iran. A 43-item safety climate questionnaire was developed after a scientific literature review and consultation with safety experts. Seventy five percent of the data gathered were subjected to principal component factor analysis with varimax rotation, using SPSS software. The remaining data [25%] applied for running confirmatory factor analysis using the AMOS 16.0 structural equation modeling program. Explanatory factor analysis displayed 8 factors with together explained 68.46% of the total variance. Cronbach Alpha [Internal consistency] across items in each of the 8 factors and the total scale were found acceptable. A 37 item questionnaire measuring safety climate was extracted from the original 43 items. Finding of confirmatory factor analysis was revealed to be a satisfactory fit index [CFI=0.91, TLI=0.93, RMSEA=0.044, Chi[2]/df =3.41]. The safety climate score calculated were found to have significant negative correlation with self-reported accident rates showing good predictive validity. One way ANOVA results display that the companies' mean safety climate scores vary significantly from each other indication that companies have different safety climate levels. The Safety Climate Questionnaire demonstrated good psychometric properties. This study has recognized Management commitment for safety and safety priority in workplace, employees knowledge and compliance from safety rules, employees attitude toward safety, workers participation and commitment to safety, safeness of work environment, and emergency preparedness in the organization, priority for safety over production and risk justification as the 8 safety climate factors in the Qazvin industries. This study provides benchmark scores for each safety climate factor with which organizations or even individual departments can be compared based on factor scores

[Measurement of the components of community-based rehabilitation [CBR]: a factor analysis]

Community-based rehabilitation is a strategy that can help satisfy the needs of people with disabilities within the community in every nation. Measurement of the components effective on the community-based rehabilitation in Iran. This descriptive, analytical and cross-sectional study was performed in two stages in 2011. The owners of qualitative step were 45 expert and factor analysis step were 564 CBR experts CBR responsible expert rehabilitation authorities of 31 provinces CBR experts and rehabilitation assistant of the studied city. Data were collected by a developed questionnaire. The validity of its content was assessed as Expert panel and their credit structures by exploratory factor analysis [main component analysis] using alpha internal parallelism of Coranbach. For adequacy of sample size Keiser Mayer Olkin scal and for suitable data, Bartlett test were used. In exploratory factor analysis we identified 7 acceptable factors with special values more than1and total variance of%61/84. 54 items with acceptable factor load[more than 0/4] were under this 7 factors. These 54 items are considered as effective factors on community-based rehabilitation and finding trust step for all 7 factors with respective items achieved appropriate reliability coefficient [greater than%0/84]. The use of semi-professional [expert community], social and political support, educational services, financial supply, health services, medical services and social integration of the disabled people, approperiate for cultural, economic, political and social contexts of our country can empower the disabled people, promote human dignity of them and their families in the community

[Family system and its effect's on HIV/AIDS high risk behaviors: a qualitative study]

The statistics of HIV/AIDS patients are increasing in the world and Iran. Since previous studies indicated that family structure and communication had an important role in high risk behaviors engagement, Assessing role of family system in high risk behaviors would be help to explore solving problem and prventing high risk behaviors. To determine the effect of family on high risk behaviors. This thematic analysis study with qualitative approach was done during 10 months in Behavioral Counseling Clinic of Imam Khomeini Hospital and West Clinic in Tehran. The participated patient were selected by purposeful sampling and data was obtained from in dept and semi-structured interview with open end questions. Total interview was recorded and typed word to word. For analysies the results review of transcripts, themes gained from data and coded categorized were done. Among 61 HIV/AIDS patients 45cases were HIV positive and 16 cases were AIDS patients with range age 21-42 years old with average age of 29.7 +/- 4.86. There were 62.3% males and 37.7 were females. Majority of them was single with secondary and high school educational level. Themes consisted of: 1- defect in family function 2- vulnareble structure of family 3- risky family norms. This study showed that core variable was inadequate support of family. Then increasing support of family in adolescents and family base intervention can reduce high risk baheviors and HIV/AIDS incidence

Prediction of exercise behavior among college students based on transtheoretical model and self-determination theory using path analysis

Despite of many benefits of exercise behavior and active lifestyle, lack of physical activity is a health problem in the community. A key issue in exercise behavior research is identifying psychological variables influencing exercise behavior based on health education models. In light of the complex and dynamic nature of physical activity behavior change, it seems unlikely that a single theoretical approach can truly capture its. In our country, especially among college students, this kind of research has been seriously neglected as a research topic. Prediction of psychological constructs influence on exercise behavior among college students based on transtheoretical model and self-determination theory using path analysis. This study is a cross-sectional study in which 418 first year students of Guilan University of medical sciences completed the valid transtheoretical model, self-determination theory and exercise behavior questionnaire. Data were analyzed by SPSS 16 and LISREL 8.80 using correlation tests and path analysis. All constructs of transtheoretical model and self-determination theory [except external regulation] have significant relationship with exercise behavior. Processes of change [behavioral strategy], self-efficacy in exercise were 0.49 and 0.20 had path coefficient respectively with stage of change as a mediator .Autonomy and processes of change were 0.28 and 0.26 had path coefficient respectively with relative autonomy index. Stage of change as a mediator accounted for 61% of the variance and relative automy index accounted for 48% of the variance in current exercise behavior. The model accounted for 60% of the variance in current exercise behavior. Our findings support the application of combine transtheoretical model with self-determination theory in exercise behavior changes in students

[Effectiveness of an ergonomic education to modify of body posture, ergonomic risk factors and musculoskeletal pain severity in computer users]

Use of computers with disregard ergonomics may lead to health problems, long-term discomfort and physical disabilities and lose workdays. To assess the effectiveness of an ergonomic education to modify of body posture, ergonomic risk factors and musculoskeletal pain severity in computer users. In this Quasi-experimental randomized controlled study, computer users were assigned to two groups: case group [n=75] receiving the theory based on intervention by using construct of theory of planned behavior and stage of change, and control group [n =75]. Both groups were evaluated at the beginning of the study and 3 and 6 months later. The following tools were used: the Rapid upper limp Assessment [RULA] method to assess upper-extremity work-related posture, self administrated questionnaire that evaluated TPB constructs, stage of change algorithm, ergonomic risk factors checklist, ergo- knowledge quiz and VAS for assessing musculoskeletal pain severity. The intervention included two program elements: staged matched informative brochure and personalized preventive educational counseling. The intervention group had significantly higher scores than controls in ergo-knowledge, attitudes, perceived behavior control, intention, as well as non natural posture maintenance as goal behavior [P<0.05] Also, finding showed the significant diminish in musculoskeletal pain severity [P<0.05]. At 3 and 6 months follow up, no significant differences were found between the two groups for subjective norms constructs. Intervention couldn't improve RULA risk level to low and very low area [1, 2 level] and only decreased risk exposure to medium level. According to the results preventive ergonomic campaigns would be more successful if educational intervention regarded as a part of multifaceted interventions: analysis and elimination of risk factors, engineering controls and administrative controls

[Study of constraining factors of research from the viewpoint of faculty members in Guilan University of Medical Sciences]

Introduction: Science, research, culture and politics are interdependent. Advent of developments in each of these fields cannot be realized without establishment of the coordinated developments in other fields in a sustainable way. Research is one the key ares in the area of national security. Quality and quantity of scientific products are the most important indicators for national development in the country. At present, there is a great gap between the scientific products of Iran and many other countries in the world. Despite the increased rate of research credits as well as the increased number of investigators in our country, there is no appropriate increase in number of research projects approved by Iranian universities of medical sciences and in number of internationally published articles. Thus, we attempted to investigate the deterrent factors and the constraints for research among the main elements of universities [faculty members]

Objective: This study was carried out to determine the deterrent factors for implementing the research projects from viewpoint of faculty members in Guilan University of Medical Sciences in 2003

Materials and Methods: Present study was carried out in a descriptive method by using a questionnaires developed by Fonk et. al and its validity and reliability was established. The questionnaire was given directly to all faculty members of Guilan University of Medical Sciences [N=28] and finally, 186 people answered. Data were analyzed by statistical software of SPSS and inferential statistics

Results: Examination of results showed that administrative and organizational factors in view of faculty members were the most important deterrent factors for research. The majority of faculty members [76.9%] as assistant- Professor believed that authorities and managers didn't pay attention to the results of applied research while the majority of faculty members as educators [87.6%] believed that there was no strong motivation for research

Conclusion: Research limitations can be eliminated by effective leadership and management in the field of research in universities and by establishment of research facilities and possibilities such as establishing research consultation nucleus and shortened period of time for assessment and improvement of research projects and by reduction of teaching hours and educational duties and by establishing opportunities in the areas of research and by enabling research areas by faculty members