Living with hypertension: a qualitative research

Background: Hypertension affects many aspects of the patients' life. Factors such as attitudes, beliefs and experiences, and social and cultural conditions of patients have effective roles in hypertension treatment process. The aim of this research was to explore perspectives and experiences of patients with hypertension while living with this disease

Methods: This is a qualitative research using content analysis approach. 27 hypertensive patients who referred to hospitals affiliated to Tehran University of Medical Sciences were selected based on purposive sampling, and semi-structured interviews were carried out. Graneheim and Lundman's approach was used for analysis of data and Lincoln and Guba's criteria were used to confirm the trustworthiness of the study's findings

Results: Experiences of the participants were divided into three main categories as follows: [1] disease shadow; [2] dual understanding of the effect of drug therapy consisting of two sub-categories known as ''perceived benefits,'' ''negative consequences''; and [3] facing the disease that includes the two subcategories of ''Compatibility'' and ''Negligence and denial''

Conclusion: Based on the findings, patients with hypertension had experienced many physical, psychological, social, familial and spiritual problems due to the disease and their cultural context. These patients obtained positive experiences following the compatibility with hypertension. Comprehensive planning tailored to the cultural, social context and their beliefs is necessary to solve problems in these patients

Predictors of post-traumatic stress disorder among victims of serious motor vehicle accidents

Background: Compelling evidence has shown that motor vehicle accidents have an enormous impact on mental health. Post-traumatic Stress Disorder [PTSD] is one of the most common psychological consequences in adult survivors of accidents, so it is important to understand the prevalence and predictors of this issue since delay causes damage to crucial daily functioning. This study aimed at investigating the prevalence and predictors of PTSD after motor vehicle accident

Methods: This cross-sectional study was conducted on 528 injured patients six weeks to six months after motor vehicle accident in Imam Reza Clinic of Poursina hospital, Rasht in 2015. Data collection tools were three questionnaires including post-traumatic stress-self report [PSS], Beck Depression Inventory [BDI-II], and the Numeric Rating Scale [NRS] for pain. The data were analyzed in SPSS [Version 19] using Chi-square, Fischer's exact test and multivariate logistic regression. Significance level was considered P

Results: The prevalence of PTSD and depression was 30.49% and 19.89% in participants, respectively. Chi-square test indicated a significant relationship among age [P=0.02], sex [P<0.001], education level [P<0.001], work status [P<0.001] and PTSD. Participants who reported pain [P<0.001] and depression [P<0.001] were more likely to have high score of PTSD than the others. Multivariate logistic regression showed this significance in sex, depression, age, educational status and pain, as constant risk factors in developing PTSD after accident

Conclusion: This study suggests that primary care setting should be readily prompted for diagnosis of these disorders in non-treatment seeking individuals in the community

Psycho-social and mental variables and post-traumatic stress disorder in traffic accident survivors in Northern Iran

Objective: To assess the psycho-social and mental variables associated with post-traumatic stress disorder [PTSD] in a series of Iranian patients

Methods: A total of 528 eligible accident survivors in pre-sampling of a randomized controlled trial targeting PTSD were included in this cross-sectional study. Psycho-social characteristics associated to PTSD were explored in these survivors in an outpatient clinic. They completed the questionnaires via interview between six weeks to six months after accident. Data collection tools were PSS [DSM-V version] for PTSD and BDI-II for depression and a researcher-made questionnaire for psycho-social variables

Results: There was a significant association between PTSD and the following variables; family communication, current depression, return to work, history of death of relatives, witnessed the death, length of amnesia, hospitalization, injured situation, and accident severity. Multivariate logistic regression indicated that some variables were associated with PTSD such as accident severity, [p<0.001], injured situation, [p<0.001], current depression, [p<0.001], RTW [p<0.001], and family communication [p=0.01]

Conclusion: Psychiatric nursing prevention efforts is best directed toward motorcycle depressed drivers with severe accident and poor family communication who do not return to work. Thus, routine assessment of PTSD, depression and psycho-social variables after traffic accidents must be taken into account

Challenges of applying continuing education in Tehran hospital practice as viewed by nurses

Although many planners of professional continuing education programs believe that this type of education positively affects the nurses' performance, the results obtained by conducted research do not confirm such a perspective. In fact, inadequate application of these trainings in clinical practice is among the most challenging areas in nursing practices. Hence, this study was conducted to describe the challenges nurses encounter in order to apply what they have learned during continuing education programs in clinical settings of TUMS hospitals. This cross-sectional study was conducted on 400 medical-surgical nurses who worked in the hospitals of Tehran University of Medical sciences. For sampling, after listing all the general hospitals, their wards were selected in proportion to hospital. Nurses filled out a questionnaire about factors affecting the application of continuing education. The questionnaire contained 43 items and the dimensions were supportive-organizational, individual, professional, and educational program design factors. The analysis was carried out using parametric and non-parametric method using SPSS 16 package. The results showed while 48.5% and 53.8% of nurses mentioned organizational and professional factors, respectively as the most inhibiting factors; only 2.25% of the nurses believed that organizational factors are facilitating. The results obtained in this study are important regarding the fact that organizational and professional factors have a key role in applying or lack of application of learned materials. Thus, hospital authorities as well as nursing managers can provide the necessary condition in application of continuing education through promotion of facilitating factors and eliminating the hindering ones

[Efficiency of staff development program and its relationship with nurse's profesional competency]

Introduction: skilled nurses are needed to achieve health promotion strategies, so operation and assessment via staff development program is essential

Objective: the purpose of this study was to evaluate staff development program through west Mazandaran hospital nurses and its relationship with the level of their professional competency

Methods: this study was descriptive - correlations in 205 nurses from general ward who were selected by cluster sampling. Data was collected by two questionnaires for competency level and staff development programs. Face and content validity was approved and reliability of the instrument was assessed by the internal consistency. Analysis of variance and chi-square tests were used to analyze data

Results: the majority of samples reported their competent level as ideal [75/6%], and the effectiveness of the program estimated as average [80/5%]. variance analysis of data showed there are no significant difference in the mean scores of survey instrument staff development, among the nurses with varying levels of competence [p =0/4, df =2]

Conclusion: organizations spend enormous amounts of money to improve development programs. If these programs loss their effectiveness, it is time consuming and will damage the economy. These results could be useful for nursing organization and executives

level of depression and assertiveness among nursing students

Nursing students are susceptible to a higher risk of depression. Recognition of depression, assertiveness and the relationship between them is important since if a relationship exists, probably enhancing the level of assertiveness can reduce depression in this high risk group. We aimed to investigate depression and assertiveness levels and the relationship between them in nursing students of Tehran University of Medical Sciences. The target population of this cross-sectional study was bachelor nursing students of Tehran University of Medical Sciences, as the largest and one of the most prestigious Iranian universities. For selecting samples, the convenience sampling method was used. Having no previous information about classes, the researcher selected the students from the courses held while the researcher was present for sampling at the faculty and studied all the students willing to participate in the study in selected classes. The questionnaire consisted of demographic information, Gambrill and Richey assertion inventory, and Beck's depression inventory. SPSS software, version 16, was used to analyze the data. ANOVA and independent samples t test were used for as appropriated. 55.6% of students indicated average and low levels of assertiveness and 38.7% were suffering from mild to severe depression. Pearson correlation test showed a significant inverse relationship [r=0.314 and P<0.001] between assertiveness and depression. There were significant relationships between depression and interest in the field of study [P=0.001] and between assertiveness and gender [P=0.035]. There was an inverse significant relationship between depression and assertiveness among nursing students. We suggest a cohort study design that can determine the effect of these variables on each other completely

Investigating the effect of clinical governess approach on patients' length of stay in emergency department: an action research study

Over the past decade, clinical governance approach with aims to improve the quality of health services has been proposed in Iran. Considering the obvious problems especially patients' length of stay[LOS] in the emergency departments[EDs]; the present study has been carried out with the purpose of Investigating the effect of clinical governess approach on patients' LOS in the one of the largest medical centers in the country. After the problem was specified by the 17 interviews with employees and managers of the ED; the emergency clinical governance committee was formed by two academic researchers and seven ED staff [key participants] that had the most involvement with the subject of study. The activities of the committee, including planning, acting, observing and reflecting, was organized by using participatory action research approach and action research cycle [Kemmis 1995]. During this time, three formal meetings with key participants were held in 6-month intervals. Monthly records of patients' average LOS and interview with ED staff were used to analyze the findings. The research was completed with two cycles in one year. Committee members took the following actions. As a result, the patients' LOS reduced from 2.68 days to 1.73 days. Make regular patients visits by medical groups especially orthopedists and neurologists; Decision making about patients situation by emergency physicians and transferring patients to the relevant units by bed managers; Refusing to admit elective patients during overcrowding times; to regulate the list of patients requiring ICU by anesthesiologists. Prolonged LOS can be due to various causes and a team approach, which is one of the requirements of clinical governance approach, is needed to manage it. The results showed that the multidisciplinary team could make positive changes and reduce LOS in emergency setting

Relationship between clinical competence and motivation needs of nurses based on the McClelland theory

Nurses' clinical competence is the most important topics of nursing professional influenced by intrinsic motivational factors in addition to external motivational factors. This study is designed to determine the relationship between clinical competence and motivational factors from McClelland's theory of needs that include: need for affiliation, need for achievement and need for power. This descriptive–correlation survey was performed on 200 nurses in three hospitals of Babol University of Medical Sciences, by simple random sampling method. Data collection tools for this study were included: demographic information, motivational needs questionnaire, and clinical competence questionnaire. Among 200 questionnaires distributed, 175 questionnaires were collected, of which 171 questionnaires completed [response rate 87.5%], this number exceeded the number was defined by sample size calculation as based sample [165 participants]. The data after collecting were analyzed, using SPSS, statistical software version 19 with descriptive statistics and Pearson tests, ANOVA test, Scheffe test, and t-test. Based on the results of the survey, there was a significant relationship between clinical competence and the motivation need for affiliation [r = 0.377, P = 0.000], need for achievement [r = 0.291, P = 0.000] and need for power [r = 0.200, P = 0.009]. As well as corresponding selfassessment nurses, need for achievement with the highest mean of 45.27 +/- 6.39 ranked first, need for affiliation with a mean of 44.36 +/- 5.83 ranked second and need for power with a mean of 39.24 +/- 7.19 was ranked third. In addition, the results showed significant differences in clinical nurses competence of hospital "C" with a mean of 115 +/- 14.97 compared with nurses competence of hospital "A" with a mean of 122.55 +/- 11.65 and hospital "B" with a mean of 121.67 +/- 9.57. There is a significant relationship between motivational needs and clinical competence, hence that the strongest relationship had existed between need for affiliation and clinical competence and the weakest relationship had existed between need for power and clinical competence, so more attention by nursing managers is essential to provide appropriate feedback to steer nurses' efforts for improving patients' care

[Relationship between perceptions of organizational culture with patients' safety behavior among nurses in Babol]

Governing organizational culture in hospitals can affect patients' safety through establishment of behavioral norms among nurses. This study aimed to determine the relationship between nurses' perception of organizational culture and their performance about patients' safety. In this cross sectional, descriptive-correlation study, we used stratified sampling method to recruit 250 nurses working in general wards and emergency departments of general hospitals in Babol, 2013. Data were collected through questionnaires and were analyzed using the descriptive and inferential statistic tests including the Pearson test, ANOVA test and T-test in the SPSS. Nurses' perception of organizational culture was [fairly desirable] [54.5%]. Performance of the nurses in the field of patients' safety was [desirable] [88%]. The Pearson test showed that there was a positive and statistically significant correlation between nurses' perception of organizational culture and their performance in the field of patients' safety [P<0.01]. It seems that improving organizational culture in hospitals can enhance nurses' performance in the field of patients' safety

General health status and burnout of the hematopoietic stem cell transplantation nurses in Tehran

Nowadays, it has been found that the mental state of caregivers may have a noticeable effect on both patient and caregivers health. This study was conducted to determine the burnout and general health status of the hematopoietic stem cell transplantation nurses in Tehran, Iran. In a cross-sectional study, burnout and general health status of 65 hematopoietic stem cell transplantation nurses in Tehran were examined. Each subject filled out two questionnaires in 2010: The General Health Questionnaire and the Maslach Burnout Inventory as well as demographic information. The data were gathered after obtaining the participants' agreement to take part in the study. The majority [67.7%] of the nurses had scores lower than the cut off score of the General Health Questionnaire-28. The majority of the nurses were in the low level in terms of emotional exhaustion [50.8%], depersonalization [66.2%], and personal accomplishment [58.5%]. The general health status score of the nurses was positively related to emotional exhaustion and depersonalization scores. However, there was an inverse relationship between health status and personal accomplishment scores. The result of the current study did not have a significant agreement with the general view indicating that working in hematopoietic stem cell transplantation units leads to an increase in burnout levels. Hence, the majority of nurses were in low levels in terms of emotional exhaustion and depersonalization and in good condition in terms of general health status; there is a need for conducting further studies in order to find out the reason behind these differences

[Adherence of family caregivers of patients with stroke to rehabilitation regimen]

Due to physical and mental complications, stroke causes disability in self-care and adherence to rehabilitation in patients. The purpose of this study was to assess the adherence to rehabilitation regimen in family caregivers of patients with stroke. In this cross-sectional study, 180 family caregivers of patients with stroke were recruited to the study using convenience sampling method. The participants were asked to complete demographic sheet and the Adherence-of-Therapeutic-Regime Questionnaires during two months of stroke. Data were statistically analyzed using descriptive and inferential tests in the SPSS-16. Findings indicated that only about 10% of caregivers were in good levels of adherence to the rehabilitation regimen; and about 25% of them were weak. The weaknesses of the adherence were related to rehabilitation of motion, cognitive and emotional deficiencies, and also prevention of respiratory and skin disorders. According to the study, a small number of family caregivers were in appropriate level for adherence to the rehabilitation regimen. The nurses should be able to empower the family caregivers to decrease physical and psychological disorders related to stroke in patients

[A survey of critical care nurses' perceptions of barriers to research utilization, and its relation to some demographic variables]

Introduction: To bridge the gap between scientific evidence and patient care, an in-depth understanding of the barriers is needed. The purpose of this study was to identify barriers of research utilization from the point of view of Zanjan registered and critical care unit's nurses

Methods: Data were collected using the Funk s Evidence Based Practice Barriers Scale. Based on statistics formula sample of study was 64 graduate nurses employed in critical care units of Zanjan Educational Hospitals. Descriptive and inferential statistics [Friedman, Kruskal-wallis, Mann-Whitney U-test] were employed to analyze the data

Results: According to the research results, the first three main barriers to research utilization identified by the respondents were: "Insufficient facilities", "Lack of time to read research", and "Insufficient time on the job to implement new ideas". Nevertheless, no statistically significant difference was found between the demographic variables such as sex, work years, level of education, and position, based on the general scale means

Conclusion: It is highly recommended that the educational hospitals systems need to change for preparation nurses with sufficient facilities and time to read and implement new finding

[Effect of music therapy on physiological pain responses of blood sampling in premature infants]

Premature infants undergo painful and stressful procedures during care and treatment. Nurses can help to reduce shortand long-term effects of pain caused by diagnostic and therapeutic procedures using various methods including music therapy. The aim of this study was to assess the effect of music therapy on physiological pain responses of premature infants during and after blood sampling. This was an experimental study with crossover design conducted on 20 premature infants hospitalized in the intensive care unit of a hospital affiliated to the Tehran University of Medical Sciences for a five months period in 2010-11. Infants were randomly allocated in two groups of experiment and/or control. Each infant was considered as its own control. We assessed the physiological pain responses caused by blood sampling such as heart rate and oxygen saturation level. Infants in the experiment group listened to the Transitions music five minutes before until 10 minutes after the blood sampling. The responses were recorded and reviewed ten minutes before until ten minutes after the blood sampling in both groups and physiological changes were detected. Data were analyzed using ANOVA and Chi-square tests in the SAS and SPSS. Results showed significant difference in heart rate between the experiment and control groups during needle exit [P=0.022]. There was also significant difference in heart rate between experiment and control group in the first 5 minutes of blood sampling [P=0.005]. Results showed that music therapy could reduce some physiological responses of pain during and after blood sampling. Music therapy can be used as a beneficial intervention following painful procedures such as blood sampling in the NICU

Significance of Attending to Instrument Planning and Validation Stages in Nursing Discipline

No abstract available.

Comparison of critical thinking skills in nursing students of semnan and Tehran Universities of Medical Sciences

Today, the promotion of critical thinking skills should be considered as an expected outcome of BSc nursing curriculum. This study was designed to compare the critical thinking skills of nursing students of Semnan University of Medical Sciences with Tehran University of Medical Sciences. In this comparative and descriptive study, 70 and 120 of Yl and Y4 BSc nursing students of Semnan and Tehran Universities [Tehran, Iran and Shaheed Beheshti Universities] were selected respectively using stratified random sampling. The California Critical Thinking Skill Test, form B [CCTST:FB] composed of 34 multiple choice questions was used to assess the critical thinking skills in five areas of analysis, evaluation, inference, inductive and deductive reasoning. Data was then analyzed using t-test and ANOVA. The results showed that the mean and standard deviation of critical thinking scores for semnan and Tehran bachelor students were 12.34 +/- 2.45 and 10.4 +/- 2.75, respectively which were significantly different [t=1.95, p=0.002]. There was a significant difference between critical thinking skills scores of nursing students in different years of study in Semnan [F3, 0=4.28, p= 0.000], But in Tehran Universities, there was only a significant difference between critical thinking skills scores of Yl and Y4 students [t=-2.77, p=0.007]. Bachelor nursing students of Semnan University had a higher score of critical thinking skills compared to their counterparts in Tehran. There was also a significant difference between junior and senior nursing students. Results from this study and of similar works suggest that more attention should be paid to the process of education based on nurturing of critical thinking skills

investigation into the effects of quality improvement method on patients' satisfaction: a semi experimental research in Iran

Today, to increase effectiveness is a Strategy for success of organizations and their viability. In health care organization not only service cost- effectiveness is a major problem for productivity and organizational management but also customer-centred is in first priority. Because of these reasons, most of health organization trend to patient satisfaction for their viability. If complex process implemented for viability without attention to patient satisfaction, this is no success result. The FOCUS PDCA process is a new strategy for effectiveness of service quality. To this reason, the recent research done and its objective is to assess effect of FOCUS PDCA process strategy on patient satisfaction in surgery units of hospitals affiliated to Tehran Medical University. This research is a semi experimental with non- equivalent design. The sample was all of patients who hospitalized in two selected surgery units. Self-report was method of data gathering. Patient satisfaction assessed with questionnaire in pre and posttest. Then manipulation implemented as post-operation care process selected. Modelling and opportunity statement Diagrams prepared and improvement team organized. Flow process, convergences and cause- effect charts used to prepare list of items to be improved. Executive program was written. This include personnel training, standard implementation, election and training of quality control nurses [Q.C Ns], daily QC of caring and providing appropriate feed back to personnel, forming group session for determining corrective actions. Then after 1 month patient satisfaction was assessed. Statistical analysis shows this process increase patient satisfaction and it leads to care effectiveness. The findings of the pre-intervention phase indicated that the satisfaction level had been low in both groups and it is not significantly different in the two groups [P> 0.05]. There was a significant difference before and after following intervention in the case study group [P>0.0001]. FOCUS PDCA is effective method for access to various objectives especially patient satisfaction, it is suggested other researcher assess effects of this strategy for other indexes and total care process effectiveness

[Comparison of nurses and hospitalized adolescents' perceptions about importance and observance of hospitalized adolescents decision making]

Participating in decision making is an important patient's right observance of which by nurses is an essential need of hospitalized adolescents. The aim of this study was to assess and compare nurses and hospitalized adolescents' perceptions about the importance and observance of hospitalized adolescents' decision making. It was a cross sectional study, 175 nurses and 180 hospitalized ill adolescents who had inclusion criteria were selected by convenience sampling, The data were collected using two parallel self-completed questionnaires. Data were analyzed by SPSS software and using Mann-Whitney and Kruskal-Wallis tests. No statistically significant difference was found between nurses' and hospitalized ill adolescents' perceptions of importance and observance of hospitalized adolescents' decision making. In addition, the results showed that, from nurses' point of view, participation in care was the most important item, while adolescents believed that the presence of support person had the most importance. Both nurses and adolescents believed that the presence of support person was mostly observed. According to the findings, from perception of two groups, hospitalized adolescents' decision making is important and moderately respected. Nurses can improve quality of care by recognotion and remove shackles of observance

[Relationship between anxiety and quality of life in students living in dormitories of Tehran University of Medical Sciences]

To assess relationship between anxiety and quality of life in students living in dormitories of Tehran University of Medical Sciences. A sample of two hundred female students who were living in dormitories of Tehran University of Medical Science was studied. Quality of life and anxiety were measured using the WHOQOL and Spilberger's anxiety questionnaires, respectively. A strong, reverse relationship was found between stress level and the quality of life [P<0.05, r= -0.66]. Reducing the stress level in students' life might improve their life quality and consequently help them in their academic progress

[Assessing the quality of work life, productivity of nurses and their relationship]

High quality of work life is known as basic prerequisite of empowering human resources in healthcare system. Nurses' productivity plays an important role in organizations' success. Knowing the correlation between quality of work life and productivity, managers can improve staffs' productivity by promoting nurses' quality of work life. This study aimed at assessing relationships between quality of work life and productivity of nurses. This cross-sectional correlation study was conducted with a random sample of 360 nurses drawn from hospitals affiliated to Tehran University of Medical Sciences. Data were gathered through self-administered questionnaires containing work quality of life questionnaire [45 questions on a likert rating scale] and productivity questionnaire [25 questions on a likert rating scale]. Both questionnaires were developed by the researchers. All statistics were computed using the SPSS software [version 13] with pearson and K square tests. Findings revealed that 31.9% of the nurses considered their productivity level, moderate. 41.9% of them reported their work quality of life at moderate level. Only 10% of them believed that their work quality of life is good. The results demonstrated statistically significant correlation between work quality of life and productivity level of nurses [r=0.357, P<0.001]. Since just 0.1 of nurses reported their productivity and quality of work life good, managers should apply the appropriate strategies to promote nurses' quality of work life and provide the ground for improving the quality of care and productivity of nurses

[Management by objective approach in nursing performance appraisal and its impact on quality of nursing care]

Performance appraisal is one of the most important duties for nursing managers. This will improve the quality of nursing care, and it needs suitable approaches and effective strategies in nursing services. The aim of this study is to determine the impact of performance appraisal using management by objective approach on nursing care quality. This was a quasi-experimental and single-blind study that was carried out in two surgical units of an affiliated hospital of Tehran University of Medical Sciences. 80 patients were selected using a randomized sampling. The quality of nursing care were controlled in both experiment and control units before and after the performance appraisal procedure. The procedure was programmed on the basis of management by objective approach for six months in the experiment unit. In the intervention unit, nursing performance appraisal was done three times and in every time head nurse and supervisors participated in giving feedbacks and recommendations for the nurses. At the end of the intervention, quality of nursing care was assessed in both groups blindly. The results were compared and statistically analyzed. Significant difference was found between quality of nursing care in the experiment and control units [P<0.001]. Quality of nursing care was significantly different before and after intervention in the experiment unit [P=0.009]. Performance appraisal using management by objective approach could increase the quality of nursing care. As a result, using nursing performance appraisal plans according to the basis of MBO could be an effective evaluation way to access the quality of nursing care