per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-09
32
119
1
12
article
Effect of Reminiscence on the Happiness the Retired Elderly Members of the Islamic Republic of Iran Army
A Sheykhi
1
A Navidian
2
R Keykha
3
N Rezaee
4
MS Student in Psychiatric Nursing, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
Professor, Pregnancy Health Research Center, Department of Psychiatric Nursing, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
Lecturer, Community Nursing Research Center, Department of Psychiatric Nursing, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran
Assistant Professor, Community Nursing Research Center, Department of Psychiatric Nursing, School of Nursing and Midwifery, Zahedan University of Medical Sciences, Zahedan, Iran (*Corresponding author) Tel:09153411705 Email: nasrin_rezaee2005@yahoo.com
Background & Aims: Aging is an inevitable biological process, which is associated with physical, psychological, and social changes. Studies have suggested that the retired elderly members of military forces have different life experiences than others, which are reflected in their wellbeing. These experiences may cause the loss of vitality and specifically happiness, which is a essential criterion of mental health. Reminiscence is considered to be a preventive and therapeutic intervention for the elderly, which affects various aspects of their social and mental health. Due to the aging population of Iran and the fact that the majority of the elderly are retired, the present study aimed to assess the impact of reminiscence on the happiness of the retired elderly members of the Islamic Republic of Iran Army (AJA).
Materials & Methods: This quasi-experimental study was conducted in winter 2018 on 90 retired men aged more than 60 years, who referred to the retired AJA personnel center. The participants were divided into two groups of experimental and control (45 subjects per each). The participants were selected via simple random method and assigned to the experimental and control groups by drawing lots. The inclusion criteria were the minimum retirement duration of six months, age of 60-70 years (young-elderly), physical and mental health for participation (as stated by the family members), adequate hearing as reported by the individual, acquiring the minimum score of seven for the cognitive assessment in the abbreviated mental test (AMT) for the screening of cognitive disorders in the elderly, written consent for participation, and living with a spouse. The exclusion criteria were absence of more than one session in the reminiscence intervention, severe family crisis during the study (e.g., loss of a family member), and group intolerance. Considering 95% confidence interval (CI) and 95% test power, the sample size of 34 subjects was determined for each group. Each group was assigned 45 subjects to compensate for the possible data loss, and 90 individuals were selected as the sample population. The experimental group received six sessions of reminiscence twice a week, and the duration of each session was 45-60 minutes at the retired AJA personnel center of Zahedan, Iran. Each session was implemented for 5-8 participants, and each participant was provided an average of 5-7 minutes for each meeting. While the control group received no intervention, a reminiscence session was held for these individuals at the posttest. Data were collected using a self-report questionnaire, which consisted of three sections. The first section included the personal data of the elderly individuals on age, education level, retirement period, number of children, and post-retirement employment. The second and third sections were the Oxford happiness questionnaire and AMT for the screening of cognitive disorders in the elderly. The questionnaires were completed on the first day before the intervention and two months after the reminiscence sessions at the posttest. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, percentage, mean, standard deviation, range) and inferential statistics (paired and independent t-test, Chi-square).
Results: The mean age of the participants in the experimental and control groups was 68 years, and all the subjects were married and had children. More than 57% of the subjects in the experimental group had a post-retirement job, and 42% were unemployed after retirement. The mean score of happiness in the experimental group increased from 48.82±3.51 to 56.51±6.14 after the intervention. In addition, the mean score of happiness in the control group increased from 47.66±6.99 to 49.68±7.96 after the reminiscence sessions. The mean score of happiness in the experimental and control groups was 7.68±5.43 and 2.02±6.70, respectively. The independent t-test indicated a significant difference in the happiness score of the study groups after the intervention (P=0.0001), and the mean score range of happiness was considered significant in both groups (P=0.0001). Additionally, the paired t-test showed a significant difference in the mean score of happiness between the experimental (P=0.0001) and control groups (P=0.04) before and after the intervention.
Conclusion: This study confirmed the positive impact of group reminiscence therapy on the happiness of the retired elderly. Since the elderly are fond of expressing memories, it is possible to use the therapeutic aspects of reminiscence to promote their vitality and mental health. Reminiscence is an appealing, simple, and inexpensive intervention, which could be employed to reduce the anxiety and stress of the elderly in various communities. According to this study, the level of happiness increased in the control group regardless of the intervention, suggesting that attention to the elderly replaced their passive state with an active and happy disposition. Therefore, such interventions are recommended in nursing homes and geriatric wards to create a congenial atmosphere. One of the limitations of this study was the physical health condition of the elderly, which occasionally caused their later arrival at the intervention sessions. In some cases, the relatives who were interested in accompanying their elders were allowed to attend the sessions as well. Another limitation was the experiences of war as the majority of the subjects tended to express unsettling memories (e.g., martyrdom of their friends), which created a gloomy atmosphere in the sessions. Therefore, it is advised that further investigations in this regard address the gradual impact and persistence of memories on the elderly in the form of longitudinal studies.
http://ijn.iums.ac.ir/article-1-2937-en.pdf
Reminiscence
Happiness
Elderly
Retirement
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-09
32
119
13
25
article
Effectiveness of a Group Educational Program on the Knowledge, Attitude, and Participation Approach of Mothers in the Sex Education of Preschool Children
H Fatehi Pouladi
1
M Akbari Kamrani
2
M Javad Noori
3
M Farid
4
Student Research Committee, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
Assistant Professor, Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran Tel: (+26) 34483105 Email: Dr.akbarikamrani@abzums.ac.ir
Associate Professor, Ahvaz University of Medical Sciences, Ahvaz, Iran
Assistant Professor, Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
Background & Aim: preschool students are vulnerable to sexual abuse due to not being taught the proper anatomical names for their body parts. Sex education reduces child sexual abuse if provided based on age and cultural conditions and presenting accurate and appropriate information about body parts and functions of each of them. On the other hand, education by knowledgeable parents will lead to both successful training and increased self-confidence in children. Therefore, parents, especially mothers, play a pivotal role in the sex education of children, which shows the necessity of sex education by parents. The present study aimed to assess the effectiveness of a group educational program on the knowledge, attitude, and participation approach of mothers in the sex education of preschool children.
Materials and Methods: This randomized, controlled, parallel clinical trial was conducted on 58 mothers with children aged 3-7 years employed at Alborz University of Medical Sciences in Karaj, Iran during May-September 2018. The inclusion criteria were being an employee at Alborz University of Medical Sciences, being a mother (or a guardian) of a child, being literate, literacy in Farsi language, and lack of attending child sex education courses in the past six months. On the other hand, the exclusion criteria were unwillingness to participate in the study and lack of participation in training sessions. Data were collected using a demographic form (nine items: child’s gender, child’s age, the birth rank of the child, number of children, maternal marital status and level of education, and paternal marital status and level of education) and a researcher-made questionnaire with three sections on maternal knowledge, attitude, and participation in the sex education of preschool children. The items of researcher-made tools were extracted from resources and related tools in the specialized field of preschool sexual education and based on the opinion of experts. In six-nine-member groups, the participants in the intervention group received three training sessions (90 minutes each) with 10-day intervals. In the intervention group, group education of mothers was carried out by a trained midwife under the supervision of a team of reproductive health professionals using methods such as brainstorming, one-on-one expression of experiences, animation, and summarizing similar problems of mothers in the field of child sex education. Finally, active learning was done in groups. The content of the sessions was, as follows: In the first session, the importance of the mother’s role in sex education of children was emphasized and the topics include the concept of sex education, teaching the right techniques of communication with children, familiarization with physiology and sexual behaviors of children. In the second session, the main topics were common questions of children, evaluation of various child sex education methods used by parents, enlightenment and confronting irrational and superstitious thoughts, and evaluation of mothers’ viewpoints. In the third session, the researchers focused on the education of skills to cope with and respond to curiosities and sexual behaviors and questions of children. In order to complete the discussed topics, an educational booklet was given to the members of the intervention group, and during the training sessions, reminders about completing the educational content were done with the help of cyberspace, SMS, and telephone calls for mothers. In addition, the researchers attempted to answer any questions raised by mothers. In order to observe ethics in research, an educational booklet was provided to the participants in the control group at the end of the study, and a workshop was held by the researcher to answer any questions in this area. The participants filled the questionnaires before and one month after the research. Moreover, data analysis was performed in SPSS version 16 using descriptive statistics (mean, standard deviation, and frequency) and analytical tests such as paired and t-tests, Chi-square, and its non-parametric equivalents (Mann-Whitney U and Wilcoxon test).
Results: In this study, there was no significant difference between the intervention (32.28±3.71) and control (35.16±4.55) groups regarding maternal age (P=0.690). The difference between the groups was assessed using Chi-square. According to the results, there was no significant difference between the groups regarding the age range of child, child’s gender, number of children, child’s birth rank, marital status, marital level of education, parental level of education, and parental occupational status. The results of the Mann-Whitney U test indicated a significant difference between the intervention and control groups in terms of the mean score of maternal knowledge of the sex education of children after the educational program (P=0.007). The results were also indicative of a significant difference between the mean knowledge score of mothers in the intervention group before and after the intervention (P=0.002). In addition, the results of the independent t-test denoted a significant difference between the intervention and control groups in terms of the mean attitude score of mothers after the training (P=0.007). in addition, the mean attitude score of mothers significantly increased after education in the intervention group. In this regard, the mean attitude score of mothers increased by 6.28 after training (P=0.003). Moreover, the results of the paired t-test showed a significant difference in the mean score of the maternal participation approach in the two groups before and after the intervention as the score increased after the educational program (P=0.0001; t(24)=8.440).
Conclusion: According to the results, the mothers reported more participation in the sex education of their children after the educational intervention. In order to increase the participation of mothers in sex education of their three to the seven-year-old child, it is recommended to use group education based on knowledge in a stress-free environment. Therefore, it is recommended that seminars, workshops, and counseling sessions be provided for parents, as well as caregivers in child care centers. The need to attend these classes as ongoing retraining is inevitable to promote the participation of women who will become mothers in the near future concerned about the sexual development of their children. Attending these courses helps women provide a healthy sexual life in childhood, sexual health in a future life for their child, and maintain the foundation of the family. Since both parents and primary caregivers of the child play an important role in their sexual education, the lack of study of fathers was a limitation of this study. Therefore, it is suggested that fathers and caregivers be trained in similar studies.
http://ijn.iums.ac.ir/article-1-2947-en.pdf
Knowledge
Attitude
Participation
Preschool Child
Sex Education
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-09
32
119
26
40
article
Evaluation of the Relationship between Self-care Behaviors and Anxiety, Family Support and Disease State in Patients with Heart Failure and Type II Diabetes Mellitus Admitted to Chamran Teaching Health Center in Isfahan, Iran in 2018
T Najafi Ghezeljeh
1
A Ghasemi
2
M Rasouli
3
M Garak Yaraghi
4
Associate Professor, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
MS in Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel:09376443016 Email: atiyeghasemi16@yahoo.com
Assistant Professor, Department of Statistics, Iran University of Medical Sciences, Tehran, Iran
Professor, Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran
Background & Aim: Heart failure is a prevalent, chronic disease in developing countries, and type II diabetes mellitus is considered to be a major cause of heart failure. In addition to increasing atherosclerosis and contributing to hypertension, diabetes changes heart function and structure, which results in heart failure. An effective approach to the control of these diseases is the active participation of patients in self-care since it will improve the participation, satisfaction with treatment, and quality of life of patients while decreasing their anxiety levels. Self-care behaviors are extremely important in patients with chronic diseases since they empower patients in terms of performance and increase their ability to deal with problems and have a healthy lifestyle. However, self-care can be affected by factors related to the patient, community, and environment. These factors can include social support and medical staff care. In patients with heart failure, self-care is often affected by various factors, which can be used to describe and determine this complicated syndrome. However, the concurrence of heart failure and diabetes is associated with complex and difficult self-care behaviors. Therefore, it is essential to identify the influential factors in self-care behaviors. The present study aimed to assess the correlations between self-care behaviors and anxiety, family support, and disease state in patients with heart failure and type II diabetes.
Materials & Methods: This descriptive-correlational study was conducted on 158 patients with heart failure and type II diabetes mellitus referring to Chamran Hospital in Isfahan, Iran in 2018. The patients were selected via continuous sampling, and inclusion criteria were age above 18 years, diagnosis of heart failure by a cardiologist based on echocardiography, lack of experience of acute coronary syndromes in the last three months, and obtaining a score above 10 in mini-mental state examination test (MMSE). Data were collected using the European heart failure self-care behavior scale (EHFSCB), Charlson comorbidity index (CCI), MMSE, Perceived Social Support from Family (PSS-Fa), and Spielberger state-trait anxiety inventory (STAI) on the last day of hospitalization (before discharge). Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, frequency percentage, mean, and standard deviation), inferential statistics (t-test and analysis of variance), Pearson’s correlation (to determine correlation), and Kolmogorov-Smirnov test (to determine the normal distribution of the data).
Results: In this study, 8.2% of the subjects had poor self-care behaviors, whereas 88.6% and 3.2% had moderate and good self-care behaviors, respectively. In this regard, the mean and standard deviation of self-care was reported to be 38.37 and 4.76, respectively, which demonstrated that the mean self-care scores were at a moderate level. According to the results, there was no significant correlation between the demographic and disease characteristics of the patients and self-care behaviors (P>0.05). Moreover, most participants received a disease status score of three-four, and the mean disease status score was estimated at 4.69 ± 1.91. Furthermore, we detected no significant relationship between disease status score and self-care behaviors (P=0.55). According to the results, the majority of subjects (47.5%) had a moderate cognitive performance state and their scores were in the range of 10-20. In addition, the mean cognitive performance score of the subjects was reported to be 19.16 ± 4.82, and no significant association was found between the mentioned variable and self-care behaviors. According to the results of the present study, the highest percentage frequency in the area of obvious anxiety was related to moderate-low anxiety (25.3%). On the other hand, no significant correlation was observed between obvious anxiety and self-care behaviors. Regarding latent anxiety, the highest frequency (29.1%) was related to moderate-high anxiety, and no significant association was observed between hidden anxiety and self-care. Furthermore, the mean family support was estimated at 11.61 ± 5.35, and no significant relationship was found between the foregoing variable and self-care behaviors.
Conclusion: According to the results, the self-care scores of the subjects were at a moderate level, and no significant correlation was observed between demographic and disease variables of the participants and their self-care behaviors. Our findings were also indicative of no significant relationship between disease status and self-care behaviors, and other variables affected self-care behaviors with the exception of other illnesses. We found no relationship between cognitive performance status and self-care behaviors. According to the results, there was no correlation between self-care behaviors and the variables of anxiety and family support. In the present study, a few participants had good self-care behaviors, which requires healthcare team members, especially nurses, to make efforts in the area of patient education and following up the performance of these behaviors in order to reduce mortality rates and treatment costs in this group of patients. In the current research, we found no association between demographic and disease variables, disease status, cognitive performance status, anxiety, and family support with self-care behaviors. Given the fact that self-care is the most important strategy for disease control and the key to successful treatment in patients with heart disease and type 2 diabetes, and since any progress in the treatment depends on the patient’s self-care and treatment outcome management abilities, investigations must continue on the influential factors in self-care behavior in order to change the attitudes of patients in this regard.
http://ijn.iums.ac.ir/article-1-2950-en.pdf
Self-care
Heart Failure
Type II Diabetes Mellitus
Anxiety
Support
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-09
32
119
41
51
article
Perceived Stress and the Contributing Factors in the Elderly with Urinary Incontinence
H Mohammadi
1
F Bastani
2
MS Student in Geriatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Professor, Department of Public Health Nursing and Geriatrics, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: 02143651800 Email: bastani.f@iums.ac.ir
Background & Aim: Recently, lifestyle-related diseases (e.g., chronic diseases) have greatly increased in old age. Cardiovascular diseases, cancers, hypertension, urinary incontinence, hearing loss, musculoskeletal weakness, and mental disorders are highly prevalent among the elderly, imposing certain anxiety and stress on these individuals. Urinary incontinence is a common physical issue in the elderly, which influences their quality of life and causes stress and psychological tension. High stress levels not only affect the quality of life, but also may prevent the use of coping, self-care, and self-efficacy skills and might play a pivotal role in daily life activities and functional independence. Therefore, perceived stress could play a determining role in urinary incontinence as a psychological component. Therefore, there is a need for basic information and a more accurate assessment of this psychological component for accurate planning in order to formulate optimal care interventions in holistic geriatric nursing and provide resident care and support for health promotion and functional capacity increase in the elderly with urinary incontinence and provide educational-counseling strategies to control and manage stress. With this background in mind, the present study aimed to assess perceived stress and the contributing factors in the elderly with urinary incontinence referring to Hasheminejad Hospital in Tehran, Iran in 2017.
Materials & Methods: This cross-sectional, causal-correlational study was conducted on 125 individuals aged 60-74 years with urinary incontinence referring to Hasheminejad Teaching Hospital (urology and urinary incontinence specialty and sub-specialty medical center) in Tehran. The participants were selected via continuous sampling, and the inclusion criteria were being a young elderly (in the range of 60-74 years based on the WHO classification), no urology surgery in the past three months, no history of malignancy of the urogenital system, urinary tract infection and serious psychiatric disorders (based on medical file), and no cognitive diseases (receiving a score of ≥7 in the abbreviated mental test [AMT] test). Data were collected using the AMT, a demographic characteristics questionnaire, and Cohen’s perceived stress scale with acceptable validity and reliability. Data collection was performed during three months via face-to-face interviews (15-20 minutes), and the process continued for three months. A perceived stress scale has been developed to determine the stress of individuals in the face of unpredictable and uncontrollable life events. After completing the demographic characteristics questionnaire and perceived stress scale, each part of the data collection tool was calculated, and data analysis was performed in SPSS version 16 using descriptive statistics (distribution frequency, frequency, mean and standard deviation) and inferential statistics (Scheffe test, analysis of variance, Pearson's correlation coefficient, and linear regression) at the significance level of P<0.05.
Results: The present study was performed on 125 elderlies (58 males and 67 females) with a mean age of 63.92±2.66 years. In terms of the level of education, 12% of the participants were illiterate, whereas 10.4%, 35.2%, 24.8%, 8%, and 9.6% had an elementary school diploma, a junior-high-school diploma, a high-school diploma, and a higher academic degree, respectively. Regarding marital status, 72.8% of the subjects were married while 1.6% and 25.6% were single and divorced or widowed, respectively. The mean and standard deviation of perceived stress in the elderly was estimated at 26.4±61.89, which showed a low stress level. The frequency distribution and percentage of perceived stress in the studied elderly showed that 56.6% of the subjects had low perceived stress and 42.3% had high perceived stress. According to the results, there was a significant relationship between perceived stress and variables of age, level of education, marital status, economic status, and duration of urinary incontinence, in a way that perceived stress was significantly higher in those aged 65 and higher, compared to those below the age of 65 (P<0.001). Moreover, perceived stress was higher in widowed participants, compared to married subjects (P=0.005). Scheffe test results were indicative of higher perceived stress in illiterate elderlies, compared to the other participants (P=0.036). There was also a significant relationship between economic status and perceived stress, meaning that those with unfavorable economic status had higher perceived stress, compared to those with good economic status (P=0.036). In addition, there was a significant relationship between stress of the elderly and urinary incontinence, in a way that stress was higher in those who were dealing with urinary incontinence for more than a year (P<0.001). Therefore, the higher the duration of urinary incontinence in the elderly, the higher their perceived stress. Regression results also showed that perceived stress in the elderly with urinary incontinence for less than one year was 2.84 units lower than in patients with urinary incontinence for more than one year.
Conclusion: According to the results of the study, about half of the participants had high perceived stress levels, and there was a correlation between the mentioned variables and age, level of education, marital status, economic status, and duration of urinary incontinence. In addition, we found a direct significant association between age and perceived stress, meaning that the higher the age of the elderly, the higher their perceived stress. Moreover, stress was significantly higher in the elderly aged 65 years and higher, compared to the elderly aged 60-65 years, and widowed participants experienced significantly higher perceived stress, compared to married subjects. Regarding the level of education, illiterate subjects had higher perceived stress, compared to the other subjects. However, no significant difference was observed at other levels of education. Moreover, those with unfavorable economic status had higher perceived stress levels, compared to those with good economic status. According to the results, stress was higher in the elderly experiencing urinary incontinence for a year or more. Considering that urinary continence affects the daily life of the elderly, planning for the development of community-based nursing interventions, performing educational/counseling strategies for the control and management of stress, and provision of family and social support are recommended in order to enhance the functional capacity of the elderly with urinary incontinence.
http://ijn.iums.ac.ir/article-1-2986-en.pdf
Perceived Stress
Elderly
Urinary Incontinence
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-09
32
119
52
63
article
Patient Safety Culture in Intensive Care Units in the Viewpoint of Nurses in Tehran, Iran
A Salamat
1
J Mohammad Aliha
2
M Mardani Hamooleh
3
E Mohammadnejad
4
SH Haghani
5
MS in Critical Care Nursing, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
Lecturer, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Assistant Professor, Nursing Care Research Center, Department of Psychiatric Nursing, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: 09132864077 Email: mardanimarjan@gmail.com
Assistant Professor, Department of Medical-Surgical Nursing, Tehran University of Medical Sciences, Tehran, Iran
MS. in Biostatistics, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
Background & Aims: Optimal safety culture plays a key role in establishing patient safety. This concept is a subset of organizational culture and defines a set of shared values, attitudes, perceptions, beliefs, and behaviors that support the safe performance of the activities of individuals in healthcare organizations. A key feature of a proper safety culture is that individuals have the support and trust of the organization to freely comment and report on events. The role of managers is particularly important in creating an environment where all the employees could easily express their concerns. Promoting a safety culture could help record and report errors and improve interpersonal communication in the event of an error, thereby maintaining patient safety. Despite the efforts of hospital managers, the clinical errors that threaten the safety of patients are still witnessed in different hospital sections, incurring substantial financial and human costs. These errors are often caused by factors such as heavy workload, fatigue of the hospital staff, high work-related stress, and lack of the time, attention, and focus to perform the tasks that require high accuracy and concentration. In intensive care units (ICUs), patients with critical and life-threatening conditions are cared for under the supervision of the most skilled staff using advanced equipment and facilities. The patients admitted to ICUs need special and advanced care measures, as well as attention and quality care due to their critical, unstable condition. In addition, nurses are faced with the challenges of high work pressure and maintaining safety in order to provide services to the patients admitted to ICUs. Therefore, the patient safety culture is crucial to improving the quality of care and determining the health status of the patients admitted to ICUs. Patient safety in ICUs is a more sensitive issue than other hospital wards. For instance, the possibility of threatening the safety of the patients in ICUs is maximized due to the complexities associated with their condition and treatment process, unconsciousness, and dependence on healthcare providers, as well as the presence of numerous electronic devices. The present study aimed to assess the patient safety culture in the viewpoint of ICU nurses.
Materials & Methods: This descriptive, cross-sectional study was conducted on all the nurses working in the intensive care units (ICUs and CCUs) of the hospitals affiliated to Tehran and Iran universities of medical sciences in 2019. The sample population consisted of 200 nurses who participated in the study via the non-probability method. Data were collected using a demographic form and the safety culture questionnaire. The demographic form contained data on the age, gender, marital status, work experience, and employment status. The content validity method was used to assess the validity of the questionnaire; the questionnaire was provided to five nursing professors, and their corrective comments were applied. In addition, the Cronbach's alpha coefficient was used to confirm the reliability of the questionnaire, which was estimated at 0.82 for the entire questionnaire. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency, percentage, mean, and standard deviation) and inferential statistics (analysis of variance and independent t-test were used to correlate the main variable with the individual variables). In the statistical analysis, the significance level was less than 5%. The study protocol was approved by the Ethics Committee of Iran University of Medical Sciences. To observe ethical considerations, the researcher explained the objectives of the study to the nurses. Furthermore, participation in the study was voluntary, and written consent was obtained from the nurses to conduct the research. The questionnaires were completed by the nurses anonymously, and they were assured of the confidentiality of their personal information.
Results: The mean score of the patient safety culture in the viewpoint of the nurses was 144.33 ± 10.98. Among the dimensions of the patient safety culture, the highest rate of positive responses was observed in 'non-punitive response to error' (67.5%), while the lowest rate belonged to 'supervisor/management expectations and actions promoting patient safety' (28%). Moreover, 60% of the nurses reported no errors during the past year. The majority of the nurses (63%) described their hospital as acceptable in terms of the patient safety culture. The results of the independent t-test were also indicative of a significant correlation between gender as a demographic variable with the patient safety culture (P=0.013).
Conclusion: According to the results, the dimensions that needed improvement in the patient safety culture were 'supervisor/management expectations and actions promoting patient safety', 'periodic questions', and 'reporting of events, and information exchange'. Therefore, in order to improve the performance and expectations of supervisors/managers regarding the enhancement of patient safety, it is imperative for hospital managers to implement training sessions to promote the patient safety culture for supervisors. These sessions could be provided in the form of workshops related to the patient safety culture, held by professors specializing in nursing management. In addition, considering our finding that the studied hospitals had a poor performance in terms of reporting errors and information exchange, it is essential to establish an appropriate and comprehensive system for reporting errors and incidents in hospitals, which leads to the identification of various types of errors and taking the necessary measures to reduce and eliminate these errors. This also indicates that various aspects of the safety culture require improvement in the studied hospitals. According to the obtained results, hospital managers should consider the issues in the hospital regarding the patient safety culture in order to provide the nurses with the opportunity to maintain and promote this culture. Furthermore, providing feedback on error reporting could help nurses learn about the causes of errors in order to reduce the possibility of errors in the future by identifying the preventive approaches. It is also suggested that interventions in the field of promoting the safety culture be implemented in the studied hospitals and further investigations in this regard be conducted to assess the effects of these interventions on the improvement of this category. In terms of nursing education, the results of this study could help nursing managers to raise the awareness of nurses regarding the patient safety culture, along with implementing training workshops and encouraging non-punitive response to error and teamwork for nurses. In these workshops, efforts should be made to clarify the performance and expectations of supervisors about the improvement of patient safety. With respect to clinical nursing, our findings have the message for nurses that whenever they receive non-disciplinary responses to error and their workload increases in the ward mostly in the form of teamwork, the patient safety culture will be promoted.
http://ijn.iums.ac.ir/article-1-2987-en.pdf
Patient Safety Culture
Intensive Care Unit
Nurse
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-09
32
119
64
75
article
The Effect of Breastfeeding Training of Grandmothers on Their Attitude toward Breastfeeding
T Gharaei
1
L Amiri Farahani
2
SH Haghani
3
SB Hasanpoor-Azghady
4
MS Student in Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Assistant Professor, Nursing Care Research Center (NCRC), Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: +98.2143651139 Email: amirifarahani.l@iums.ac.ir
MS. in Biostatistics, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
Assistant Professor, Nursing Care Research Center (NCRC), Department of Reproductive Health and Midwifery, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Background & Aim: Breastfeeding has many benefits for both babies and their mothers, including scoring higher on IQ tests as adults and reduced chance of diabetes type 2, high serum lipid levels, and hypertension in adulthood (for the former), and decreased chance of breast and ovarian cancer, reduced postpartum hemorrhage by causing uterine contractions and reduced anemia (for the latter). Attitude toward breastfeeding is one of the strong predictors of breastfeeding intention, initiation, and continuation. A positive attitude toward breastfeeding leads to more belief about the benefits of breastfeeding. In addition, a person’s attitude toward this issue has a stronger impact on choosing to breastfeed (as a feeding method), compared to other demographic and social factors. Moreover, attitude toward breastfeeding is the first step toward increased breastfeeding duration and amount and can be affected by maternal, cultural, and environmental factors. Several identification factors affect attitude toward breastfeeding positively, which include high maternal age, high socioeconomic status, high level of education, and the decision to breastfeed. On the other hand, return to work was associated with a negative attitude toward breastfeeding. In addition, family members’ beliefs and opinions played an important role in mothers’ decision to breastfeed. Meanwhile, grandmothers are the key to success in breastfeeding since they affect mothers’ intention to initiate and continue breastfeeding using their knowledge and experience. Evaluation of grandmothers’ attitude toward breastfeeding can ensure that feeding with breastmilk is the natural feeding approach. Therefore, the present study aimed to determine the effect of the education of grandmothers on their attitude toward breastfeeding.
Materials and Methods: This was a clinical trial with a pretest-posttest design and a control group, which was performed on 64 maternal grandmothers referred to Amir al Momenin Hospital in Tehran in 2018. Eligible individuals were selected by continuous sampling until the desired number of subjects was achieved. The next stage included the non-random allocation of the participants to the groups. The inclusion criteria were being literate, ability to understand and speak Persian, and gestational age of 31-34 weeks reported for their daughters. The subjects were allocated to two intervention (n=32) and control (n=32) groups weekly. In the intervention group, maternal grandmothers of infants participated in two one-hour breastfeeding training sessions along with their primiparous daughters at gestational ages of 31-34 weeks and 35-37 weeks. However, maternal grandmothers in the control group received no training, and the educational content was provided to these individuals at the end of the training sessions of the intervention group. In this study, the Iowa Infant Feeding Attitude Scale was completed by all participants before and after education, which evaluates attitude toward different feeding approaches in a valid and reliable manner. The items are scored based on a five-point Likert scale from one (completely disagree) to five (completely agree), and the score range was 17-85. In this regard, a higher score was indicative of a positive attitude toward breastfeeding. In addition, data analysis was carried out using descriptive and inferential statistics.
Results: In this study, there was no significant difference between the two groups after the statistical analysis of the participants in terms of demographic characteristics. All grandmothers had breastfeeding experience, and, according to the independent t-test results, there was no significant difference between the groups regarding the mean score of the attitude toward breastfeeding before the intervention (P=0.24). Immediately after the intervention, however, we detected a significant difference between the groups in this regard (P<0.001), in a way that the mean score of the intervention group was higher, compared to the control group. Paired t-test also showed that the mean score of breastfeeding attitude of mothers in the intervention and control groups was significantly higher immediately after the intervention, compared to the beginning of the study (P<0.05). In addition, the mean changes in the control and intervention groups were 0.46 and 12.5, respectively. Moreover, the results were indicative of a higher increase in the score of the intervention group, compared to the control group (P<0.001). In other words, the education of grandmothers significantly improved their attitude toward breastfeeding in the intervention group.
Conclusion: According to the results of the present study, raising grandmothers’ knowledge of breastfeeding led to an improvement in their attitude toward breastfeeding. In addition, grandmothers’ attitude toward breastfeeding more increased in the intervention group immediately after the intervention, compared to the control group. During the training sessions, grandmothers had the chance to share information and experiences and exchange opinions, and ask questions to more effectively understand the topic. After the intervention, some of the participants concluded that they have had false beliefs about breastfeeding, changing their opinions based on the facts presented by the researcher during the training sessions. According to the results, the prenatal breastfeeding training program had a positive effect on mothers' and grandmothers’ attitudes toward breastfeeding immediately and one week after the intervention. Grandmothers have little information about breastfeeding, and some of them have a negative attitude toward breastfeeding or have misconceptions about it. Therefore, it is recommended that breastfeeding training classes be held for these individuals to correct these beliefs. The topics presented to the participants in the intervention group included breastfeeding, breastfeeding misconceptions and correction of these beliefs, which increased the mean score of attitude towards breast milk in the grandmothers of the intervention group, compared to the control group. In addition, maternal grandmothers’ breastfeeding experience was a predictor of their positive attitude toward breastfeeding. Attitudes toward continued breastfeeding depend on family support, and grandmothers are one of the most important sources of maternal support. Grandmothers' participation in prenatal and postpartum breastfeeding training sessions can encourage mothers to breastfeed and correct their breastfeeding attitudes and misconceptions, and create a positive attitude toward breastfeeding and continued breastfeeding for up to two years. The main goal of breastfeeding training for grandmothers is not only to increase their knowledge and information but also to improve their attitude towards breastfeeding.
http://ijn.iums.ac.ir/article-1-2990-en.pdf
Breastfeeding Education
Grandmother
Attitude and Breastfeeding
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-09
32
119
76
86
article
Effects of Coping Style Training on the Treatment Adherence in Adolescents with Congenital Heart Disease
L Shirkavand
1
F Alaee Karahroudy
2
J Mohtashami
3
E Ghasemi
4
MS Pediatric Nursing, Islamic Azad university, Tehran Medical Branch, Tehran, Iran
PhD in Nursing, Assistant Professor, Department of Pediatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: 09122750213 Email: fatemeha71@gmail.com
PhD in Nursing, Associate Professor, Department of Psychiatric Nursing, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
PhD Candidate in Biostatistics, School of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Background & Aims: Congenital heart disease (CHD) is the commonest birth defect worldwide, affecting millions of newborns every year. There is a growing need for proper healthcare services for adults and youth with CHDs, who have had a good childhood. These needs include medical, social, emotional, and functional needs in life. A chronic disease, CHD always imposes limits on the quality of life, especially when they need recurrent and complicated surgeries and have to cope with the physical, social and psychological consequences of illness and problems in various aspects of their quality of life. Most chronic diseases are generally not cured and the goal is to just support the child in passing the acute and critical period of the disease. The adolescent may show the outburst of contradictions in the form of a lack of cooperation with the treatment plan and denying the disease to maintain their similarity with their peers. One of the common problems faced by healthcare staff is the lack of adherence to treatment in patients with chronic diseases, especially those in adolescence and puberty. Poor adherence to treatment is alarming for both patients and healthcare systems. Clinically speaking, lack of proper adherence to treatment reduces its beneficial effects, increases the disease’s symptoms and hospitalization period, and may even cause mortality. Therefore, understanding coping mechanisms can be applied in the prevention and treatment of disorders, and preventive measures that are taken during adolescence and even childhood through teaching various coping strategies can help people face problems. Therefore, the present study aimed to determine the effects of coping style training on treatment adherence in adolescents with congenital heart disease.
Materials & Methods: This experimental study was conducted with a pretest-posttest design and a control group on 70 adolescents aged 9- 19 years with CHD at Shahid Rajaee Heart Center in Tehran, Iran in 2018. The patients were selected via continuous sampling and divided into two groups of intervention and control via simple random sampling. The research tools included a demographic characteristics questionnaire and psychometric properties of the adherence questionnaire in chronic patients. In addition to routine care, the subjects in the intervention group received training based on stress coping styles in the form of educational content. Data were collected using Folkman and Lazarus ways of coping questionnaire, and the control group received routine care within the department. For adolescents who were included in the intervention group, coping techniques and stress reduction techniques were taught by lecturing, group discussion, Q&A, and role-playing and in a cross-sectional manner in four sessions of 1.5 hours with break time and catering was provided from each group. The generalities of the program and Lazarus and Folkman’s model were introduced in the first session, while different coping strategies were covered and explained in the second and third sessions. The fourth session focused on ways to prevent stress. At the end of the education, the adherence questionnaire was completed by both groups again, and the educational package was provided to the control group along with an educational session to cover the content. Data analysis was performed in SPSS version 16 using independent and paired t-test, Chi-square, and Fisher's exact test.
Results: In this study, the mean age of the subjects in the intervention and control groups was 13.42 ± 2.11 and 13.77 ± 2.42 years, respectively. According to the results, no significant difference was observed between the two groups in terms of mean age, gender, birth order, paternal occupational status, maternal occupational status, and level of education. In addition, there was no significant difference between the two groups regarding the mean score of treatment adherence (P=0.175). At the end of the study, the mean score of treatment adherence was significantly higher in the intervention group, compared to the control group (P=0.002). Similarly, the mean scores of making effort for treatment (P=0.03), intention to take the treatment (P<0.001), and commitment to treatment (P<0.001) were significantly higher after education in the intervention group, compared to the control group. Overall, commitment to treatment was significantly higher in the intervention group, compared to the control group (P=0.002). In the intervention group, adherence to treatment, intention to take the treatment, adaptability, and commitment to treatment were significantly higher after the intervention, compared to before the intervention. It is notable that overall adherence to treatment in this group was significantly higher after the intervention, compared to before the intervention. In the control group, adherence to treatment and its dimensions were significantly higher one month after the intervention, compared to before the intervention. The paired t-test results were indicative of a significant difference between the first and second times of treatment regarding the mean score of treatment adherence in the control group, and the scores obtained were significantly higher in the second time of treatment (P<0.001). In the intervention group, there was a significant difference between the mean score of treatment adherence before and after the intervention, and the score was significantly higher at the end of the education (P<0.001).
Conclusion: According to the results, there was a significant difference between the two groups regarding treatment adherence and its dimensions after the intervention. In other words, training strategies to cope with stress increased treatment adherence in adolescents with CHDs. This is due to the fact that education led to the management of stress in adolescents and more attendance in treatment plans. Moreover, since the education of coping strategies improved the adolescents’ emotional style, it could be used as an effective technique in this regard. According to the results, while no intervention was carried out in the control group, the routine training in the ward somehow increased the subjects’ intention to adhere to treatment in this group. The use of coping style training programs in adolescents with chronic diseases, in parallel with routine treatment measures and training appropriate to the age and developmental conditions of adolescents, increases awareness and behavior change and thus increases the level of self-efficacy, adherence to treatment and overcoming treatment complications and threats posed by the disease. It will also increase their self-confidence and ability to adapt to stressful conditions during the illness. Given the results obtained in the present study, it is suggested that teaching coping strategies be considered by healthcare providers in educational and counseling programs to improve treatment adherence in adolescents with CHDs.
http://ijn.iums.ac.ir/article-1-2992-en.pdf
Training
Congenital Heart Diseases
Adolescents
Coping Styles
Adherence to Treatment
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-09
32
119
87
98
article
The Correlation between the Anxiety of the Family Members of the Patients Referring to the Emergency Department and Their Views on the Communication Skills of Nurses
M Seyedoshohadaee
1
M Ahmadi
2
H Haghani
3
Instructor, Nursing Care Research Center, Department in Internal-Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
MS in Emergency Department Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: 09224501760 Email: mina.ahmadi3388@gmail.com
Instructor, Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran
Background & Aims: Emergency departments (EDs) are the most challenging ward concerning patient care. The hospitalization of a family member in the hospital, especially in ED, increases anxiety and psychological problems in other members of the family. Given the emergency patients’ need for immediate and special care, understanding their problems in the ED is crucial to provide favorable services and increase satisfaction in these individuals. Effective communication and intrapersonal skills are the basic principles for the provision of high-quality care. Therefore, establishing effective communication between the healthcare team and family members of the patient is significantly vital to provide safe care and prevent damage to the patient. This is specifically important in stressful hospital wards (e.g., Eds). The way nurses interact with patients and their companions play an important role in the control and management of their anxiety levels. In addition, favorable nurses’ communication with patients and their families could contribute to gathering the required information and proper management of the treatment process. The present study aimed to determine the relationship between the anxiety of emergency patients’ family members with their views on nurses’ communication skills.
Materials & Methods: This was a descriptive, correlational and cross-sectional study performed on 263 family members of patients referring to the Eds of two selected training healthcare centers affiliated with Iran University of Medical Sciences in 2019. The participants were selected by continuous sampling based on the inclusion criteria, which included age above 18 years, being literate, no history of psychological disorders or use of psychiatric medications (based on self-report), and being a first-degree relative (mother, father, sister, brother, child, spouse). The sample size was estimated at 263 to determine the sample size at 95% confidence level and 90% test power assuming that the correlation coefficient between the relationship between the nurse and anxiety in the patients' families was at least 0.2, so that this correlation is considered statistically significant. Data were collected using a demographic characteristics questionnaire (age, gender, level of education, marital status, economic status, occupational status, kinship, insurance status, and triage level), the health care climate questionnaire (HCCQ), and Beck anxiety inventory (BAI). Data analysis was performed in SPSS version 16 using Pearson’s correlation coefficient, analysis of variance, and the Kruskal-Wallis test. In addition, a P-value of 0.05 was considered statistically significant.
Results: In this study, the mean age of the participants was 42.92 ± 11.64 years. In terms of gender, 56.3% of the participants were male and the rest were female. Regarding the level of education, the highest frequency was related to below diploma degrees (40.7%). In addition, poor (48.3%) and moderate (46.8%) economic states had the highest frequency, respectively. The majority of the participants were married (75.3%), and most of the companions were patients’ children (58.2%) and spouse (22.1%). Moreover, 89.4% of the patients had basic insurance coverage. Cardiovascular disease with 44.9% was the most common cause of referral, and the ratio of patients' triage level was almost equal. According to the results, the score of nurses’ communication skills in EDs was reported to be poor from the perspective of patients’ companions (36.74 ± 7.3). In addition, the results obtained from the BAI indicated that most family members (75.3%) had a mild anxiety level, whereas 18% and 6.8% of them had moderate and severe anxiety levels, respectively. Furthermore, the total anxiety score of the companions was estimated at 13.25 ± 14.16, which demonstrated their low anxiety level. Pearson’s correlation coefficient results were indicative of no significant relationship between nurses’ communication skills and their dimensions with anxiety levels in patients’ family members. In addition, the analysis of patients’ family members’ anxiety based on demographic characteristics showed a significant relationship between anxiety and level of education (P=0.039), economic status (P=0.033), and kinship (P=0.001). Moreover, the mean anxiety score was significantly higher in children of patients, compared to spouses (P=0.008). Furthermore, there was a significant relationship between the triage level of patients and the anxiety level of companions of patients (P<0.001). In addition, anxiety was significantly lower in family members of patients with a triage level of three and higher, compared to patients with a triage level of one (P=0.012) and two (P<0.001).
Conclusion: According to the results, nurses had unfavorable communication skills from the perspective of patients’ family members. In addition, a mild anxiety level was observed in most family members of emergency patients. Despite a lack of a significant relationship between the anxiety of family members and their views on nurses’ communication skills, it seems that the poor communication skills of nurses from the perspective of the patient's family member need special attention. As the first service providers that clients encounter, nurses are responsible for the perception of family members of patients about healthcare services. Therefore, it seems necessary to more focus on factors affecting the effective communication between nurses and companions of patients in hospitals. In addition, attempts should be made to remove or reduce communication issues through proper plans and measures. The results of the present study can be used to plan for improving nurses’ communication skills by designing and implementing in-service training or other incentive mechanisms to increase nurses' communication skills as well as managing the anxiety of patients and their companions.
http://ijn.iums.ac.ir/article-1-2993-en.pdf
Anxiety
Family
Emergency Department
Communication Skills
Nurses