per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-12
32
121
1
13
article
Medication Errors in Intensive Care Units in the Viewpoint of Nurses: A Descriptive Study
M Ghanbari Afra
1
J Mohammad Aliha
2
M Mardani Hamooleh
3
L Ghanbari Afra
4
SH Haghani
5
. MS in Critical Care Nursing, Shahid Beheshti Hospital, Qom University of Medical Sciences, Qom, 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
MS in Critical Care Nursing, Kamkar Hospital, Qom University of Medical Sciences, Qom, Iran
MS in Biostatistics, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
Background & Aims: Among healthcare professionals, nurses spend the most time with patients and monitor them throughout the medication process from the time of admission until discharge. Since nurses are responsible for the direct care of patients and participate in their medication process, the risk of medication errors by nurses increases. The process of medication involves prescription, copying the instructions of physicians, medication distribution, delivery of medication to the patient, and medication control. Failure in any of the mentioned stages is referred to as medication error. In the nursing profession, medication errors include the incorrect dosage of medication, elimination of medication, negligence of the symptoms of drug poisoning, and choosing the wrong site for the administration of medication. Medication error is a preventable incident, which could cause damage to the patient if not managed. The patients admitted to intensive care units (ICUs) receive more drugs compared to the patients admitted to other wards. Furthermore, due to drowsiness or unconsciousness, the process of patient identification and monitoring of drug side-effects in these patients is associated with more challenges in these patients. The importance of medication errors is considered in terms of consequences such as increased disabilities, patient dissatisfaction with healthcare systems, increased length of hospital stay, and increased treatment costs. ICU nurses experience higher stress levels due to special working conditions, such as heavy workload, the need to respond quickly to emergency situations, heavy responsibility of the care of critically ill patients, frequent encounters with emotional situations, and being in unwanted and enforced situations for delivering unpleasant news to patients' families. The present study aimed to determine the causes of the incidence of medication errors, their lack of reporting, and their frequency in ICUs.
Materials & Methods: This cross-sectional, descriptive study was conducted on 300 ICU and CCU nurses in three teaching hospitals affiliated to Qom University of Medical Sciences in Qom, Iran in 2019. The subjects were selected via census sampling. Data were collected using a demographic questionnaire to determine the variables of age, gender, marital status, education level, ward of employment, work shift, nursing experience, work experience in the current ward, type of employment, number of overtime hours per month, overtime work in one/more hospitals, other overtime work than nursing, number of the working hours per week, and valid and reliable tool of medication errors. The content validity method was used to assess the validity of the tool, which was provided to five nursing professors at Iran University of Medical Sciences (IUMS), and their corrective comments were applied. The Cronbach's alpha coefficient was also used to measure the reliability of the tool. For this purpose, 15 nurses who matched the research samples and were not members of the research units completed the tool in one turn. Data analysis was performed in SPSS version 21 using descriptive statistics (percentage, frequency, mean, and standard deviation) and inferential statistics (analysis of variance and independent t-test), and the P-value of less than 0.05 was considered significant. The ethics code of the study was IR.IUMS.REC 1397.102. In order to comply with ethical considerations, a written letter of introduction was obtained from IUMS to perform the research at Qom University of Medical Sciences. In addition, the nurses were enrolled after obtaining written consent and were assured of the confidentiality of their responses in the questionnaires without mention.
Results: Systemic errors (mean score: 4.1±1.2) and pharmacy errors (mean score: 2.5±1.1) had the highest and lowest mean scores among the causes of medication errors, respectively. Furthermore, managerial causes with the mean score of 3.8±1 and causes associated with disagreement with the mean score of 2.6±1.1 had the highest and lowest mean scores among the causes of the non-reporting of medication errors, respectively. Intravenous errors (22.56%) had a higher frequency compared to non-intravenous errors (21.89%). Among the demographic variables, significant correlations were observed medications errors with age (P=0.029) and work experience in the current ward (P=0.007) according to the analysis of variance.
Conclusion: According to the results, the highest to lowest mean scores of the causes of medication errors belonged to systemic causes, drug packaging, medical and nursing causes, document registration, and pharmacy causes, respectively. Among the demographic variables, significant correlations were denoted between medication errors, ICU work experience, and age, so that with the increased work experience and age of the nurses, the incidence of medication errors would decrease. It seems that the increased calendar age and working age resulted in their increased dominance over the work environment, so that the incidence of medication errors would decrease. Therefore, it could be stated that knowledge of the influential factors in the incidence of medication errors is essential to the development of proper strategies by nurses to prevent these errors. In this regard, it is critical that special attention be paid by nursing managers to proposing strategies to enhance the knowledge of nurses regarding medication errors in order to reduce these errors through holding clinical management workshops based on the approach of medication errors, accompanied by obtaining points from the continuous education system for nurses. The results of this study indicated that in order to reduce the incidence of errors by nurses, it is necessary to create the conditions to reduce systemic errors in hospitals. In addition, it is imperative for nursing managers to lay the foundations for nurses to report their errors. On the other hand, nursing managers should closely monitor the administration of medications by nurses, especially in the case of intravenous medications. Since the findings of this study were obtained using a questionnaire, the perceptions of nurses toward medication errors could not be assessed in depth. Therefore, it is suggested that studies with a qualitative approach be performed in order to achieve a complete picture of this concept. Furthermore, the results of this study could lay the groundwork for interventional studies to reduce the incidence of medication errors for nurses.
http://ijn.iums.ac.ir/article-1-3033-en.pdf
Medication Errors
Intensive Care Unit
Nurse
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-12
32
121
14
27
article
Analysis of the Education Costs of Nursing and Midwifery Students in the Autonomous Hospitals Affiliated to Iran University of Medical Sciences
T Najafi Ghezeljeh
1
A Rezapour
2
T Sharifi
3
M Soleymani Movahed
4
A Teimourizad
5
Y Yousefi
6
S Mohammadpour
7
Associate Professor, Nursing Care Research Center, Department of Nursing Management, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Associate Professor, Department of Health Economics, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
PhD Candidate in Healthcare Management, School of Health, Tehran University of Medical Sciences, Tehran, Iran
Assistant Professor, Department of Health Economics, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
PhD Candidate in Health Economics, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
MS in Health Economics, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
PhD Candidate in Health Economics, Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: 09371030217 Email: mohammadpour.sa@iums.ac.ir
Background & Aims: Given the clear role of education in the economic development process of countries, the economics of higher education and the move towards realizing costs have been fundamentally changed as one of the pillars of the package of "Moving Towards Third Generation Universities" in the Medical Education Transformation Plan. Estimation and analysis of students’ educational costs can help managers and investors of the education system make more informed decisions by providing information related to the actual performance of activity units. Given the lack of financial resources and budget and the growing increase in costs, the higher education systems have no choice but to adopt new solutions to use resources optimally and manage costs in order to survive and continue favorable activities. In universities of medical sciences affiliated to the ministry of health, a considerable part of students’ education occurs in healthcare centers under the supervision of the universities, which imposes costs on the system. With this background in mind, this study aimed to analyze the educational costs of students of nursing-midwifery school in independent hospitals of Iran University of Medical Sciences.
Materials & Methods: This was a descriptive, cross-sectional research with a retrospective design, which aimed to estimate the direct costs of nursing and midwifery students’ education based on the level of education. The participants were selected by consensus sampling and all educational groups of the nursing and midwifery school of Iran University of Medical Sciences, who had educational activities in independent healthcare training centers of the university, were entered into the study based on the curricula approved by the ministry. The research settings were Shahid Hasheminejad Hospital, Ali Asghar Children Hospital, Iran Psychiatry Hospital, Rasul-e Akram Hospital, Haft Tir Martyrs Hospital, Lolagar Hospital, Shahid Motahari Hospital, Shafa Yahyaian Hospital, Akbarabadi Hospital, Firoozabadi Hospital, and Firoozgar Hospital. The study was carried out in two stages with research, actual and direct cost accounting approach; in the first stage, we conducted a qualitative research to identify the costs of nursing and midwifery students in training hospitals affiliated to Iran University of Medical Sciences. To this end, we interviewed all heads of departments in different fields-grades in the nursing-midwifery school, managers of hospital nursing services, educational supervisors of hospitals, and clinical wards engaged in nursing-midwifery students’ education. After the interviews, the expense headings were determined by applying the content analysis method. Notably, the main variable of the research was the per capita cost of nursing and midwifery students’ training in training hospitals of Iran University of Medical Sciences based on various levels of education. A researcher-made checklist was applied in the second stage to collect information related to hospital expenses. The face validity of the checklist was confirmed by the vice-chancellor for the education of the nursing and midwifery school and educational supervisors of all hospitals. In addition, the reliability of the information collected was confirmed by gathering information related to the consumption of items from two sources, nursing and midwifery students in each degree and clinical head nurses of hospital wards. After collecting data, the kappa coefficient was analyzed to confirm the reliability of the data. In this regard, the kappa coefficient above 0.7 confirmed the reliability of the data in the desired field of study-degree, whereas the coefficients of 0.5-0.7 and below 0.5 were indicative of moderate and low reliability, respectively. A Time-and-motion study was performed to determine the share of students’ use of expense headings. The study tools in the first and second stages were an interview guideline and a checklist, respectively. In addition, since MSc internal-surgical nursing students, MSc emergency nurses, MSc pediatrics nurses, and MSc psychology nurses were obligated to pass internship courses as work shifts in hospitals, the unpaid salaries of these students were considered as implicit hospital income.
Results: In this study, the most important expense heading for training nursing and midwifery students in hospitals was reported to be medical consumables. The highest number of undergraduate students was related to the field of nursing (488) and the master's degree was related to the field of internal surgery nursing (37). In addition, the highest mean age was related to the MSc of neonatal intensive care nursing (36.52) and the highest age standard deviation was related to the MSc of elderly nursing students (17.46). according to the results, the highest per capita cost of student education was related to the field of BSc nursing, whereas the lowest cost was related to BSc midwifery. According to the results, the highest per capita cost of student education in undergraduate midwifery was in Akbarabadi Hospital (1125926) and the lowest level was in undergraduate psychiatric nursing in Ali Asghar Hospital (46154). Moreover, the most important cost heading for students’ education was related to the cost of consumables.
Conclusion: According to the results of the study, the per capita education cost of BSc students was significantly higher than MSc students. Access to the information related to the actual education costs of students in training hospitals can facilitate the analysis of fields and degrees that have a higher cost. By doing so, we can identify the expensive activity centers and reasons for these costs and make proper decisions to decrease the costs. This can help implement a proper cost control procedure. Furthermore, the calculated information can be used for budgeting and planning, especially operational budgeting in the education sector. The information can also create a basis for decision-making about the costs in the future so that the performance of medical universities could be compared based on various educational groups and levels. Given the high education cost of students, it is possible to manage educational costs by creating transparency in educational processes through holding brainstorming sessions between the heads of departments and the officials of the School of Nursing and Midwifery, the educational officials of hospitals and students. According to the managers of educational departments and students, the decreased workload in hospital wards, increase of service providing quality and patient satisfaction due to the presence of students must be considered in the cost calculation. In order to reduce education-related costs, it is recommended that the correct and optimal consumption of consumables as well as insurance laws be taught to students. In addition, it is suggested that briefing sessions be held in addition to clinical discussions in order to heighten awareness about the importance of costs.
http://ijn.iums.ac.ir/article-1-3035-en.pdf
Cost Analysis
Costing
Direct Cost of Services
Autonomous Hospitals
Student Education per Capita
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-12
32
121
28
40
article
The Association of Competence and Critical Thinking in the Nurses in Imam Khomeini Hospital, Affiliated to Tehran University of Medical Sciences, Iran
H Jafari
1
T Taghavi Larijani
2
F Ghadirian
3
HS Emamzadeh Ghasemi
4
PhD Candidate in Nursing, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Associate Professor, Department of Psychiatric Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: 021-66927171 Email: ttaghavi@tums.ac.ir
Assistant Professor, School of Nursing, Khomein University of Medical Sciences, Khomain, Iran
Assistant Professor, Department of Nursing Management, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Background & Aims: The growing sophistication of modern diseases demands a critical level of nursing competence, which could enhance the quality of patient care and patient satisfaction with nurses. Nursing competence is influenced by several factors, such as the clinical environment, work experience, motivation, theoretical knowledge, and personal traits of nurses. In addition, critical thinking could affect the competence of nurses. Critical thinking enables individuals to make decisions and take actions when there are no specific answers, and opposing forces influence decision-making. Critical thinking is a fundamental process for safe, efficient, and skilled nursing in various situations and is also essential to the competence of healthcare professional for the assessment, diagnosis, and effective patient care. Regardless of the correlation of these two variables, competence and critical thinking should be evaluated separately since they are vital to the management, provision, and fulfillment of healthcare services. Therefore, it is possible to ensure the quality of the healthcare services provided to patients by determining the educational needs of nurses and the area that requires improvement. The assessment of these criteria not only assists nurses and managers to be aware of the quality of the competence and critical thinking of nurses, but it also identifies their cognitive deficiencies and weaknesses for their rectification and improvement. Considering the complexity of the assessment of each of the variables of competence and critical thinking and their association in the nurses working in hospitals where many patients with special and complicated conditions refer to, the present study aimed to evaluate the association of competence and critical thinking in the nurses of Imam Khomeini Hospital affiliated to Tehran University of Medical Sciences, Iran.
Materials & Methods: This cross-sectional, descriptive-correlational study was conducted in 2019 on 170 nurses at Imam Khomeini Hospital affiliated to Tehran University of Medical Sciences, who were selected via proportionate stratified sampling. To achieve the research objectives, data were collected using the competency inventory for registered nurses (CIRN) and Ricketts' critical thinking dispositions questionnaire. The inclusion criteria were employment with a bachelor's or higher nursing degree, employment in Imam Khomeini Hospital, work experience of more than one year, no employment in managerial and executive positions, and no apprenticeship. Incomplete questionnaires were excluded from the study. The questionnaires were completed in a self-reported manner. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency distribution, mean, and standard deviation) and analytical statistics, including the analysis of variance (ANOVA), independent t-test, Pearson's correlation-coefficient (r), and Spearman's correlation-coefficient (ρ), Mann-Whitney U test, and Kruskal-Wallis test, at the significance level of 0.05.
Results: The mean age of the nurses (n=170) was 34.38±7.06, and 146 participants (85.9%) were female. The majority of the participants (53.5%) were employed in the public sector and 47.1% had a formal contract. The mean clinical work experience of the nurses was 10.82±6.83 years. In terms of education level, 146 nurses (85.9%) had a bachelor's degree, and the others had a master's degree. The mean total score of competence was 169.74±16.04 (out of 220), which was considered high based on the scoring scale of the instrument. The scores of the subscales of nursing competence were also determined for clinical care (30.18±3.65 out of 40), leadership (27.84±3.24 out of 36), interpersonal communication (24.76±2.57 out of 32), moral/legal performance (25.92±2.43 out of 32), professional progress (18.84±2.33 out of 24), coaching and training (18.51±2.44 out of 24), and willingness for research or critical thinking (23.67±3.19 out of 32). If the scores of the subscales were measured based on four, the maximum and minimum score would be assigned to the subscales of moral/legal performance (3.24±0.30) and willingness for research or critical thinking (2.95±0.39), respectively. The total score of the critical thinking of the nurses was 124.75±12.27 (out of 165), which indicated the high critical thinking performance of the participants. In addition, the scores of the subscales of critical thinking were determined for creativity (27.85±3.28 out of 55), maturity (16.54±3.52 out of 45), and commitment (46.15±5.67 out of 65). A positive, significant correlation was observed between the total scores of nursing competence and critical thinking (r=0.64; P<0.0001). The assessment of the associations of competence and critical thinking with the demographic variables demonstrated no significant correlations between the variables of age, work experience, gender, ward of employment, education level, and employment type with nursing competence. However, the critical thinking of the intensive care unit (ICU) nurses was significantly higher compared to the nurses working in the non-ICU units (P=0.008).
Conclusion: According to the results, the nurses with better critical thinking abilities had superior nursing competence and could provide appropriate and effective nursing care independently. The improvement of critical thinking could positively influence nursing competence. Furthermore, our findings demonstrated that the nurses were not so willing to participate in clinical surveys. Therefore, the healthcare system should be modified for nurses to adapt with evidence-based care studies. Notably, no significant correlation was observed between education level and nursing competence. As education plays a key role in the realization of the clinical competencies of professional nursing, it is expected that with higher education levels, nursing competence would also increase. However, evidence attests to the gap between theoretical and clinical practices, which requires qualitative and in-depth studies to examine the causes of this negative correlation. Furthermore, the impact of various educational systems across the world on the critical thinking and clinical competence of nurses should be addressed in further investigations.
http://ijn.iums.ac.ir/article-1-3040-en.pdf
Competency
Critical Thinking
Nurse
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-12
32
121
41
53
article
The Association of Moral Distress and Demographic Characteristics in the Nurses of Critical Care Units in Tehran, Iran
N Mohamadi
1
F Fakoor
2
H Haghani
3
S Khanjari
4
Associate Professor, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
MS Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: 0912776635 Email: fakoorfaezeh@gmail.com
Instructor, Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran
Associate Professor, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Background & Aim: Nurses need peace of mind in the workplace in order to provide proper patient care and accurately perform their complicated responsibilities. On the other hand, workplace stress and ethical issues affect the nursing profession. Moral distress is an inevitable issue in the nursing profession and occurs when nurses want to operate based on knowledge and what is morally accepted. Nurses experience moral distress based on their occupational role and professional status, and various factors are involved in the emergence of moral distress, including organizational factors, collaborative and group relationships, and factors related to patients and their treatment processes. However, nurses working in intensive care units (ICUs) are more at risk of moral distress due to stressful situations. In addition, the highest level of moral distress in ICU is due to nonstandard care and treatment caused by a shortage of staff. Another factor that contributes to this issue is working with the unqualified staff at various nursing and medical levels. Moral distress can affect nurses’ work-life and have various impacts on the life of staff, patients, and health organizations. This could lead to confusion, fear, anxiety, and lack of power in nurses, which results in job dissatisfaction and intention to leave in nurses. Therefore, the present study aimed to determine the relationship between moral distress and demographic characteristics of nursing in ICUs of medical training centers of Tehran, Iran.
Materials & Methods: This cross-sectional, correlational, and descriptive research was performed on 200 nurses working in ICUs of medical training centers in Tehran, affiliated with Iran and Shahid Beheshti universities of medical sciences in 2018. A stratified sampling method with proportional allocation was used to enroll participants, and CCU, ICU, and ICU-OH were considered as categories. Data were collected using a demographic characteristics questionnaire, which included background information of nursing staff. In addition, a 24-item moral distress scale by Corly was applied, which assessed the frequency and intensity of moral distress, and its items were scored based on a five-point Likert scale. In this regard, the mean of 24 items was calculated to estimate the moral distress score. In addition, the score range was 0-96. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency distribution, mean, and estimation of numerical indicators), and inferential statistics such as independent t-test and (to evaluate the relationship between intensity and frequency of moral distress with demographic characteristics of the participants), analysis of variance (for pairwise comparison) and Scheffé's method.
Results: In this research, 79.5% of the participants working in intensive care units (n=200) were female, and the age range of 30-39 years had the highest frequency (46.5%). In addition, 57.5% of the subjects were married, 22% of whom had no children. Most subjects (55%) had a work experience of more than 10 years, which showed the presence of experienced nurses in these wards. Regarding the level of education, 87.5% of the subjects had a BSc and the rest had an MSc. Moreover, 56.5% of the participants were permanently employed. The majority of the participants (78.5%) worked in rotating shifts, and nurses with 10-14 night shifts per month (27.5%) had the highest frequency in the number of night shifts. The results of the analysis of variance and t-test showed no significant relationship between the frequency of moral distress and variables of gender, age, marital status, number of children, level of education, work experience, employment status, work shift, number of night shifts per month and ethics training. Overall, there was no significant relationship between the frequency of moral distress and the demographic characteristics of nurses. According to the results, the mean and standard deviation of the frequency of moral distress was estimated at 48.96 ± 18.21, which was near the medium score of the tool (49), and the mean and standard deviation of intensity of moral distress was reported at 52.04 ± 18.43, which was higher than the medium score (49). Meanwhile, we found a significant relationship between the frequency of moral distress and the type of ward (P=0.014). However, the frequency of moral distress was significantly lower in the ICU-OH ward, compared to CCU (P=0.040) and ICU (P=0.018). Nonetheless, this difference was not significant between ICU and CCU. In addition, there was a significant difference between the intensity of moral distress and ward (P=0.030). Furthermore, moral distress intensity was significantly lower in ICU-OH, compared to CCU (P=0.005) and ICU (P=0.008), and no significant difference was found between ICU and CCU.
Conclusion: In the present research, we observed a moderate frequency and intensity of moral distress in nurses working in intensive care units, which could have a negative impact on patient care and the health of personnel. According to the results, there was a significant relationship only between the ward and moral distress. In addition, there was no significant association between moral distress and ethics training. According to our findings, there was no significant relationship between the demographic characteristics of the participants and their moral distress. Therefore, other factors such as organizational support, socioeconomic factors, and other predisposing factors of moral distress should be assessed in this regard. In addition, training the staff and familiarizing them with factors of moral distress could play a role in decreasing this issue in nurses working in intensive care units. In this respect, training could be carried out by nursing managers and instructors in the form of researcher, counselor, and planner to familiarize nurses with moral distress and decrease this factor in these individuals. It is recommended that our findings be used by nursing managers and authorities to develop proper treatment policies to decrease moral distress in nurses working in intensive care units.
http://ijn.iums.ac.ir/article-1-3082-en.pdf
Moral Distress
Nurse
Critical Care Units
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-12
32
121
54
67
article
The Correlation of Health Literacy with Quality of Life in Asthmatic Patients
M Kazemi
1
M Barkhordari-Sharifabad
2
KH Nasiriani
3
H Fallahzadeh
4
MS of Medical-Surgical Nursing, College of Medical Science, Islamic Azad University, Yazd Branch, Yazd, Iran
Assistant Professor, Department of Nursing, College of Medical Science, Islamic Azad University, Yazd Branch, Yazd, Iran (*Corresponding author) Tel: 00983538210540-41 Email: Barkhordari_m@iauyazd.ac.ir
Associate Professor, Department of Nursing, Nursing and Midwifery Research Center, Mother & Newborn Health Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Professor, Department of Biostatistics and Epidemiology, School of Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Background & Aims: Health literacy is defined as the degree to which an individual can obtain, communicate, process, and understand basic health information and services to make appropriate health decisions. Asthma is a common, chronic disease, which has a deep impact on life and physical, social, and mental performance, group activities, and even the economic advancement of patients, all of which are factors that affect their quality of life. On the other hand, effective management of the disease requires identifying effective factors, including health literacy. Therefore, with regard to the importance of asthma and quality of life of those with this condition, and given the effect of health literacy on this issue, the present study aimed to determine the relationship between health literacy and quality of life of asthmatic patients referring to healthcare clinics of Shahid Sadoughi University of Medical Sciences, Yazd, Iran, in 2018.
Materials & Methods: This correlational and descriptive study was performed on 300 asthmatic patients selected by simple random sampling. The inclusion criteria were the age range of 18-60 years, Farsi language proficiency, being literate, lack of malignancy and other underlying diseases, and lack of physical and psychological disabilities. On the other hand, the exclusion criteria were living in other provinces and lack of referring to the healthcare centers for several months. Data were collected using demographic characteristics questionnaire (age, gender, marital status, level of education, and occupational status), patient-reported asthma life quality questionnaire, which included 20 items in four physical, psychological, social, and health concern aspects, and patient-reported test of functional health literacy in adults (TOFHLA). Data analysis was performed in SPSS version 16 using descriptive and inferential statistics, including mean and standard deviation, absolute and relative frequency, and Kolmogorov-Smirnov test (to evaluate the normal distribution of the data). In case of a lack of normal distribution (P<0.05), we applied Spearman’s test to determine the relationship between the variables.
Results: In this study, most patients were female (52.3%) and married (87.3%) with the mean age of 43.9±11.08 years and minimum and maximum ages of 19 and 60 years, respectively. In addition, most of the subjects (73.3%) used the option of asking the physician and health care staff to receive information about asthma. The mean health literacy score of the subjects was 100.78±28.55 and the highest and lowest scores were related to the components of evaluation (68.5) and access (55.36), respectively. In addition, the majority of the participants (45%) had inadequate health literacy. Moreover, the mean life quality score of the participants was 46.91±5.32, and the lowest and highest mean scores were related to the physician (10.66±2.88) and health concern (17.41±2.88) dimensions, respectively. According to the results, there was no significant difference between the variables of health literacy and life quality with gender (P>0.05). However, there was a significant relationship between health literacy and marital status, meaning that single individuals had higher health literacy, compared to married subjects (P<0.001). However, there was no significant relationship between marital status and life quality (P=0.61). Kruskal-Wallis test results were indicative of a significant relationship between health literacy with the level of education and occupational status (P<0.001). In other words, there was a significant difference between those with MSc and BSc degrees and those with associate and below diploma degrees P<0.001). In addition, student and employed patients had a significantly different life quality, compared to housewives and retired participants (P<0.001). However, there was no significant difference between the level of education and occupational status regarding the quality of life (P>0.05). Spearman’s test results demonstrated a significant, reverse association between age and health literacy Rho=-0.76, P<0.001), which was not observed between age and life quality (Rho=-0.01, P=0.82). Moreover, no statistically significant relationship was found between health literacy and its components with quality of life and its dimensions (P>0.05).
Conclusion: According to the results of the study, the mean health literacy score of the subjects was 100.78; therefore, the overall health literacy of the subjects was below moderate. In addition, according to the ranking, the health literacy of most of the subjects was inadequate. This indicates the need to use effective strategies to improve the health literacy of asthmatic patients because adequate health literacy is essential for patient participation in health care systems and making appropriate health decisions and leads to the empowerment of people to use relevant information and instructions. It seems that due to insufficient health literacy in the present study, it should be considered by health care workers. The mean life quality score of the patients was 46.91 ± 5.32, which showed the below moderate life quality of the participants. Similar to other diseases, asthma affects the lives of patients in many ways, in a way that it becomes the main concern of patients. This condition extremely decreases the quality of life of individuals. Therefore, it is not uncommon for people with asthma to have poor living standards. Nevertheless, it is necessary to pay more attention to the quality of life of these patients and use and implement appropriate interventions to improve their quality of life. According to the results, the level of health literacy and quality of life of patients with asthma was not favorable and there was no significant relationship between health literacy and its components with quality of life and its dimensions. Therefore, it is suggested that more studies be performed to evaluate the intermediating factors that could affect these variables to better understand this condition. Moreover, it is possible to develop health literacy skills and improve the quality of life of asthmatics by developing comprehensive programs, creating simple and understandable educational materials, and effective psychological interventions. The lack of a relationship between health literacy and quality of life in this study does not mean that these variables have no effect on each other. In fact, the relationship might be indirect, and a better understanding is required to assess other intermediating simultaneously with these two variables. It is recommended that variables such as adherence to treatment be assessed in future studies as an intermediary variable between health literacy and life quality of patients with asthma.
http://ijn.iums.ac.ir/article-1-3091-en.pdf
Health Literacy
Quality of Life
Asthma
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-12
32
121
68
81
article
The Effectiveness of the Combination of Cinnamon and Ginger with Exercise Training in the Treatment of Dysmenorrhea and Premenstrual Syndrome
B Ebrahimi Azmoudeh
1
M Habibian
2
B Askari
3
MS in Sports Physiology, Department of Physical Education and Sports Sciences, Islamic Azad University, Qaemshahar Branch, Qaemshahar, Iran
Associate Professor of Sports Physiology, Department of Physical Education and Sports Sciences, Islamic Azad University, Qaemshahar Branch, Qaemshahar, Iran (*Corresponding author) Tel: +011-42241041 Email: habibian_m@yahoo.com
Assistant Professor of Sports Physiology, Department of Physical Education and Sports Sciences, Islamic Azad University, Qaemshahar Branch, Qaemshahar, Iran
Background & Aims: Premenstrual syndrome (PMS) is a common disorder among young and middle-aged women, which is associated with various physical, cognitive, psychological, and emotional symptoms during the menstrual cycle in women. Approximately 70-80% of women experience some degrees of PMS symptoms, and 20-40% of these women, the symptoms lead to disorders in their functioning and daily life. Today, considering the high prevalence of PMS and primary dysmenorrhea in women and the unknown causes of these disorders, various treatments have been proposed for the control or reduction of the pain intensity and symptoms of the disease. Herbal and sports non-pharmacological therapies have received more attention from researchers and women owing to their variety, fewer side-effects, and cost-effectiveness. Cinnamon and ginger are among the medicinal plants that are effective in the reduction of pain intensity. Cinnamon consumption is associated with no particular risks in humans, and previous findings have confirmed the effectiveness of cinnamon consumption in the reduction of pain intensity and the systemic symptoms of primary dysmenorrhea. Ginger is also known as an effective medicine in several traditional herbal remedies, such as the treatment of nausea, increasing appetite, treatment of indigestion, fever, and infections, and body cleansing, especially in East Asian countries. Researchers have reported that regular exercise is effective in reducing the symptoms of PMS, as well as the duration and intensity of primary dysmenorrhea pain. The present study aimed to assess the effectiveness of the combination of cinnamon and ginger with walking and stretching exercises on dysmenorrhea and PMS.
Materials & Methods: This quasi-experimental study was conducted with a pretest-posttest design and a control group on the young women living in Ghaemshahr, Iran in 2019. Among the volunteers participating in the study, the individuals with regular menstrual periods, PMS (minimum of five signs of PMS), and primary dysmenorrhea (moderate-to-severe pain) were sampled via convenience sampling. After obtaining written consent, the selected candidates were enrolled in the study and divided into four groups of exercise, cinnamon-ginger, combination of exercise and cinnamon-ginger, and control by drawing lots. The exercise training program comprised of stretching exercises and walking three sessions per week for eight weeks. A cinnamon-ginger capsule (500 mg) was administered thrice daily with the onset of pain within the first 72 hours of menstruation for two months. The patients were assessed before and eight weeks after the intervention using the visual analogue scale (VAS) of menstrual pain intensity, PMS screening tool, and PMS daily status. The VAS is a standard tool for the evaluation of pain intensity within the score range of 0-10, with score zero indicating no pain, scores 1-3 showing mild pain, scores 4-7 indicating moderate pain, and scores 8-10 showing severe pain. The subjects with the pain intensity score of higher than four were enrolled in the study. Cox menstrual symptom scale was used to measure the duration of pain (from the onset of pain to the end). Based on this criterion, the subjects were assigned five scores within the range of 0-4, including the absence of pain, less than/equal to half an hour of pain, half to equal to one hour of pain, more than one hour of pain, and more than one day of pain, respectively. Data analysis was performed using paired t-test, the Mann-Whitney U test, one-way analysis of variance (ANOVA), Kruskal-Wallis test, and Tukey's test.
Results: The results of one-way ANOVA indicated no significant differences in the duration and period of menstruation, pain intensity, duration of pain, psychological symptoms (mood and behavioral symptoms), and physical PMS symptoms at baseline. After eight weeks, the intensity and duration of primary dysmenorrhea pain and the scores of the physical and psychological PMS symptoms (mood and behavioral symptoms) significantly decreased in the intervention groups compared to the control group (P<0.05). Furthermore, the effects of the combination therapy on the rate of the changes in the intensity and duration of primary dysmenorrhea pain and scores of the physical and mental symptoms of PMS were more significant compared to the cinnamon-ginger and exercise groups. Meanwhile, the rate of the mean changes in the mood and physical symptoms of the cinnamon-ginger group was significantly higher compared to the exercise group.
Conclusion: According to the results, the duration and intensity of dysmenorrhea pain and physical and mental symptoms of PMS (mood and behavioral symptoms) decreased after eight weeks of the consuming the combination of cinnamon and ginger, and these changes were reinforced with the physical exercises. It seems that regular exercise as a source of psychological changes could reduce the duration and intensity of dysmenorrhea pain through decreasing the disorders associated with neurotransmitters (especially serotonin and gamma-aminobutyric acid), stress reduction, development of blood circulation, increasing the endorphins and neurotransmitters, and decreasing the serum aldosterone, body fat mass, and estrogen levels, thereby improving the symptoms of PMS. In addition, the anti-inflammatory effects of ginger were exerted through the inhibition of cyclooxygenase and lipoxygenase, followed by the reduction of leukotriene and prostaglandin. The examination of cinnamon compounds and their effects also indicated that cinnamaldehyde, eugenol, and terpene in cinnamon have analgesic, tranquilizing, and anti-inflammatory properties. As a result, the non-pharmacological interventions of walking and stretching exercises, simultaneous consumption of cinnamon and ginger, and combination therapy could be considered as effective treatments in improving the physical and psychological symptoms of PMS and decreasing the intensity and duration of primary dysmenorrhea pain in young women.
http://ijn.iums.ac.ir/article-1-3094-en.pdf
Cinnamon
Dysmenorrhea
Ginger
Premenstrual Syndrome
Walking
eng
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-12
32
121
82
93
article
The Association of Emotional Intelligence and Job Satisfaction in Operating Room Technologists
P Rezagholi
1
P Foroughi
2
A Foroughi
3
S Shahsawari
4
Lecturer, Department of Operating Room, faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences, Sanandaj, Iran
MS in Midwifery, Imam Khomeini Divandareh Hospital, Kurdistan University of Medical Sciences, Sanandaj, Iran
Student Research Committee, Kurdistan University of Medical Sciences, Sanandaj, Iran (*Corresponding author) Tel: +989180819368 Email: foroughiasra@gmail.com
Lecturer, Environmental Health Research Center, Kurdistan University of Medical Sciences, Sanandaj, Iran
Background & Aims: Occupational satisfaction is one of the most important and effective factors for the increase in organizational productivity. In addition, emotional intelligence is a series of skills that increase a person’s ability to face environmental pressures. Given the effect of emotional intelligence on individual psychological health, and with regard to the role of occupational satisfaction on the quality of services provided by operating room technicians, this study aimed to determine the relationship between emotional intelligence and occupational satisfaction in operating room technicians.
Materials & Methods: This cross-sectional, descriptive, and analytical study was performed on all operating room technicians in hospitals of Sanandaj, Iran (n=110) were selected by census sampling in 2016, 10 of whom were excluded from the research due to a work experience less than one year. The inclusion criteria were a minimum work experience of one year, lack of chronic psychological diseases, lack of drug use, and no severe crises such as the death of first-degree family members, divorce, bankruptcy, and loss of property in the last six months. Data were collected using a demographic characteristics questionnaire (e.g., gender, marital status, education, income level, type of employment, number of children, age, work shift, and work experience), Sibriashring emotional intelligence questionnaire (including self-awareness, self-control, social awareness, social skills, and self-motivation), and Spector job satisfaction survey (nine dimensions of pay, promotion, supervision, benefits, contingent rewards, operating procedures, co-workers, nature of work and communication). In addition, data analysis was performed in SPSS version 16 using Pearson’s correlation coefficient, independent t-test, and one-way analysis of variance.
Results: About 62% of the participants were female and the rest (38%) were male. In terms of marital status, 34% of the subjects were single and 66% were married. In addition, the majority of the participants were below 30 years and had a BSc. According to the results, there was no significant relationship between emotional intelligence and occupational satisfaction (P>0.05). On the other hand, a significant correlation was observed between the social skills of emotional intelligence and dimensions of promotion, supervision, and communication. In this regard, the relationship with promotion and supervision was reverse, while it was direct with communication. In addition, a significant correlation was observed between the social awareness dimension of emotional intelligence with the subscales of contingent rewards and communication, which was direct regarding the latter but poor and reverse in terms of the former. Moreover, we detected a poor, direct, and significant association between the self-awareness dimension of emotional intelligence and the total score of occupational satisfaction. Furthermore, there was a significant correlation between self-motivation and total occupational satisfaction and the dimensions of contingent rewards and communications. In this regard, the relationship was poor and direct with total occupational satisfaction and contingent rewards. In addition, we found a poor, reverse, and significant relationship between the self-control dimension of emotional intelligence and dimensions of benefits, co-workers, and communication. Moreover, the total emotional intelligence had a significant correlation with the dimensions of promotion, benefits, and communication, which was poor and reverse with communication, reverse with benefits, and direct with communication. The mean emotional intelligence was 112, which demonstrated the favorable level of emotional intelligence of the participants. Moreover, the mean occupational satisfaction was 121.5, which was below moderate.
Conclusion: According to the results of the study, the occupational satisfaction of operating room technicians was significantly lower than moderate. Overall, occupational satisfaction is affected by various factors, which change depending on time, location, and social situations. It seems that social, economic, and cultural situations of a society significantly determine the factors affecting occupational satisfaction. The occupational satisfaction of operating room technicians affects their work quality. Therefore, officials should pay more attention to this issue by holding educational workshops and courses to increase the occupational satisfaction of operating room technicians. Given the high workload of these individuals, researchers had limited time for filling the questionnaires, which was resolved by referring to the participants in evening and night shifts and on holidays when they had a lower workload. The researchers referred to the operating room to fill the questionnaire. Given the rapid growth of technology and advances in the field of health sciences, it is necessary to conduct a similar study with more up-to-date tools. The results of the present study can be presented to the officials of the University Educational and Medical Center in order to find a solution or design interventions to increase the welfare facilities in the workplace and provide appropriate promotions and favorable working environment conditions to improve the job satisfaction of operating room technicians.
http://ijn.iums.ac.ir/article-1-3104-en.pdf
Emotional Intelligence
Job Satisfaction
Operating Room
per
دانشگاه علوم پزشکی ایران
Iran Journal of Nursing
2008-5931
2008-5931
2019-12
32
121
94
106
article
The Effect of the Empowerment Program on the Chronic Sorrow of the Parents of Premature Newborn in Neonatal Intensive Care Units
H Moradi
1
L Borimnejad
2
N Seyed Fatemi
3
H Haghani
4
M Moradi
5
. MS in Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Professor, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: 88201978 Email: borimnejad.l@iums.ac.ir
. Professor, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Instructor, Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran
MS in Medical-Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
Background & Aims: Sorrow is a natural response to adverse events such as loss and birth of premature or abnormal neonates, which increases the risk of chronic physical diseases, substance abuse, and suicide if prolonged. In addition, sorrow decreases the quality of life of individuals, causing variable degrees of disability in individual and social functions. The components of chronic sorrow in the parents of premature neonates include premature birth, developmental disabilities, Down syndrome, neural tube defects (e.g., meningococcus), and chronic diseases (e.g., cancer). The parents of these neonates experience variable degrees of chronic sorrow, which in turn makes it difficult to care for and interact with the newborn. The birth of a premature neonate is the main challenge in postpartum care. In general, approximately 13 million births lead to premature birth each year. Iran has one of the highest prevalence rates of premature birth across the world, where 5,000 neonates are born daily, 12% of whom are underweight and 10-15% are born premature before 37 weeks of gestation. The birth of a newborn that needs special care causes psychologically special and shocking conditions for the parents, preventing the fulfillment of their true role as a parent. Sorrow occurs when parents find out that their newborn is 'incomplete'. Sorrow encompasses both internal phenomena (e.g., thoughts and feelings) and external phenomena in the form of behaviors related to sorrow (e.g., sadness and crying). One of the main nursing interventions in this regard involves diminishing the problems of the parents whose newborn is hospitalized in the intensive care unit through their empowerment by providing the required knowledge for the better care of admitted premature neonates, which has been highlighted within the context of family-oriented care to increase the quality of life of the neonate and families. In general, the implementation of proper nursing interventions could lead to positive outcomes for parents, reducing issues such as grief, stress, changed parental roles as a major nursing measure for diminishing the problems of the parents whose neonates are admitted to the neonatal intensive care unit. The empowerment of parents occurs by providing the necessary conditions for the interaction and participation of parents in the care of premature neonates. The creating opportunities for parent empowerment (COPE) was designed by Melnyk et al. in 2001 for the parents of premature infants. COPE is a four-stage educational-behavioral intervention based on the self-regulatory and control theories. In addition to the mental support of parents, this program provides the necessary information regarding the complexion and behaviors of premature infants, parental roles, conditions of the intensive care unit, and proper care of the neonates. The present study aimed to assess the effects of the COPE on the chronic sorrow of the parents of the premature neonates admitted to the neonatal intensive care unit (NICU).
Materials & Methods: This non-randomized clinical trial was conducted with a control group after the approval of the research plan and obtaining the required permit from the Ethics Committee and an introduction letter from Iran University of Medical Sciences at NICUs of Rasoul Akram and Ali Asghar hospitals in Tehran, Iran. Based on the inclusion criteria, 68 parents with premature infants admitted to the NICU were selected via convenience sampling. The stratification of the subjects to two groups was based on a time framework. Initially, the control group was samples, followed by the sampling of the intervention group. Data were collected using a demographic questionnaire and Kendall chronic sorrow instrument with 18 items scored based on a Likert scale, which were collected by the subjects in both groups. In the intervention group, the COPE program (four-stage educational-behavioral intervention) was carried out, and the control group received the routine care of the ward. The trainings and meetings with the parents were performed in groups of 2-4, including the mother and father, in the conference room of the ward with the permission of the head nurse by the researcher and the co-researcher. One month after the launching of the study, the questionnaires were completed again by the subjects via WhatsApp social network. Data analysis was performed in SPSS version 16 using descriptive statistics (frequency distribution tables and numerical indices), followed by inferential statistics using Chi-square, Fisher's exact test, independent t-test, and paired t-test for the comparison of the study groups.
Results: No significant differences were observed between the intervention and control groups in terms of age, education level, place of residence, length of the neonate's admission, gender of the neonates, and mode of delivery between the intervention and control groups, and the groups were homogenous in this regard at the significance level of 0.05. In addition, the results of independent t-test showed no significant difference between the intervention and control groups in terms of the score of chronic sorrow (P>0.05). After the intervention, the mean score of chronic sorrow in the control and intervention groups was 43.11±8.38 and 32.85±5.45, respectively, which indicated a significant difference in this regard (P<0.001). This finding indicated the effectiveness of the COPE program in decreasing the chronic sorrow of the parents of the premature infants admitted to the NICU.
Conclusion: According to the results, the symptoms of sorrow appeared in the parents in the intervention and control groups upon the admission of the premature neonates to the NICU. Therefore, the parents whose premature infants are admitted to the NICU require proper examination and treatment for the symptoms of sorrow. Our findings confirmed the effectiveness of the COPE program in the alleviation of the sorrow of the parents whose premature neonates were admitted to the NICU. Therefore, it is recommended that this program be implemented as an effective and cost-efficient strategy in NICUs. Furthermore, the use of audio-visual training programs along with routine treatments could positively influence the care of premature infants and reduce the psychological effects on care on the parents. Owing to technological advancement, the easy application of such educational programs could maintain the independence of families and increase the knowledge interaction of parents in the care of the newborn, while decreasing their stress and sorrow.
http://ijn.iums.ac.ir/article-1-3127-en.pdf
Chronic Sorrow
Empowerment
Premature Infants
Parents