OTHERS_CITABLE «نامه به سردبیر» آیا زنان باید باروری خود را در زمان پاندمی COVID-19 به تأخیر بیندازند؟ به درستی مشخص نیست که آیا زنان می‌توانند طی پاندمی کرونا تصمیم به بارداری بگیرند یا این که خطری آن‌ها را تهدید می‌کند یا خیر، زیرا بررسی پیامدهای طولانی مدت ابتلا به این ویروس به ویژه در ماه‌های اول بارداری، نیاز به گذشت زمان و مطالعات بیشتر دارد(۱). ویروس COVID-۱۹ در مایع منی و بیضه‌های مردان آلوده به ویروس در مرحله حاد یا دوره نقاهت بیماری یافت نشده است، بنابراین احتمال این که بیماری از طریق جنسی منتقل شود غیر محتمل است(۲). با این وجود گزارش شده است که سیستم تولیدمثل مردان نسبت به عفونت آسیب پذیر است و تغییرات قابل توجهی در هورمون‌های جنسی بیماران COVID-۱۹ مشاهده شده است که مطرح کننده آسیب به عملکرد گنادها می‌باشد. بنابراین مردان جوانی که از COVID-۱۹ بهبود یافته‌اند و علاقمند به فرزندآوری هستند، باید در زمان تصمیم‌گیری برای باروری، مشاوره دریافت کنند(۳). به دلیل آسیب به ایمنی سلولی و تغییرات فیزیولوژیک، زنان باردار نسبت به بیماری‌های تنفسی حساس هستند و احتمال وقوع پنومونی شدید در آن‌ها بیشتر است(۴). زنان باردار ممکن است در معرض افزایش خطر نوع شدید بیماری COVID-۱۹ باشند. برای کاهش بیماری شدید COVID-۱۹ زنان باردار باید از خطرات بالقوه نوع شدید بیماری آگاه باشند. بنابراین باید بر لزوم پیشگیری از COVID-۱۹ در زنان باردار تأکید شده و موانع بالقوه برای این اقدامات مشخص گردد(۵). با این وجود در یک مقاله مرور نظام‌مند مشخص شد که زنان باردار مبتلا به COVID-۱۹ نسبت به جمعیت عمومی با علایم خفیف‌تری مراجعه می‌کنند و با وجود علایم پنومونی ویروسی ممکن است آزمایش RT-PCR آن‌ها منفی باشد(۶). در زنان باردار مبتلا به COVID-۱۹ شیوع زایمان زودرس، وزن کم هنگام تولد، زایمان سزارین و بستری در NICU نسبت به جمعیت عمومی بیشتر است(۶،۷). در زنان سنین باروری مبتلا به عفونت COVID-۱۹، بارداری با بستری و افزایش خطر بستری شدن و بستری در بخش مراقبت‌های ویژه و تهویه مکانیکی همراه بوده است ولی خطر مرگ را افزایش نداده است. اگر چه بیشتر مادران بدون هیچ عارضه جدی از بیمارستان مرخص شده‌اند، موربیدیته شدید مادری، موارد متعددی از مرگ مادر و مرگ‌های پریناتال در اثر COVID-۱۹ گزارش شده است. احتمال انتقال عمودی ویروس به جنین رد نشده است و بنابراین پایش دقیق بارداری در موارد COVID-۱۹ و اقدامات لازم برای پیشگیری از عفونت نوزادی ضرورت دارد(۸،۹). انتقال عمودی در چندین مورد عفونت مادری حوالی زایمان در سه ماهه سوم گزارش شده است که مطرح کننده عفونت جنینی است اما شایع نمی‌باشد. پیامدهای نوزادی در نوزادان در معرض خطر در فقدان سایر مشکلات مثل زایمان زودرس یا دکولمان جفت، به خوبی گزارش شده‌اند(۱۰). اطلاعات در مورد پیامدهای عفونت مادری در سه ماهه اول و دوم بارداری اندک است(۱۰). تب یا هایپرترمی طی سه ماهه اول بارداری که ارگانوژنز رخ می‌دهد ممکن است به عنوان یک عامل خطر محیطی برای ناهنجاری‌های جنینی به ویژه نقایص لوله عصبی و سقط مطرح باشد(۱۱). با توجه به این که هیچ شواهدی برای تراتوژن بودن یا افزایش خطر سقط، مورتالیته یا موربیدیته مادر وجود ندارد، تصمیمات باروری (مانند تصمیم‌گیری برای بارداری، ختم بارداری) نباید از ابتدا بر اساس این نگرانی‌ها صورت گیرد(۱۰). باید در نظر داشت که برخی از داروهایی که برای درمان COVID-۱۹ به کار گرفته می‌شوند، در بارداری منع مصرف دارند یا پیامدهای آن‌ها بر جنین شناخته شده نیست. داروهای ضد ویروسی رمدسیویر (Remdesivir) و آربیدول (arbidol) که در برابر COVID-۱۹ اطمینان بخش بوده‌اند، اگرچه بررسی اثربخشی آن‌ها در بارداری نیاز به تحقیقات بیشتری دارد(۴). در مطالعاتی که بر روی رمدسیویر صورت گرفته است، زنان باردار و شیرده از مطالعه خارج شده‌اند(۱۲). هنوز هیچ واکسنی برای پیشگیری از عفونت کرونا ویروس جدید وجود ندارد و داروهای کمی در کاهش مورتالیته و موربیدیته مؤثر بوده‌اند(۱۳). بحران COVID-۱۹ ممکن است دسترسی به اطلاعات، خدمات و کالاهای ضروری در زمینه سلامت باروری و جنسی را نیز برای زنان دچار مشکل کند(۱۴). پاندمی COVID-۱۹ تعداد ویزیت‌های بارداری را به نصف کاهش داده است(۱۰). در مورد سلامت روانی کوتاه مدت و طولانی مدت مادر و جنین به دنبال تجربه مادری طی پاندمی نیز هنوز دانش کافی وجود ندارد(۱۵). با این وجود بر اساس گایدلاین کالج متخصصین زنان و مامایی آمریکا، بارداری در شرایط COVID-۱۹ یک انتخاب شخصی است و افراد باید در زمینه باردار شدن به صورت مستقل و بر اساس وضعیت سلامت خود، خطرات بالقوه COVID-۱۹ و سایر فاکتورها تصمیم بگیرند. در افرادی با سابقه بیماری دیابت، بیماری ریوی و بیماری قلبی، خطر بیماری شدید ناشی از COVID-۱۹ بیشتر است. بیماران در این شرایط که پاندمی به اقتصاد صدمه وارد کرده، باید به ابعاد اقتصادی بارداری و افزایش ابعاد خانواده نیز بیندیشند(۱۶). بر اساس توصیه WHO، در کسانی که در شش ماه گذشته زایمان داشته یا شرایطی نظیر دیابت، فشار خون بالا یا سرطان پستان را تجربه کرده‌اند یا سیگار می‌کشند، باید از یک روش جلوگیری از بارداری مطمئن در زمان پاندمی کرونا استفاده کنند(۱۷). با توجه به شکاف موجود در دانش، بیماران نابارور نیز باید در مورد مزایا و معایب شروع درمان ناباروری طی پاندمی کرونا مشاوره شوند. این مشاوره باید شامل کسانی شود که شرایط خاص مانند فشارخون، دیابت و چاقی دارند و ممکن است در صورت ابتلا به عفونت در معرض افزایش خطر عوارض باشند. همچنین افرادی که مبتلا به بیماری هستند باید تا زمان اطمینان از بهبودی کامل، از بارداری پیشگیری کنند و در صورتی که طی سیکل درمان ناباروری هستند نیز توصیه شده است که تخمک‌ها یا جنین‌های خود را فریز کنند و تا زمان بهبودی کامل انتقال جنین انجام ندهند(۱۳). رعایت توصیه‌های مرکز کنترل و پیشگیری از بیماری‌ها (CDC) از جمله شستشوی دست‌ها با صابون، لمس نکردن صورت، رعایت انزوای فیزیکی در تمام زنان باردار یا کسانی که قصد بارداری دارند ضروری است(۱۸). واضح است که دسترسی به روش‌های پیشگیری از بارداری نیز باید همچنان حفظ شده و طیفی از روش‌های پیشگیری از بارداری طولانی اثر برگشت پذیر تا کوتاه مدت شامل روش‌های اورژانسی باید در دسترس افراد وجود داشته باشند. ترجیحاّ وسایل پیشگیری باید به اندازه مصرف چند ماه در اختیار افراد قرار گیرد و در صورت امکان مشاوره‌ها از راه دور انجام شده و افراد به سمت خودمدیریتی سوق داده شوند(۱۰،۱۴). با توجه به این که تا زمان کشف واکسن یا دارو ناگزیر به زندگی در این شرایط خاص هستیم، تمام زوجینی که تمایل به بارداری دارند باید در مورد خطرات شناخته شده عفونت COVID-۱۹ در دوران بارداری و روش‌های پیشگیری از آن اطلاعات کافی و به روز دریافت کنند و قاعدتاّ استفاده از پزشکی از راه دور یا telehealth برای مشاوره پیش از بارداری و دریافت سایر خدمات سلامت باروری و جنسی در اولویت قرار دارد. http://ijn.iums.ac.ir/article-1-3140-fa.pdf 2020-04-04 1 5 10.29252/ijn.33.123.1 COVID-19 بارداری فرزند آوری “Letter to Editor” Should women postpone childbearing during the COVID-19 pandemic? It is not clear whether women can decide to become pregnant during the COVID-19 pandemic or whether they are at risk, because examining the long-term consequences of the virus, especially in the first months of pregnancy, requires further time and research(1). The COVID-19 virus has not been found in the semen and testicles of men infected with the virus in the acute phase or during the recovery period, so it is unlikely that the disease will be transmitted sexually(2). However, it has been reported that the male reproductive system is vulnerable to the infection, and significant changes have been observed in the sex hormones of patients with COVID-19, suggesting damage to gonadal function. Therefore, young men who have recovered from COVID-19 and are interested in having children should receive counseling when deciding to have children(3). Due to damage to cellular immunity and physiological changes, pregnant women are susceptible to respiratory diseases and are more likely to develop severe pneumonia(4). Pregnant women may be at increased risk for severe COVID-19 disease. To reduce severe COVID-19 disease, pregnant women should be aware of the potential risks of the severe form of the disease. Therefore, the need to prevent COVID-19 in pregnant women should be emphasized, and potential barriers to these measures should be identified(5). However, a systematic review study found that pregnant women with COVID-19 had milder symptoms than the general population, and that despite the symptoms of viral pneumonia, their RT-PCR tests may be negative(6). Pregnant women with COVID-19 have a higher prevalence of preterm labor, low birth weight, cesarean delivery, and hospitalization in the NICU than in the general population(6,7). In reproductive-aged women with COVID-19 infection, pregnancy has been associated with increased risk of hospitalization in the intensive care unit and mechanical ventilation, but has not increased the risk of death. Although most mothers have been discharged from the hospital without any serious complications, severe maternal morbidity, multiple maternal deaths, and prenatal deaths due to COVID-19 have been reported. The possibility of vertical transmission of the virus to the fetus has not been ruled out, and therefore careful monitoring of pregnancy in cases of COVID-19 and measures to prevent neonatal infection are essential(8,9). Vertical transmission has been reported in several cases of maternal infection around delivery in the third trimester, suggesting fetal infection but it is not common. In the at risk newborns, neonatal outcomes such as preterm labor or placental abruption have been well reported in the absence of other problems(10). Little is known about the consequences of maternal infection in the first and second trimesters of pregnancy(10). Fever or hyperthermia during the first trimester of pregnancy, when organogenesis occurs, may be an environmental risk factor for fetal abnormalities, especially neural tube defects and miscarriages(11). Given that there is no evidence of maternal teratogenicity or increased risk of miscarriage, mortality, or maternal morbidity, fertility decisions (such as pregnancy decisions, termination of pregnancy) should not be made on the basis of these concerns from the outset(10). It should be noted that some of the drugs used to treat COVID-19 are contraindicated in pregnancy or their effects on the fetus are unknown. Antiviral drugs such as Remedivir and Arbidol have been shown to be effective against COVID-19, but further investigation is needed to assess their effectiveness in pregnancy(4). Pregnant and lactating women have been excluded from these studies(12). There is still no vaccine to prevent coronavirus infection, and few drugs have been shown to reduce mortality and morbidity(13). The COVID-19 crisis may also make it difficult for women to access to information, services, and essential products for sexual and reproductive health(14). The COVID-19 pandemic has reduced the number of pregnancy visits(10). There is still scarce knowledge about the short-term and long-term mental health of mothers and fetuses following maternal experience during the pandemic(15). However, according to the American College of Obstetricians and Gynecologists, pregnancy in the COVID-19 conditions is a personal choice and decisions about becoming pregnant should be made independently and based on their health status, potential risks of COVID-19 and other factors. People with a history of diabetes, lung disease, and heart disease have a higher risk of developing severe COVID-19 disease. Patients should also consider the economic aspect of pregnancy and the increase in family size in the situation that the pandemic has impaired the economy(16). According to the WHO, those who have given birth in the past six months or have experienced conditions such as diabetes, high blood pressure or breast cancer, or who smoke cigarette, should use a safe contraceptive method during the COVID-19 pandemic(17). Given the gap of knowledge, infertile patients should also be consulted about the advantages and disadvantages of initiating infertility treatment during the COVID-19 pandemic. This advice should be given to those who have certain conditions such as high blood pressure, diabetes and obesity that may be at increased risk if they become infected. Also, people with the disease should avoid pregnancy until they are fully recovered, and if they are during the infertility treatment cycle, it is recommended that they freeze their eggs or embryos and do not transmit the embryo until complete recovery(13). It is important to follow the recommendations of the Centers for Disease Control and Prevention (CDC), including washing hands with soap, not touching face, and observing physical isolation in all pregnant women or those planning to become pregnant(18). It is clear that access to contraception must also be maintained, and a range of long-term to short-term contraceptive methods, including emergency contraceptives, must be available to individuals. Preferably, contraceptive methods should be given to people for a few months and, if possible, counseling should be done remotely and people should be directed to self-management(10,14). Considering that we have to live in these certain conditions until the discovery of a vaccine or drug, all couples who want to become pregnant should receive sufficient and up-to-date information about the known risks of COVID-19 infection during pregnancy and how to prevent it. The use of telehealth or telemedicine for pre-conception counseling and other sexual and reproductive health services is a priority. http://ijn.iums.ac.ir/article-1-3140-en.pdf 2020-04-04 1 5 10.29252/ijn.33.123.1 COVID-19 Pregnancy Childbearing F Ranjbar 1 Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0001-7558-9815 M Gharacheh 2 Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: 021-88671613 Email: gharacheh.m@iums.ac.ir AUTHOR https://orcid.org/0000-0002-7659-0786
OTHERS_CITABLE ارتباط شادکامی با خود- تعالی در سالمندان شهر خشکرود شهرستان زرندیه زمینه و هدف: شادکامی و خود- تعالی از عوامل مهم در ابعاد سلامت سالمندان هستند. شادکامی یکی از نیازهای مهم انسان است که در سلامت روان و سلامت جسمی تأثیر به‌سزایی دارد که در مقابله با موقعیت‌های استرس زا، به سالمندان کمک می‌کند. خود- تعالی به عنوان یک مکانیزم مقابله قدرتمند بوده و می‌تواند منجر به تحول شخصی شود و بهبود کیفیت زندگی را فراهم کند. پژوهش حاضر با هدف تعیین ارتباط شادکامی با خود- تعالی در سالمندان شهرخشکرود شهرستان زرندیه استان مرکزی در سال 1398 انجام شد.   روش بررسی: این پژوهش مقطعی از نوع تحقیقات توصیفی- همبستگی اسـت. نمونه‌های پژوهش از بین سالمندان شهر خشکرود مراجعه کننده به مرکز‌ جامع ‌سلامت به روش مستمر از مهر تا آذر 1398 انتخاب شدند. ابزار آزمون کوتاه‌ شناختی، فهرست شادکامی آکسفورد، و پرسشنامه خود- تعالی برای جمع آوری داده استفاده شدند. جهت تحلیل داده‌ها در نرم افزار SPSS نسخه 16 از آزمون‌های آمار استباطی پارامتریک (ضریب همبستگی پیرسون، آزمون تی مستقل و آنالیز واریانس) استفاده شد. یافته‌ها: میانگین شادکامی در سالمندان 3/14 ± 42/54 و میانگین سطح خود- تعالی 9/5 ± 4/39 بود. بین خود- تعالی با شادکامی (016/0=p، 263/0=r) و مؤلفه‌های رضایت از زندگی (001/0=p، 348/0=r) و رضایت خاطر (003/0=p، 325/0=r)، ارتباط مستقیم و معنی‌داری وجود داشت. بین سطح تحصیلات (به ترتیب 009/0=p، 038/0=p) با شادکامی و خود- تعالی، و بین شغل با شادکامی، اختلاف معنی‌دار وجود داشت (039/0=p). همچنین بین تعداد فرزندان (037/0=p) و نحوه سکونت (028/0=p) با خود- تعالی نیز تفاوت معنی‌داری مشاهده شد. بحث و نتیجه‌گیری: نتایج پژوهش نشان داد، ارتباط مستقیم و معنی‌داری بین خود- تعالی با شادکامی وجود دارد. با توجه به نتایج، توصیه می‌شود خانواده‌ها و مسئولین از طریق برآورده کردن نیازهای مادی، اجتماعی و معنوی سالمندان، زمینه افزایش توانایی درک و پذیرش خویشتن، احساس رضایت خاطر و شادی را در آن‌ها ایجاد کنند که سلامت آن‌ها را به دنبال دارد و با ایجاد محیط شاد و با نشاط عملکرد آن‌ها ارتقاء می‌یابد که تبعات مثبتی برای سالمند، خانواده و جامعه به دنبال دارد. همچنین شرایطی فراهم شود تا آن‌ها از تجارب یکدیگر بهره‌مند شده و حضور در جمع سبب ارتقاء سلامت آن‌ها شود. http://ijn.iums.ac.ir/article-1-3157-fa.pdf 2020-04-06 6 21 10.29252/ijn.33.123.6 شادکامی خود- تعالی سلامت روان سالمندی The Correlation between Happiness and Self-transcendence in the Elderly of Khoshkrud, Zarandieh City Background & Aims: The population of the elderly has been on a rise, which shows more attention to ensuring the health and well-being of the elderly. On the other hand, the growth of the elderly population and its impact on the social and economic conditions of society leads to more attention to the issue of aging in society. In addition, physical and psychological abilities decrease with aging, which affects the quality of life of people. Overall, quality of life and well-being assessed by indicators such as health, happiness, and loneliness. Happiness is one of the most important needs of human beings, which considerably affects their psychological and physical health that helping the elderly cope with stressful situations. Another factor affecting well-being is self-transcendence, which is a powerful coping mechanism and can lead to personal transformation and improvement of the quality of life, thereby facilitating the process of understanding life changes such as aging. Therefore, self-transcendence is defined as a positive trait in relation to the expansion of one’s outlook on life. This issue includes factors such as spirituality, finding a purpose in life, optimism for the future, coping with problems, using power-based approaches, and connecting with others. In the elderly, by restoring the concept of aging and accepting disability, it reduces stress and focuses more on ability than disability. Therefore, happiness and self-transcendence are important factors in the elderly’s health dimensions. The present study aimed to determine the relationship between happiness and self-transcendence in the elderly of Khoshkrud, Zarandieh City. Materials & Methods: This descriptive-correlational research performed on the elderly selected from those who referred to the health center to receive elderly-related care using sequential sampling. Data collection continued for three months (October-December, 2019), and 84 elderlies who were willing to participate in the research were selected. The inclusion criteria were the age of more than 60 years, the ability to respond to questions physically and mentally, having psychological health  which assessed  by Abbreviated Mental Test (obtaining a score above 7) and not losing a family member or experiencing a stressful situation in the past two months. Abbreviated Mental Test used to diagnose cognitive impairment, including dementia and delirium in the elderly, applied to assess concentration, attention, short-term and long-term memory. Notably, the Cronbach’s alpha of the tool was 0.76 in Iranian society. The Oxford Happiness Index has 29 questions that scored in a range of zero to 87 and includes five components of life satisfaction, self-honor, subjective well-being, satisfaction, and positive mood. Internal consistency was used to determine the reliability of the instrument. The Cronbach's alpha coefficient for the components of life satisfaction, self-honor, subjective well-being, satisfaction, and positive mood estimated at 0.85, 0.71, 0.74, 0.79, and 0.77, respectively. On the other hand, the self-transcendence questionnaire included 15 items scored in a range of 15-60, where a higher score was indicative of higher self-transcendence. Internal consistency was used to determine the reliability of the instrument and its Cronbach's alpha coefficient estimated to be 0.69. Researcher with questions from the elderly completed all tools and it took an average of 45 minutes for each elderly person to complete the tools. In addition, data analysis was performed in SPSS version 16 using descriptive statistics (to describe demographic variables and variables of happiness and self-transcendence) and parametric inferential statistics (Pearson’s correlation coefficient, independent t-test, and analysis of variance). Results: In this study, the mean age of the elderly was 65.7±4.8 (60, 79). Moreover, 55 subjects were female (65.5%), 81% were married, 59.5% were illiterate and 64.3% were homemakers. In addition, the mean number of children of the participants was 6.2±1.6 (0, 14). Furthermore, 66.7% had an underlying illness, 56% had a moderate economic status, 61.9% had a family support system and 79.8% lived with their spouse. According to the results, the mean of happiness and self-transcendence in the elderly were 54.42±14.3 and 39.4±5.9, respectively. There was a significant and direct relationship between self-transcendence and happiness (r=0.263, P=0.016), components of life satisfaction (r=0.348, P=0.001) and satisfaction (r=0.325, P=0.003). In addition, a significant difference was observed between the level of education (P=0.038 and P=0.009, respectively) with happiness and self-transcendence and between occupational status and happiness (P=0.039). Moreover, a significant difference was found between the number of children (P=0.037) and residential status (P=0.028) with self-transcendence. Conclusion: According to the results of the study, happiness and its components were more than the average level in the elderlies. In addition, the results were indicative that level of education, job, and economic status had significant differences with happiness. A proper education, job and economic status creates safety in the individual, which improves happiness. Self-transcendence was moderate and economic status, level of education, residential status and number of children had significant differences with elderly’s self-transcendence. Good economic situation causes security in the person and the person can try to help himself without worry and play a role in promoting self-transcendence. On the other hand, the level of education promotes awareness and the ability to obtain information from various sources, which can empower the elderly in self-care and increase their adaptation to old age, and ultimately lead to the promotion of self-transcendence. The presence of children, their support, and care for parents cause security for the elderly, who in return try to adapt to the current situation in order to calm their children and accept their situation and ultimately improve their self-transcendence. In general, self-transcendence promoted by having a good friend and a person to talk to, and in the traditional society of Khoshkroud, communication with children, relatives, and neighbors can promote self-transcendence. Although in the present study, the economic situation was moderate and most of the elderly were illiterate, the level of happiness and self-transcendence of the participants was above average, which can be attributed to the existence of social relations at the family and traditional society and respect for the elderly. These factors played a key role in individual satisfaction and support of the elderly and covered the educational and economic states. Moreover, there was a direct and significant relationship between happiness and self-transcendence. Happy people feel more in control, think more about their abilities rather than inabilities, better cope with life stressors, have higher self-esteem, value themselves, and love themselves. Overall, happiness can affect the scope of life and the way people relate and interact with the environment. As such, happiness promotes other life aspects, including self-transcendence. In Khoshkroud, where the elderly and families adhere to their religious and traditional beliefs and the family has a special position, the elderly enjoy health in all dimensions, and they can accept the conditions of old age and use effective adaptation mechanisms to improve well-being. It recommend that the families and authorities by meeting the economic, social and spiritual needs of the elderly to increase their ability to understand and accept themselves, create a sense of satisfaction and happiness, which increases their health. By creating a happy and lively environment, their performance will be improve, which has positive consequences for the elderly, family, and society. Furthermore, conditions should be provided for them to benefit from each other's experiences and to be present in public to improve their health. http://ijn.iums.ac.ir/article-1-3157-en.pdf 2020-04-06 6 21 10.29252/ijn.33.123.6 Happiness Self-transcendence Psychological Health Elderly M Lalehkani 1 Department of Nursing, Shahed University, Tehran, Iran AUTHOR https://orcid.org/0000-0001-5169-0281 A Davati 2 Department of Medicine, Shahed University, Tehran, Iran AUTHOR https://orcid.org/0000-0001-6155-2392 A Isanejad 3 Department of Physical Education, Shahed University, Tehran, Iran AUTHOR https://orcid.org/0000-0002-3293-1518 M Jadid-Milani 4 Department of Nursing, Shahed University, Tehran, Iran. (*Corresponding Author) Tel: 02151212143 Email: milani@shahed.ac.ir AUTHOR https://orcid.org/0000-0002-9819-9649
OTHERS_CITABLE تأثیر آموزش تاب‌آوری بر توانمندی روانشناختی پرستاران بخش‌های مراقبت ویژه زمینه و هدف: پرستاران، مراقبت ویژه در مقایسه با سایرین با تنش‌های شغلی، روانی و فیزیکی بیش‌‌تری مواجه هستند و بیم آن می‌رود که توانمندی روانشناختی آنان به مخاطره افتد. این در حالی است که برخورداری از توانمندی روان شناختی برای پرستاران باعث افزایش اعتماد و تعهد سازمانی شده و نهایتاّ اثربخشی سازمان و کاهش تنش شغلی را برای پرستاران به ارمغان می‌آورد. در این میان، یکی از عواملی که با توانمندی روانشناختی پرستاران ارتباط دارد، تاب‌آوری است. هدف این مطالعه، تعیین تأثیر آموزش تاب‌آوری بر توانمندی روانشناختی پرستاران شاغل در بخش‌های مراقبت ویژه بود. روش بررسی: در این مطالعه نیمه‌تجربی، 96 نفر از پرستاران شاغل در بخش‌های مراقبت ویژه مراکز آموزشی درمانی وابسته به دانشگاه علوم پزشکی ایران در نیمه اول سال 1398 به روش نمونه‌گیری در دسترس، شرکت نمودند. پرستاران به شیوه غیرتصادفی در دو گروه آزمون و کنترل قرار گرفتند. اطلاعات با استفاده از ابزار توانمندی روانشناختی گردآوری شد. برنامه آموزشی در خصوص تاب‌آوری توسط پژوهشگر تهیه شد. این برنامه طی کارگاه دو روزه، هر روز چهار ساعت برای گروه آزمون برگزار گردید. در هر جلسه، ارائه محتوا به شیوه سخنرانی همراه با پرسش و پاسخ، بحث گروهی و پخش اسلاید برای پرستاران بود. به پرستاران تمریناتی برای ارتقای تاب‌آوری داده می‌شد و بازخوردهای آنان در طول هر جلسه ارزیابی می‌شد. گروه کنترل برنامه‌ای دریافت نکردند. یک ماه پس از اتمام مداخله، از هر دو گروه پس‌آزمون گرفته شد. داده‌ها با استفاده از آزمون‌های کای دو، دقیق فیشر، تی مستقل، تی زوجی، و تحلیل کوواریانس تحت نرم افزار SPSS نسخه 16 تجزیه و تحلیل شدند. یافته‌ها: در مرحله پیش‌آزمون بین نمرات توانمندی روانشناختی و تمام ابعاد آن به غیر از بعد معنی‌داری اختلاف معنی‌داری وجود داشت (05/0>P). در مرحله پس آزمون پس از کنترل اثر مخدوشگر، نمرات توانمندی روانشناختی و ابعاد آن در گروه آزمون به صورت معنی‌داری از گروه کنترل بیش‌تر بود (001/0>P). در گروه آزمون نمرات بعد از آزمون به صورت معنی‌داری بیش‌تر از قبل از آن بود (001/0>P) در صورتی که در گروه کنترل نمرات به صورت معنی‌داری کاهش یافته بود (001/0>P). هم چنین، تغییرات نمرات توانمندی روان شناختی و ابعاد آن در گروه آزمون به صورت معنی‌داری از گروه کنترل بیش‌تر بود (001/0>P). نتیجه‌گیری کلی: نتایج مطالعه حاضر بیان داشت که آموزش تاب ‌آوری منجر به بهبود توانمندی روانشناختی پرستاران شاغل در بخش‌های مراقبت ویژه می­شود. بنابراین،کاربرد برنامه‌های آموزشی با مضمون تاب‌آوری که ضمن کم هزینه بودن، در دسترس و با قابلیت اجرایی بالا نیز هستند به منظور ارتقای توانمندی روانشناختی کارکنان پرستاری به طور کلی و به طور خاص، پرستاران شاغل در بخش‌های مراقبت ویژه، باید مدنظر مدیران پرستاری قرار گیرد. http://ijn.iums.ac.ir/article-1-3161-fa.pdf 2020-04-11 22 34 10.29252/ijn.33.123.22 آموزش تاب‌آوری توانمندی روانشناختی پرستار بخش مراقبت ویژه The Effect of Resilience Training on the Psychological Empowerment of ICU Nurses Background & Aims: Nurses work in stressful and challenging environments, which threaten their mental health. Among nurses, those in the intensive care units (ICUs) of hospitals are more likely to experience occupational, psychological, and physical stress compared to others. Due to their special working conditions (heavy workload, the need for a quick response to emergency situations, heavy responsibilities of care for critically ill patients, frequent contact with emotional situations, and being in unwanted situations to deliver bad news to the families of patients), these nurses are forced to endure more psychological pressures, which brings up the grave concern of their psychological empowerment being jeopardized. Psychological empowerment in nurses could increase organizational trust and commitment, thereby resulting in job satisfaction, productivity, participation in decision-making, provision of high-quality care, patient satisfaction, self-sufficiency, independence, self-confidence, responsibility, job control, and ultimately organizational effectiveness and occupational stress reduction. Therefore, it seems that nurses working in hospitals (especially in ICUs) need to improve their psychological empowerment. Meanwhile, resilience is one of the factors associated with the psychological empowerment of nurses. Resilience results in the better professional performance of nurses and is also a feature to help them adapt to the stresses of their work environment and improve their professional health. In the current century, nurses need to skillfully develop their resilience as it helps them to overcome their negative experiences and turn them into positive experiences. Therefore, nurses who are exposed to high stress levels could be trained to enhance their ability to overcome these pressures and gain a sense of worth. From a deeper perspective, resilience knowledge is a key to professional development in nursing. It has become increasingly important for nurses to be resilient as resilience with a preventative approach improves their mental health. Resilience training also seems to improve the psychological empowerment of nurses. The present study aimed to assess the effects of resilience training on the psychological empowerment of ICU nurses. Materials & Methods: This quasi-experimental study was conducted in the second half of 2019 on 96 nurses working in the ICUs of the teaching hospitals affiliated to Iran University of Medical Sciences. The subjects were selected via convenience sampling. The nurses were non-randomly assigned to two groups of experimental and control (48 ​​per each). Data were collected using a demographic data form to measure age, gender, economic status, marital status, employment status, work experience, and type of shifts. In addition, the psychological empowerment scale was used for data collection with the dimensions of sense of competence, independence, effectiveness, and meaningfulness. The validity of the scale was evaluated using the content validity method, and its reliability was confirmed at the Cronbach's alpha coefficient of 0.84. Initially, pretest was performed on both groups. The resilience educational program was developed by the researcher based on concepts such as optimism, empathy, humor, problem-solving, coping with stress, self-efficacy, social adequacy, emotional management, and spirituality. The program was held for two hours per day for the experimental group during a two-day workshop. In each session, the presentation of the contents was performed in the form of a lecture with questions and answers, group discussions, and slide shows for the nurses. In addition, the nurses were provided with exercises to improve resilience, and their feedback was assessed during each session. The control group received no intervention. One month after the intervention, posttest was carried out on both groups. After the posttest on both groups, the resilience training contents were also provided electronically to the control group. This article was extracted from a research project approved by Iran University of Medical Sciences. During the research process, the ethical policies of the university were observed, including obtaining informed consent from the nurses. Data analysis was performed in SPSS version 16 using descriptive statistics (mean and standard deviation) and inferential statistics (Chi-square, independent and paired t-test, Fisher's exact test, and analysis of covariance). Results: At the pretest stage, significant differences were observed in the scores of psychological empowerment and all its dimensions, with the exception of meaningfulness (P<0.05). At the posttest and after the control of the effects of the confounders, the scores of psychological empowerment and its dimensions were significantly higher in the experimental group compared to the control group (P<0.001). In the experimental group, the scores were significantly higher after the intervention compared to before the intervention (P<0.001), while the scores significantly decreased in the control group (P<0.001). Furthermore, the changes in the scores of psychological empowerment and its dimensions were significantly higher in the experimental group compared to the control group (P<0.001).     Conclusion: According to the results, resilience training could improve the overall psychological empowerment of the ICU nurses in the four dimensions of sense of competence, independence, effectiveness, and meaningfulness. Considering that nursing is a profession that may threaten psychological empowerment, the use of resilience-based training programs that are low-cost, available, and high-performance could enhance the psychological empowerment of the nursing staff in general and ICU nurses in particular and should be considered by nursing managers. http://ijn.iums.ac.ir/article-1-3161-en.pdf 2020-04-11 22 34 10.29252/ijn.33.123.22 Training Resilience Psychological Empowerment Nurse Intensive Care Unit Z Hezaveh 1 Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0001-9943-0016 M Mardani Hamooleh 2 Nursing Care Research Center, Department of Psychiatric Nursing, Iran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0001-5945-9121 N Seyed Fatemi 3 Nursing Care Research Center, Department of Psychiatric Nursing, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: 02143651722 Email: seyedfatemi.n@iums.ac.ir AUTHOR https://orcid.org/0000-0002-5292-4219 SH Haghani 4 Biostatistics, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0003-3691-8246
OTHERS_CITABLE وضعیت و تعیین‌کننده‌های فاصله موالید در بین زنان روستایی زمینه و هدف: فاصله گذاری مناسب بین موالید به عنوان یکی از عوامل تضمین کننده سلامت مادر و کودک همواره مورد تأکید و توجه قرار گرفته است. برنامه‌های بهداشت باروری برای تحقق این امر مهم، ضروری به نظر می‌رسد. فاصله‌گذاری به معنی تلاش برای حفظ فاصله‌ای مشخص بین تولدها است که صریحاً نسبت به کودک تازه متولد شده تعریف خواهد شد. بارداری با فواصل نزدیک که گاهی در ادبیات بهداشت و سلامت عمومی با عنوان تکرار سریع حاملگی یاد می‌شود، خطر بیماری‌های نامطلوب مادر و کودک را افزایش خواهد داد. ادبیات موجود در این حوزه نشان داده است که هر سال بیش از 54 میلیون زن از عوارض طول دوره بارداری و زایمان رنج می‌برند و حدود 5/1 میلیون نفر نیز فوت می‌کنند که 99 درصد این مرگ‌ها به کشورهای در حال توسعه اختصاص دارد. از آن جا که زمان و فاصلۀ تولدهای متعاقب یکی از تعیین‌کننده‌های اصلی باروری است از این‌رو محققانی که باروری را تحلیل می‌کنند همیشه دو عامل فوق را بررسی کرده‌اند. به‌علاوه نشان داده شده است که فاصله کوتاه بین موالید، پیامدهای منفی بی‌شماری در دوران کودکی و بزرگسالی خواهد داشت. هدف مطالعه حاضر تعیین فاصله موالید در میان زنان روستایی و تعیین‌کننده‌های آن در استان فارس است. با مطالعه فوق تلاش شد که گروه زنان آسیب‌پذیر مشخص شوند تا در برنامه‌ریزی‌های حوزه سلامت و بهداشت باروری مورد توجه ویژه‌ای قرار گیرند. با این هدف می‌توان سطح عمومی سلامت مادر و کودک را در جامعه نیز ارتقاء داد. روش بررسی: مطالعه حاضر از نوع مقطعی و تحلیلی است که با استفاده از پرسشنامه محقق ساخته انجام شده است. نمونه آماری دربرگیرنده 882 نفر از زنان دارای همسر 15 تا 49 ساله ساکن در مناطق روستایی استان فارس است که حداقل دو فرزند داشته‌اند. پیمایش با تکنیک نمونه‌گیری خوشه‌ای در مهر ماه سال 1394 انجام شده است. سن زن، سن همسر، سال ازدواج، قومیت، مذهب، سطح تحصیلات، و وضعیت اشتغال متغیرهای مستقل تحقیق حاضر بودند. همچنین سال تولد هر فرزند از زنان پرسیده شد. فاصله موالید متغیر وابسته تحقیق حاضر بود. در مطالعه حاضر با توجه به سطح میزان باروری زنان، فواصل بین موالید اول و دوم و نیز موالید دوم و سوم مورد توجه و تأکید قرار گرفته شد. تجزیه و تحلیل داده‌ها با استفاده از جداول فراوانی و آزمون رگرسیون خطی چند متغیری در محیط نرم افزار SPSS نسخه 16 انجام شده است. سطح معنی‌داری نیز 05/0 در نظر گرفته شده است. یافته‌ها: نتایج نشان داد که میانگین و انحراف معیار سن شرکت کنندگان 25/6 ± 29/35 و در مقابل میانگین و انحراف معیار سن همسران آن‌ها 89/6 ± 31/40 بود. میانگین و انحراف معیار سن زنان در اولین ازدواج 95/3 ± 56/19 بود. عمده پاسخگویان فارس و شیعی مذهب بودند. غالب زنان مورد مطالعه با نسبت 6/53 درصد دو فرزند داشتند. به‌علاوه، چهار درصد زنان روستایی تحصیلات دانشگاهی یا بالاتر از دیپلم داشتند که درصد مشابه برای مردان 6/5 درصد بود. یافته‌ها همچنین نشان داد که بیشترین نسبت زنان روستایی و شوهران‌شان تحصیلات راهنمایی و کمتر داشتند. همچنین 3/3 درصد زنان روستایی شاغل و در مقابل 9/94 درصد همسران آن‌ها شاغل بودند. به‌علاوه، یافته‌ها از آن حکایت داشت که 6/83 درصد خانوارهای روستایی کمتر از یک میلیون تومان و 9/0 درصد نیز بیش از 5/2 میلیون تومان درآمد ماهانه داشتند. نتایج نشان داد که 8/31 درصد از زنانی که دو فرزند داشتند فرزند دوم خود را با فاصله کمتر از سه سال از فرزند اول به دنیا آورده‌اند. این نسبت برای زنانی که سه، چهار و یا پنج فرزند داشته‌اند به ترتیب برابر با 52، 7/65 و 80 درصد بوده است. نتایج گویای آن بود که فاصله تولد دوم تا سوم به ترتیب برای 3/25، 5/50 و 8/78 درصد از زنانی که سه، چهار یا پنج فرزند داشته‌اند کمتر از سه سال بوده است. تمامی زنانی که چهار فرزند داشتند فرزند چهارمی را با فاصله کمتر از سه سال از فرزند قبلی خود به دنیا آورده بودند. تحلیل چند متغیره داده‌ها نشان داد که متغیرهای قومیت (023/0 P=) و مذهب (002/0 P=) اثر معنی‌داری بر فاصله فرزند اول تا دوم داشتند به طوری که متوسط فاصله موالید زنان روستایی متعلق به قومیت فارس و نیز زنان اهل تشیع بیشتر از متوسط این فاصله برای زنان سایر قومیت‌ها و زنان اهل تسنن بود. دو متغیر قومیت (001/0 P=) و مذهب (027/0 P=) نیز تنها متغیرهای معنی‌دار تأثیرگذار بر فاصله فرزند دوم تا سوم زنان روستایی استان فارس بود. نتیجه‌گیری کلی: نتایج این مطالعه نشان داد که ویژگی‌های جمعیتی و اقتصادی- اجتماعی اثر نسبتاً مشابهی بر فاصله موالید تا فرزند سوم دارد اما قدرت تبیین‌کنندگی مشخصه‌های فوق برای موالید رتبه دوم تا سوم به طور نسبی افزایش می‌یابد. به‌عبارتی می‌توان گفت در موالید رتبه‌های اول تا سوم کنش فرزندآوری زنان روستایی، مشخصاً فاصله موالید، نسبتاً یکسان است و تفاوت زیادی برحسب ویژگی‌های اقتصادی- اجتماعی زنان ندارد. قومیت و مذهب اثرات معنی‌داری بر فاصله موالید داشتند. قومیت و مذهب زنان مورد بررسی می‌تواند با وضعیت اقتصادی- اجتماعی آن‌ها در ارتباط باشد. به نظر می‌رسد زنان شاغل به منظور ترکیب نمودن فرزندآوری و اشتغال، مجبورند فاصله فرزندآوری خود را افزایش دهند. با این وجود، در مطالعه حاضر، هیچ رابطه معنی‌داری بین وضعیت اشتغال زنان و فاصله موالید به دست نیامد اما یافته‌های این مطالعه نشان داد که زنان شاغل در مقایسه با زنان خانه‌دار، فرزند دوم خود را با فاصله بیشتری از فرزند اول به دنیا می‌آورند اما فاصله تولدهای دوم تا سوم بالعکس است. تحصیلات زنان در مطالعات پیشین از متغیرهای معنی‌دار تأثیرگذار بر فاصله بین موالید بوده است که در مطالعه حاضر چنین رابطه معنی‌داری به دست نیامد. بر اساس یافته‌های فوق می‌توان نتیجه گرفت که زنان اهل تسنن و زنان غیر فارس زبان باید مورد توجه بیشتری قرار بگیرند و اهمیت فاصله‌گذاری مناسب بین موالید باید به این زنان آموزش داده شود. زنان مذکور نیازمند توجه بیشتری با هدف آگاه سازی در ارتباط با فاصله مناسب موالید هستند. با اتخاذ و اجرایی کردن دوره‌های آموزشی لازم در میان زنان آسیب‌پذیر می‌توان خلاء فوق را کاهش داد و در نتیجه سطح عمومی سلامت این دسته از مادران و نوزادان آن‌ها را نیز ارتقاء بخشید   http://ijn.iums.ac.ir/article-1-3168-fa.pdf 2020-04-13 35 46 10.29252/ijn.33.123.35 زنان مناطق روستایی فاصله موالید رتبه تولد The Status and Determinants of Birth Interval in the Rural Women of Fars Province, Iran Background & Aims: Proper intervals between births have been emphasized as a factor to guarantee the health of the mother and infant. Therefore, reproductive health programs are essential to achieving this important goal. Birth intervals are an effort to maintain a certain interval between births, which is explicitly defined relative to the newborn. Closely birth intervals are referred to as rapid repeated pregnancy in the public health and medical literature and increase the risk of various disorders in the mother and infant. The current literature in this regard indicates that more than 54 million women suffer from health problems during pregnancy and delivery each year, and approximately 1.5 million die, 99% of which occur in developing countries. Since the time and interval of subsequent births are the main determinants of fertility, fertility researchers have widely investigated these factors. In addition, evidence suggests that short intervals between births cause numerous adverse consequences in childhood and adulthood. The present study aimed to investigate the birth intervals and its determinants in the rural women of Fars province, Iran. In general, we sought to identify the vulnerable groups of women that need special attention in health and reproductive health programs, so that the general health of mothers and infants would be promoted in the community. Materials & Methods: This cross-sectional, analytical study was conducted using a researcher-made questionnaire on 882 married women aged 15-49 years with two or more children living in the rural areas of Fars province. The survey was performed using cluster sampling in October 2015. The independent variables included age, age of the spouse, year of marriage, ethnicity, religion, education level, and occupation status. In addition, the birth year of each child was recorded by asking the women, and birth interval was the dependent variable. Based on the fertility level of the women, the intervals between the first and second births, as well as the second and third births, were also considered and emphasized. Data analysis was performed in SPSS version 16 using frequency tables and multiple regression analysis at the significance level of 0.05. Results: The mean age of the participants was 35.29±6.25 years, and the mean age of the spouses was 40.31±6.89 years. The mean age of the women in the first marriage was 19.56±3.95 years. The majority of the respondents were Persians and Shiites, and the majority of the women (53.6%) had two children. Furthermore, 4% of the rural women had academic education or higher educational degrees than diploma, and this rate was estimated at 5.6% for men. The findings also indicated that the largest proportion of the rural women and their spouses had secondary education or lower. In terms of occupation status, 3.3% of the rural women and 94.9% of the spouses were employed. In addition, approximately 83.6% of the rural households earned less than 10 million Rials, and 0.9% earned more than 25,000,000 million Rials per month. According to the results, 31.8% of the women with two children gave birth to their second child less than three years after the birth of the first child. This rate was estimated at 52%, 65.7%, and 80% for the women with three, four, and five children, respectively. The interval between the second and third birth for 25.3%, 50.5%, and 78.8% of the women with three, four, and five children was less than three years, respectively. On the other hand, all the women with four children gave birth to their fourth child less than three years after their last child. The multivariate analysis of the data indicated that ethnicity (P=0.023) and religion (P=0.002) had a significant effect on the birth interval between the first and second births, and the average birth interval in the Persian and Shiite women was higher than the women of other ethnicities and Sunni women. Notably, ethnicity (P=0.001) and religion (P=0.027) were the only significant variables to affect the interval between the birth of the second and third children of the rural women in Fars province. Conclusion: According to the results, demographic and socioeconomic characteristics had relatively similar effects on the birth interval between the first and third children, while the explanatory power of these factors increased relatively with the interval between the second and third births. In other words, the interval between the first and third childbirths in the rural women was relatively the same, and no significant differences were observed in terms of the socioeconomic characteristics of the women. Ethnicity and religion also had significant effects on the birth interval, which could be associated with the socioeconomic status of the rural women. It seems that the employed women had to increase their birth intervals due to the combination of childbirth and occupation. Nevertheless, no significant correlation was denoted between the occupation status of the women and birth intervals, while our findings indicated that the employed women were more likely to give birth to their second child within an increased interval from the first birth compared to the unemployed women, while it was the opposite in the case of the interval between the second and third births. Previous studies have indicated that the education level of women is a significant influential factor in birth intervals, while no such significant correlation was observed in this study. Furthermore, it could be inferred that the Sunni and non-Persian women needed more attention as a vulnerable population, and they should be properly trained on the importance of adequate birth intervals. These women also need more attention to raise their awareness regarding adequate birth intervals. By adopting and implementing the necessary training courses in vulnerable women, the issues associated with birth intervals could reduce, which in turn promotes the general health of these women and their infants. http://ijn.iums.ac.ir/article-1-3168-en.pdf 2020-04-13 35 46 10.29252/ijn.33.123.35 Women Rural Areas Birth Interval Birth Order S Mahmoudiani 1 Demography, Department of Sociology and Social Planning, Shiraz University, Shiraz, Iran AUTHOR https://orcid.org/: 0000-0003-3686-1171 R Khosravi 2 Social Work, Department of Sociology and Social Planning, Shiraz University, Shiraz, Iran AUTHOR https://orcid.org/0000-0002-3188-3745 A Javadi 3 Department of Statistics, Vice Chancellor of Health, Shiraz University of Medical Sciences, Shiraz, Iran (*Corresponding author) Tel: 09171209934 Email: afshan.javadi@gmail.com AUTHOR https://orcid.org/0000-0002-3145-7893
OTHERS_CITABLE تأثیر یادگیری الکترونیکی تعاملی بر دانش پرستاران مراقبت ویژه ICU در زمینه بیماری دلیریوم زمینه و هدف: دلیریوم یکی از حادترین و رایج­ترین اختلالات شناختی در میان بیماران بستری در بخش­های مراقبت ویژه می­باشد. یکی از عوامل مرتبط با مراقبت ضعیف در بین پرستاران، کمبود دانش کافی و مؤثر برای شناسایی دلیریوم است. این مطالعه با هدف تعیین تأثیر یادگیری الکترونیک تعاملی بر دانش پرستاران مراقبت ویژه درخصوص دلیریوم صورت گرفت. روش بررسی: این مطالعه نیمه­تجربی به روش پیش آزمون- پس آزمون با گروه کنترل بر روی 88 پرستار شاغل در بخش­های مراقبت­های ویژه دو بیمارستان آموزشی منتخب دانشگاه علوم پزشکی لرستان در سال 1398 که به روش تمام شماری انتخاب شدند، انجام گرفت. به منظور جلوگیری از آلودگی یک بیمارستان به عنوان مداخله و دیگری به عنوان کنترل انتخاب شدند. مداخله شامل استفاده از محتوای یادگیری الکترونیکی تعاملی بود که بر روی سایت بیمارستان گروه مداخله بارگذاری شد. بلافاصله قبل و ۲ ماه پس از ورود به مطالعه، داده­ها با استفاده از پرسشنامه دانش پرستاران در مورد دلیریوم (DKQ) در دو گروه سنجیده شد. پس از جمع­آوری داده، تحلیل آن­ها با استفاده از آزمون تی مستقل، تی زوجی، کای اسکوئر، آزمون دقیق فیشر در نرم افزار  SPSSنسخه 16 انجام گرفت. یافته‌ها: نتایج نشان داد که نمرات دانش پرستاران ICU پس از یادگیری به شیوه الکترونیکی تعاملی در گروه مداخله افزایش یافته و به طور معناداری در مقایسه با گروه کنترل بالاتر بود (001/0 P<). تغییرات نمره دانش در دو گروه مورد مطالعه در برخی حیطه ها مثبت بود، اما این افزایش نمره درگروه مداخله به طور معنی­داری بیشتر از گروه کنترل بود (001/0 P<). نتیجه‌گیری کلی: با توجه به نتایج پژوهش، استفاده از یادگیری به شیوه الکترونیک تعاملی بر دانش پرستاران شاغل در بخش­های ICU مؤثر بود. بنابراین استفاده از این روش آموزشی برای آموزش کارکنان سلامت بویژه پرستاران و نیز دانشجویان پرستاری پیشنهاد می­شود. http://ijn.iums.ac.ir/article-1-3169-fa.pdf 2020-04-15 47 61 10.29252/ijn.33.123.47 دانش دلیریوم آموزش از راه دور آموزش مداوم The Effect of Interactive E-learning on the Knowledge of ICU Nurses Regarding Delirium Background & Aims: Delirium is one of the most acute and prevalent cognitive disorders with complex causes among hospitalized patients and is also considered to be a common issue in the patients admitted to intensive care units (ICUs) worldwide. As the patients admitted to ICUs are exposed to numerous life-threatening physiological diseases and health challenges, their care process is extremely difficult to nurses. As such, the management of delirium as an important component of the routine care of these patients is highly demanding and challenging for ICU nurses. The high incidence and prevalence of this disorder in ICUs imposes significant costs on the healthcare system of countries and is also a strain of care for nurses, which ultimately leads to numerous adverse consequences in the affected individuals. Despite the importance of this syndrome and availability of various screening tools, the care level of these patients by nurses is rather poor. Since the nursing team is a key element in ICUs and in constant contact with patients, nurses could play a key role in the prevention of the clinical consequences and management of delirium since the preventative strategies for the occurrence and development of delirium or shortening its duration is highly effective owing to the provided care by these healthcare professionals, who provide full-time care to critically ill patients. Lack of sufficient and effective knowledge regarding delirium is an important factor associated with poor nursing care to identify this disorder. Therefore, increasing their knowledge could help with the timely identification and accurate and optimal management of the disorder, which in turn prevent the permanent complications, disabilities, and cerebral dementia, lengthy ICU admission, and reducing the associated mortality. Although education is recognized as an important factor in delirium prevention and treatment strategies, the type and methods of education and use of various approaches to the training of nurses on delirium could also be effective in this regard. Today, the advancement in educational technology has prompted the use of new methods as an alternative to traditional methods. Considering the easy access to educational contents and use of interactive feedback mechanisms, interactive e-learning has been described as an alternative approach to the teaching of large groups and offers a more flexible and cost-effective method than traditional teaching methods. The present study aimed to assess the effects of interactive e-learning on the knowledge of ICU nurses regarding delirium. Materials & Methods: This quasi-experimental study was conducted with a pretest-posttest design and a control group on 88 ICU nurses of two teaching hospitals affiliated to Lorestan University of Medical Sciences, Iran in 2019. The subjects were selected via counting sampling. Based on the sampling method and inclusion criteria of the study, the nurses were selected. After obtaining informed consent from the research units, Shahid Rahimi Hospital was selected as the intervention group, and Shohada Ashayer Hospital was considered as the control group. In order to prevent contamination, one hospital was selected as the intervention, and another was selected as the control. The intervention involved the use of interactive e-learning contents in the form of four outputs of the Storyline software with various definitions of delirium and its characteristics, clinical symptoms, and types of delirium (16 minutes), as well as the predisposing and accelerating factors of the disease and preventive methods (20 minutes). In addition, the duration of the treatment was 23 minutes, and the diagnostic strategies and screening tools were presented for 22 minutes, along with the questions of each ward. The educational contents were uploaded on the hospital site that was considered as the intervention environment, and its link was provided to the nurses of the intervention group for two months. Immediately before and two months after enrollment, the obtained data were assessed using the delirium knowledge questionnaire (DKQ) in both groups. After data collection, data analysis was performed in SPSS version 16 using independent and paired t-test, Chi-square, Fisher's exact test, and effect size. Results: The knowledge scores of the ICU nurses and its dimensions were significantly higher in the intervention group compared to the control group after the interactive e-learning (P<0.001). However, no significant differences were observed in the control group in this regard after the interactive e-learning compared to before the intervention (P>0.05). In general, the effect of interactive e-learning on the knowledge of the intervention group (2.22 and 1.29) was 1.75, which showed the large effect of training on increasing the knowledge of the nurses in the intervention group compared to the control group. In addition, the changes in the total score of knowledge in the intervention group were more significant compared to the control group, so that education could increase the knowledge of the nurses. The higher effect size than 0.8 after the intervention in the total score and scores of the subscales of knowledge indicated the large impact of interactive e-learning on the increased knowledge of delirium and its subscales in the nurses. Conclusion: The results of the study showed the positive effect of interactive e-learning on the knowledge of the nurses in the intervention group compared to the control group working in the ICUs of the research environments. Therefore, the use of interactive e-learning was effective in improving the knowledge of the ICU nurses, and this educational method is recommended for the training of health workers, especially nurses and nursing students. Although the changes in knowledge scores and subscale scores of delirium symptoms, signs, and consequences were positive in both groups, the increase in the scores was more significant in the intervention group compared to the control group, which could be attributed to interactive e-learning. Although the knowledge score was observed to decrease in both subscales of the risk factors and causes of delirium and disease management and prevention strategies in the control group, the changes in the knowledge scores of the intervention group increased after training in these subscales. Therefore, the decreased knowledge score in the control group may be due to the lack of interactive e-learning, while the increase in the scores of the intervention group was attributed to interactive e-learning. http://ijn.iums.ac.ir/article-1-3169-en.pdf 2020-04-15 47 61 10.29252/ijn.33.123.47 Knowledge Delirium Continuing Education Distance Learning T Najafi Ghezeljeh 1 Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0002-2779-2525 F Rahnamaei 2 Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: +09369694744 Email: rahnamaeia@yahoo.com AUTHOR https://orcid.org/0000-0002-2917-4122 S Omrani 3 Distance Education Planning, Instructional Design Consultant at E-Learning Center, Iran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0002-4962-7555 SH Haghani 4 Biostatistics, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/ 0000-0002-1334-9759
OTHERS_CITABLE تأثیر برنامه آموزشی مدیریت خشم بر پرخاشگری افراد دارای اختلالات دوقطبی: یک مطالعه نیمه تجربی زمینه و هدف: یکی از ویژگی‌های افراد دارای اختلال دو قطبی دوره‌های خشم انفجاری است که سبب آسیب به خود و دیگران می‌شود. پیامد پرخاشگری در این گروه از افراد آسیب‌‌پذیر، رانده شدن آنان به سوی سوء مصرف مواد و الکل خواهد بود و در نهایت عملکرد اجتماعی آنان مختل می‌گردد. بر این اساس، هدف تحقیق حاضر، تعیین تأثیر برنامه آموزشی مدیریت خشم بر پرخاشگری افراد دارای اختلالات دو قطبی بود. روش بررسی: پژوهش حاضر یک مطالعه نیمه ‌تجربی و تک گروهی بود که در سال 1398 در مرکز روانپزشکی ایران انجام شد. مشارکت‌کنندگان  به تعداد 39 نفر و به روش مستمر از بین افراد بستری دارای اختلالات دوقطبی بر اساس معیارهای ورود و خروج انتخاب شدند. ابزار مورد استفاده، مقیاس روا و پایا شده پرخاشگری  Perryو Buss بود. برنامه آموزشی مدیریت خشم شامل راه‌های برخورد با خشم و پرخاشگری، آموزش مهارت‌های مدیریت خشم مؤثر، ایفای نقش در زمان خشم، آموزش مهارت حل مسأله و آموزش مهارت قاطعیت برای افراد دارای اختلالات دوقطبی ارائه شد. این برنامه در گروه‌های کوچک به مدت چهار هفته، هر هفته دو جلسه 60 دقیقه‌ای به صورت سخنرانی توسط پژوهشگر همراه با پرسش و پاسخ و بیان تجارب و ایفای نقش اجرا شد. یک ماه پس از اتمام مداخله، از شرکت کنندگان در مطالعه، پس آزمون گرفته شد. تحلیل داده‌ها نیز با بهره‌گیری از نرم افزار SPSS نسخه 16 و با استفاده از آمار توصیفی (میانگین و انحراف معیار) و استنباطی (آزمون تی زوجی) انجام شد. یافته‌ها: در مرحله پیش آزمون، میانگین نمره پرخاشگری افراد، 73/14±  74/99 بود. در مرحله پس آزمون، این میانگین نمره به 68/11±  21/83 کاهش یافت. آزمون تی زوجی نشان داد که نمرات پرخاشگری افراد دارای اختلالات دوقطبی در مراحل پیش آزمون و پس آزمون با هم اختلاف آماری معنی‌داری داشتند (003/0 P=و 061/ 3-t= ). طبق نتایج، برنامه آموزشی بر همه خرده مقیاس‌های پرخاشگری به جز پرخاشگری کلامی (814/0P=) مؤثر بود. نتیجه‌گیری کلی: نتایج پژوهش حاضر نشان داد که آموزش مدیریت خشم، می‌تواند پرخاشگری افراد دارای اختلال دوقطبی را در خرده مقیاس‌های پرخاشگری فیزیکی، خشم و خصومت، کاهش بخشد. نتایج این تحقیق می‌تواند گامی در جهت پیاده سازی و اجرای آموزش مدیریت خشم برای این گروه از افراد بستری در مراکز روانپزشکی به منظور بهبود پرخاشگری آنان باشد. http://ijn.iums.ac.ir/article-1-3172-fa.pdf 2020-04-18 62 72 10.29252/ijn.33.123.62 آموزش مدیریت خشم پرخاشگری اختلالات دوقطبی The Effect of Anger Management Educational Program on Aggression in the Individuals with the Bipolar Disorder: A Quasi-experimental Study Background & Aims: In the bipolar disorder, the mood of the individual is damaged and constantly and abnormally changes from very good to very bad and depressed. Outbursts of explosive anger are one of the characteristics of patients with the bipolar disorder, which causes self-harm and harm to others. Aggression occurs in this population due to factors such as the lack of social support, frequent recurrence of the disease, and failure to use medication. The main consequence of aggression in this vulnerable population is that they are pushed toward substance abuse and alcohol consumption, which eventually disrupt their social functioning. Considering the adverse, debilitative effects of aggression on patients with the bipolar disorder, proper measures must be taken for effective management. Since patients with the bipolar disorder experience severe emotional fluctuations that could damage themselves, their families, other patients, and nurses, it is important to reduce the damages to others and replace aggressive behaviors with constructive interactions in the form of anger management programs. Anger management is a skill taught for the control of aggression in bipolar patients. In fact, anger management helps these individuals learn how to stay calm and control their negative emotions before the onset of anger. In other words, the purpose of this psychological training is to increase psychosocial abilities, effectively deal with the conflicts in life, prevent harmful behaviors to health, and promote the mental health of bipolar patients. The present study aimed to evaluate the effect of an anger management educational program on the aggression of individuals with bipolar disorders. Materials & Methods: This single-group, quasi-experimental study was conducted at Iran Psychiatric Center in 2019 on 39 participants, who were selected via continuous sampling from the admitted patients with the bipolar disorder based on the inclusion and exclusion criteria of the study. Data were collected using a demographic questionnaire for the variables of age, gender, marital status, occupation status, education level, and history of admission due to bipolar disorders. In addition, the valid and reliable aggression scale by Buss and Perry was used for data collection, which consisted of for subscales, including physical aggression, verbal aggression, anger, and hostility. Initially, a pretest was performed on the participants. Afterwards, the anger management training program was presented to the participants. Notably, the contents of the educational program were prepared based on the available texts regarding anger management with an emphasis on the psychotherapeutic considerations regarding the aggression of patients with the bipolar disorder. The covered subjects in the program included ways to deal with anger and aggression, teaching effective anger management skills, playing a role in anger, teaching problem-solving skills, and decisiveness training for patients with the bipolar disorder. Following that, the validity of the educational contents was confirmed by psychiatric nursing professors. The training program was presented through lecture by the co-researcher with questions and answers between the researcher and the participants and expressing the experiences and roles played by the participants in the study. The program was implemented for four weeks with two 60-minute sessions each week. Due to the fact that it was not possible to gather all the participants in the training sessions, the sessions were held in small groups with gender segregation for 5-7 participants. The meetings were held after the hour of prayer and lunch in the visiting rooms of the inpatient wards. In addition, a 15-minute break was considered for each session. One month after the intervention, the participants were post-tested. This article was extracted from a research project approved by Iran University of Medical Sciences. During the research process, the ethical policies of the university were observed, including obtaining informed consent from the participants and their voluntary participation. Data analysis was performed in SPSS version 16 using descriptive statistics (mean and standard deviation) and inferential statistics (paired-t test). Results: At the pretest, the mean score of aggression was 99.74±14.73, which reduced to 83.21±11.68 at the posttest. At the pretest and posttest stages, the mean scores of physical aggression, verbal aggression, anger, and hostility were 32.90±8.02 and 28.87±6.86 (P=0.042), 19.41±3.73 and 17.77±3.55 (P=0.814), 22.69±4.47 and 17.85±3.41 (P=0.010), and 24.74±7.55 and 18.72± 6.55 (P=0.032), respectively. In addition, the results of paired t-test indicated significant differences in the scores of aggression at the pretest and posttest in the patients with the bipolar disorder (t=-3.061; P=0.003). The anger management educational program affected all the dimensions of aggression, with the exception of verbal aggression (P=0.814). Conclusion: According to the results, anger management training could reduce the aggression of the patients with the bipolar disorder in the subscales of physical aggression, anger, and hostility. Our findings could be a step toward the implementation of anger management training for this population of inpatients admitted to psychiatric centers in order to improve their aggression. Furthermore, it is recommended that nurses working in psychiatric wards become familiar with the educational contents of anger management for the subjects under study, so that they could perform the program at the bedside of these patients in appropriate situations in admission wards. In addition, the obtained results are useful for nursing managers and psychiatrists to better manage the care of individuals with the bipolar disorder. In the field of clinical education, the content of anger management could be provided to clinical nursing instructors to acquaint their students with such trainings, so that students could use the contents in their care plans for patients with the bipolar disorder. http://ijn.iums.ac.ir/article-1-3172-en.pdf 2020-04-18 62 72 10.29252/ijn.33.123.62 Education Anger Management Aggression Bipolar Disorders M Khoshnevisan 1 Psychiatric Nursing, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran AUTHOR N Seyedfatemi 2 Nursing Care Research Center, Department of Psychiatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0002-5292-4219 M Mardani Hamooleh 3 Nursing Care Research Center, Department of Psychiatric Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran (*Corresponding author) Tel: 02143651814 Email: mardanihamoole.m@iums.ac.ir AUTHOR https://orcid.org/0000-0001-5945-9121 M Ranjbar 4 Psychiatric Nursing, Iran Psychiatric Center, Iran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0001-6569-6609 H Haghani 5 Department of Biostatistics, School of Health, Iran University of Medical Sciences, Tehran, Iran AUTHOR https://orcid.org/0000-0002-2239-7139
OTHERS_CITABLE ضرورت‌ها و الزامات بخش آنژیوگرافی کودکان از منظر تیم مراقبتی: یک مطالعه کیفی زمینه و هدف: آنژیوگرافی اطفال برای تشخیص و درمان ناهنجاری‌های قلبی مادرزادی در اطفال به صورت گسترده در دو دهه گذشته استفاده شده است. به منظور ارتقاء و بهبود محیط مراقبت ویژه کودکان توجه به تجارب و نظرات پرستاران شاغل در محیط مراقبت ویژه کودکان از اهمیت به سزایی برخوردار است. هدف تحقیق حاضر، تبیین ضرورت و الزامات بخش آنژیوگرافی کودکان از منظر تیم مراقبتی بود. روش بررسی: این پژوهش به شیوه رویکرد تحلیل محتوای کیفی در سال 2018 انجام شد. مشارکت کنندگان 20 نفر شامل نه پرستار، چهار رادیولوژیست و هفت پزشک قلب بودند که به روش هدفمند از بخش آنژیوگرافی بیمارستان هاجر شهرکرد انتخاب شدند. مدت مصاحبه‌ بین 35 تا 60 دقیقه بود. جمع‌آوری داده‌ها و مصاحبه‌ها تا اشباع داده‌ها انجام شد. جمع‌آوری و تجزیه تحلیل داده‌ها چهار ماه طول کشید. جهت تحلیل داده‌ها از روش تحلیل محتوای کیفی قراردادی استفاده شدبه منظور اطمینان از صحت یافته‌های پژوهش از چهار معیار 1- اعتبار یا مقبولیت 2- قابلیت اعتماد یا همسان بودن 3- قابلیت انتقال 4- تأیید پذیری استفاده شد. یافته‌ها: از تحلیل داده‌ها سه طبقه حساسیت بخش، ضرورت کاربرد صحیح تجهیزات تخصصی، و ضرورت آموزش و مهارت آموزی به دست آمد. طبقه حساسیت بخش با سه زیرطبقه ویژه بودن بیماران، استریل بودن محیط آنژیوگرافی، و لزوم آشنایی با بخش مشخص شد. طبقه تجهیزات تخصصی با دو زیرطبقه گران بودن تجهیزات، و ضوابط مدیریت نگهداشت تجهیزات تخصصی، به دست آمد. طبقه ضرورت آموزش و مهارت آموزی با دو زیرطبقه نیاز به مهارت‌های دانشی و نیاز به مهارت‌های ارتباطی مشخص شد. نتیجه‌گیری کلی: سه یافته مهم این مطالعه ضرورت آشنایی و ضرورت کاربرد صحیح تجهیزات تخصصی و ضرورت آموزش و مهارت آموزی، همچون گنجینه‌ایی طلایی است که کلید آن در دست مدیران و مسئولان بیمارستان است. آموزش تیم مراقبتی در بخش آنژیوگرافی امری یکباره نیست بلکه فرآیندی مستمر است. از جمله مهارت‌های مورد نیاز کار در بخش آنژیوگرافی داشتن دانش کافی و توانایی ارتباط صحیح با بیمار و همراهان، و توانایی استفاده صحیح و مناسب از تجهیزات تخصصی در بخش است که می‌توان با برگزاری دوره‌های آموزشی ارتباط و مشاوره، برگزاری کلاس‌های آموزشی تجهیزات تخصصی، آمادگی‌های لازم برای کارکنان این بخش فراهم کرد. http://ijn.iums.ac.ir/article-1-3176-fa.pdf 2020-04-21 73 83 10.29252/ijn.33.123.73 بخش آنژیوگرافی کودکان تیم مراقبتی The Necessities and Requirements of the Pediatric Angiography Ward from the Perspective of the Healthcare Team: A Qualitative Study Background & Aims: Pediatric angiography has been widely used for the diagnosis and treatment of congenital heart disorders in children over the past two decades. The work environment of the nurses of pediatric intensive care units is highly stressful due to various technical and medical equipment and patients with life-threatening diseases. In order to improve special pediatric care environments, attention must be paid to the experiences and opinions of the nurses employed in these units. To this end, the prioritization of the health of workplace and applying multidimensional approaches to the health promotion of the workplace are paramount. Considering the teamwork involved in patient care and treatment and increased number of beds in intensive care units, it is critical to evaluate the perceptions of physicians and nurses regarding the aspects of care in intensive care units. The improvement of the performance of pediatric critical care nurses and attention to their experiences and viewpoints are also essential in this regard. To this end, the prioritization of the health of workplace and applying multidimensional approaches to the health promotion of the workplace are paramount. The use of pediatric angiography has increased in the past two decades. In addition, the differences in the culture, environment, and education of nurses in pediatric intensive care units, along with the differences in the hospitalized patients further emphasize on the necessity of qualitative research. However, most of the studies in this regard have been performed with a quantitative approach, while only qualitative research could determine the dimensions of the perceptions of the healthcare team. To date, no qualitative studies have assessed the experiences of the healthcare team in the pediatric angiography ward. The present study aimed to elaborate on the necessities and requirements of the pediatric angiography ward from the perspective of the healthcare team. Materials & Methods: This study was conducted using the qualitative content analysis approach in 2018. The sample population included 20 subjects, including nine nurses, four radiologists, and seven cardiologists, who were selected via purposeful sampling from the angiography unit of Hajar Hospital in Shahrekord, Iran. The inclusion criteria were the nurses and physicians with one year of work experience in the angiography or cardiology ward and willingness to participate in the study, and the exclusion criterion was unwillingness to participate. The duration of the interviews was 35-60 minutes, and the recordings were performed in accordance with ethical principles. Data collection and interviews continued until reaching data saturation. Data collection and analysis continued for four months. The semi-structured, individual interviews were initiated with the nurses and physicians with an open question ("Please explain your experiences of working in the pediatric angioplasty ward."/"What challenges have you faced in performing pediatric angiography?") The interviews continued with probing questions ("Please explain further."/"Please set an example.") The obtained data were analyzed using the qualitative content analysis method. After the researcher listened to the recorded interviews several times, he was immersed in the data to obtain an overview of the interviews. All the interviews were transcribed word-for-word, so that the words containing the key concepts would be highlighted and the codes would be extracted. After extracting the concepts and codes from important sentences and paragraphs, they were classified into categories based on the similarities and differences, and the categories were reduced to a smaller number of categories based on their correlations. In order to maximize the diversity of the participants, the research units were selected from the nurses, physicians (pediatric cardiologists), and radiologists engaged in the angiography ward. To ensure the accuracy and reliability of the research findings, the four criteria of credibility, dependability, transferability, and conformability were considered. To observed ethical considerations, a letter of recommendation was obtained from the Vice-Chancellor of Research of Shahrekord University of Medical Sciences. In addition, written informed consent and permission to record the interviews were obtained from the subjects prior to participation. Results: The mean age of the nurses was 34 years, and the mean work experience in the angiography ward was five years. The mean age of the radiologists was 31.5 years, and the mean work experience in the angiography ward was three years. The mean age of the pediatric cardiologists was 45 years, and the mean work experience in the angiography ward was five years. Data analysis yielded the three categories of the sensitivity of the ward, the necessity of the proper use of specialized equipment, and the need for education and skills training. The category of the sensitivity of the ward had three subcategories of the special conditions of the patients, sterilization of the angiography environment, and the need to become familiarized with the ward. The category of the proper use of specialized equipment had two subcategories of expensive equipment and management regulations of the maintenance of specialized equipment. The category of the need for education and skills training had two subcategories of the need for knowledge skills and the need for communication skills. Conclusion: The three most important findings of this study were the need for familiarity and proper use of specialized equipment and the necessity of education and skills training, which are like a golden treasure, the key to which is in the hands of hospital managers and officials. The training of the healthcare team in the angiography ward is a gradual and continuous process. Among the required skills for practice in the angiography ward are having adequate knowledge and the ability to properly communicate with the patients and their companions and the ability to use the specialized equipment correctly and appropriately, which could be achieved through the implementation of communication and counseling training courses, training on the use of specialized equipment, and the necessary preparations for the personnel of this ward. Considering the sensitivity of the angiography ward, the criticality of the applied procedures in the ward, and important issues such as clinical governance and accreditation, special attention should be paid to educational need assessment in order to implement proper interventions by hospital managers and health planners in terms of the training and skills of the personnel. http://ijn.iums.ac.ir/article-1-3176-en.pdf 2020-04-21 73 83 10.29252/ijn.33.123.73 Angiography Ward Children Healthcare Team H Heidari 1 School of Nursing and Midwifery, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran (*Corresponding author) Tel: 0989133822402 Email:heidari.h@skums.ac.ir AUTHOR https://orcid.org/0000-0003-2818-9928 A Khaledifar 2 School of Medicine, Modeling in Health Research Center, Shahrekord University of Medical Sciences, Shahrekord, Iran AUTHOR https://orcid.org/0000-0001-2467-9879
OTHERS_CITABLE مدل‌یابی بروز نشانه‌های اختلالات شخصیت در پرستاران در مرحله گذراندن طرح نیروی انسانی و دانشجویان سال آخر رشته پرستاری بر اساس آسیب‌های دوران کودکی با نقش واسطه‌ای تنظیم شناختی هیجان زمینه و هدف: آسیب‏‏های دوران کودکی، عواقب پایدار و جبران‏ناپذیری را بر جا می‏گذارد. به طوری که از آثار روان‏شناختی طولانی‏مدت آن، می‏توان به بروز مشکلات رفتاری و روان‏شناختی عمده در نوجوانی و بزرگسالی از جمله اختلالات شخصیت خوشه C اشاره کرد. یکی از متغیرهایی که به نظر می‏رسد از آسیب‏های دوران کودکی تأثیر می‏پذیرد و می‏تواند منجر به بروز نشانه‏های اختلالات شخصیت شود، تنظیم شناختی هیجان است. از آنجا که پرستاران بزرگ‌ترین گروه بهداشتی و درمانی را تشکیل و بیش از هر گروه دیگری از کارکنان بیمارستان، بهره‏وری و پیشرفت سازمان را تحت تأثیر قرار می‏دهند، بنابراین مطالعه و بررسی پیشایندهای اختلال شخصیت در دانشجویان پرستاری از اهمیت بالایی برخودار است. هدف اصلی این پژوهش ارائه‏ی یک مدل از آسیب‏های دوران کودکی و تنظیم شناختی هیجان برای کمک به فهم بهتر اختلالات شخصیت خوشه C دانشجویان پرستاری بود. روش بررسی: در این پژوهش مقطعی از نوع توصیفی- همبستگی، 291 نفر از دانشجویان پرستاری دانشگاه علوم پزشکی شیراز در سال 1398 که به روش خوشه‌ای ساده انتخاب شده بودند، شرکت کردند. ابزارهای مورد استفاده در پژوهش حاضر شامل پرسشنامه آسیب‏های دوران کودکی، پرسشنامه تنظیم‏ شناختی هیجان (CERQ) و پرسشنامه چند محوری بالینیMillon -3 (MCMI-III) بودند. به منظور تحلیل داده‏های آماری از روش ضریب همبستگی پیرسون توسط نرم‏افزار SPSS نسخه 16 و به منظور تعیین برازش مدل مورد مطالعه از مدل معادلات ساختاری در نرم‏افزار AMOS-22 برای تحلیل مسیر متغیرهای مشاهده ‏پذیر بهره‏گیری به عمل آمد. یافته‏ها: یافته‏ها نشان داد که آسیب‏‏های عمومی، سوءاستفاده‏های جسمی و سوءاستفاده‏های جنسی دوران کودکی می‌توانند اختلال‏ شخصیت وسواسی- جبری دانشجویان را یا به صورت مستقیم (به ترتیب 01/0>p، 0005/0>p و 0005/0>p) و یا به صورت غیرمستقیم از طریق سبک‏های سازگار و ناسازگار تنظیم شناختی هیجان (01/0>p) تبیین کنند. سوءاستفاده‏های جسمی دوران کودکی می‌توانند اختلال شخصیت اجتنابی دانشجویان را یا به صورت مستقیم (05/0>p) و یا به صورت غیرمستقیم از طریق سبک‏های سازگار و ناسازگار تنظیم شناختی هیجان (05/0>p) تبیین کنند. سوءاستفاده‏های جسمی و سوءاستفاده‏های جنسی دوران کودکی می‌توانند اختلال‏ شخصیت وابسته دانشجویان را یا به صورت مستقیم (به ترتیب 001/0>p  و 05/0>p) و یا به صورت غیرمستقیم از طریق سبک‏های ناسازگار تنظیم شناختی هیجان (05/0>p) تبیین کنند. نتیجه‏گیری کلی: نتایج نشان داد آسیب‏های دوران کودکی، بدتنظیمی‏های هیجانی در دوران بزرگسالی را به دنبال دارند و نبود راهبردهای تنظیم هیجان مناسب، می‏تواند منجر به بروز نشانه‏های اختلالات شخصیت خوشه C شود. بنابراین آموزش راهبردهای سازگار تنظیم شناختی هیجان به عنوان یک مکانیسم تأثیرگذار بر اصلاح تنظیم شناختی هیجان عمل کرده و راهی مناسب برای بهبود اختلالات شخصیت خوشه C دانشجویان محسوب می‌شو http://ijn.iums.ac.ir/article-1-3222-fa.pdf 2020-04-23 84 107 10.29252/ijn.33.123.84 کودک‌آزاری تنظیم هیجان اختلالات شخصیت اختلال شخصیت جبری اختلال شخصیت وابسته Modeling of the Symptom Manifestation of Personality Disorders in Nursing Students and Temporary Nurses within the Human Research Project Based on Childhood Trauma and the Mediating Role of Emotional Cognitive Regulation Background & Aims: According to the World Health Organization (WHO) statistics, millions of children are victims of abuse each year. Childhood trauma could be physical or psychological abuse, sexual abuse or neglect of a child by the guardian. Abuse has long-lasting and irreversible effects on the psyche of children, which may linger even through adulthood. Among the long-term psychological effects of childhood abuse are major behavioral and psychological disorders in adolescence and adulthood. Such an example is the onset of the symptoms of cluster C personality disorders, which encompass avoidant, dependent, and obsessive-compulsive personality disorders, commonly characterized by anxiety, apprehension, and fear in the affected individuals. Cognitive emotional regulation is a variable that may be influenced by childhood trauma and lead to symptoms of personality disorders. Emotional regulation refers to the process through which an individual recognizes the emotions that are affecting them, how to experience these emotions, and their management. Recent findings suggest that even when child abuse is controlled, the problems associated with emotional regulation persist. Nurses constitute the largest portion of healthcare providers and affect the productivity and progress of the organization more than other hospital staff. In addition, the productivity of nurses ultimately leads to better decision-making in planning healthcare services. Therefore, assessing the predispositions of personality disorders in nursing students and temporary nurses within the program of human research project is paramount. One of these preconditions is the childhood traumas of the nursing students and temporary nurses within the program of human research project . The present study aimed to propose a model of childhood trauma and cognitive emotional regulation to help recognize cluster C personality disorders in the nursing students and temporary nurses within the program of human research project in 2019. Materials & Methods: This cross-sectional, descriptive-correlational study was conducted on the nursing students of Shiraz University of Medical Sciences in 2019 and the temporary nurses within the program of human research project in Shiraz, Iran. The inclusion criteria were consent to participate in the research, no history of psychological treatments for emotional disorders, no use of psychiatric medications for the reduction of anxiety, stress, and depression, living with parents, absence of specific chronic disorders affecting physical and mental health (e.g., migraine, severe lower back pain, diabetes, cardiac and renal diseases, and infertility), and normal course of life within six months before the investigation (i.e., no specific incidents or crisis such as the death of a loved one, an incurable disease of a family member, and change of residence). The subjects with incomplete questionnaires and those using psychiatric medications were excluded from the study. Data were collected using the self-report early trauma inventory-short form, cognitive emotion regulation questionnaire, and Millon clinical multiaxial inventory-III, which was completed in a self-report manner. During the completion of the questionnaires, the researcher, who was experienced in mental illness counseling, accompanied the participants to gain their trust and address their concerns in responding to the questions. The sample size of the study included 291 nursing students and employed nurses, which was estimated using the G-power software. The subjects were selected via simple cluster sampling. After providing the necessary explanations regarding the importance of the research and attracting sincere cooperation, the questionnaires were distributed among the students and nurses. Considering individual differences, the set time for the completion of the questionnaires was 15-30 minutes, and the questionnaires were received after completion. Data collection continued for one week and was performed at the hospital for the temporary nurses within the program of human research project with the coordination of the supervisor and at the nursing school for the senior nursing students. Data analysis was performed in SPSS version 22 using Pearson's correlation-coefficient to describe and analyze the statistical data. In addition, the AMOS-22 software was applied to determine the fit of the studied model based on the structural equation model and analyze the path of the observable variables. Notably, all the calculations were carried out at the statistical inference limit of P<0.05. Results: Childhood general traumas, childhood physical abuse, and childhood sexual abuse could explain the obsessive-compulsive disorder in the nursing students both directly (P<0.01, P<0.0005, and P<0.0005, respectively) and indirectly through adaptive and maladaptive cognitive emotional regulation styles (P<0.01). Moreover, childhood physical abuse could explain the avoidant personality disorder of the students both directly (P<0.05) and indirectly through adaptive and maladaptive cognitive emotional regulation styles (P<0.05). Childhood physical abuse and childhood sexual abuse could explain the dependent personality disorder of the students both directly (P<0.001 and P<0.05, respectively) and indirectly through maladaptive cognitive emotional regulation styles (P<0.05). The statistical findings also indicated that the obtained data supported the theoretical model of explaining personality disorders to a great extent, and all the indicators of fit confirmed that the proposed model is acceptable. Conclusion: According to the results, the senior nursing students and employed nurses within the program of human research project who have been abused as children were more likely to present with symptoms of cluster C disorder in their behaviors in adulthood. Furthermore, cognitive emotional regulation strategies acted as a mediating variable in the association of childhood trauma and cluster C personality disorder; in other words, childhood trauma leads to emotional maladjustment in adulthood, and the lack of appropriate emotional regulation strategies could lead to the symptoms of cluster C personality disorder. Based on the findings, it is expected that training on cognitive emotional regulation strategies would act as an effective mechanism in the modification of cognitive emotional regulation and become an proper approach to the improvement of cluster C personality disorders in nursing students and employed nurses within the program of human research project, thereby preventing mental illnesses and personality disorders. http://ijn.iums.ac.ir/article-1-3222-en.pdf 2020-04-23 84 107 10.29252/ijn.33.123.84 Child Abuse Emotional Regulation Personality Disorders Compulsive Personality Dependent Personality Disorder MA Ghodratollahifard 1 Depatmant of Psychology, Arsanjan Branch, Islamic Azad University, Arsanjan, Iran AUTHOR https://orcid.org/0000-0001-5362-6937 M Chinaveh 2 Depatmant of Psychology, Arsanjan Branch, Islamic Azad University, Arsanjan, Iran (Corresponding author) Tel: 09177194031) Email: chinaveh@yahoo.com AUTHOR https://orcid.org/0000-0001-7199-0740 S Aminimanesh 3 Depatmant of Psychology, College of Economics and Management, Shiraz Branch ,Islamic Azad University, Shiraz, Iran AUTHOR https://orcid.org/0000-0002-8613-0708