فهرست مطالب فهیمه محمدی فخار

Burnout is a common syndrome in people who spend their time on providing support to others. Nurses are particularly susceptible to burnout، because of the nature of their profession. Workplace social support is one of the ways to reduce burnout. So the aim of this study was to determine the relationship between supervisor social support and burnout in nurses. It was a descriptive correlational study. Two hundred nurses working in hospitals affiliated to Tehran University of Medical Sciences were recruited by proportionate stratified sampling. The instruments included Maslach Burnout Inventory (MBI) and the Support Appraisal for Work Stressors Inventory (SAWS). Data were analyzed by descriptive statistics and Pearson correlation coefficient using (SPSS) -PC (18). The majority of nurses experienced high levels of emotional exhaustion and lack of personal accomplishment (61% and 97% respectively)، and moderate levels of depersonalization (59%). The mean supervisor social support scores were 2. 03-2. 1 in various dimensions. Significant relationship was found between all dimensions of supervisor social support and frequency of depersonalization. Moreover، there was significant relationship between emotional and informational dimensions of supervisor social support and frequency of personal accomplishment (P<0. 05). Administrators can reduce nurses’ burnout with the appropriate workplace social support. Further studies are suggested to assess and compare other factors related to burnout.

job stress is associated with many factors and different hypotheses have been proposed respectively. However, empirical evidence is needed to support these assumptions to guide nursing practice. To test the hypothesis derived from a related grounded theory study in order to determine the relationship between frequency and intensity of nurse's confrontation with intra-organizational factors of burn centers and their job characteristics. It was a cross-sectional and correlational study. Nurses working in Shahid Mottahari Burn Center (N=98) were recruited by census during 2010. Data were collected by intra-organizational questionnaire and job characteristics form, derived from the previous grounded theory study of the researcher and analyzed with SPSS-PC version 14 using Pearson correlation, ANOVA, Spearman, and Stepwise Regression tests. Auxiliary tests such as Tukey and Scheffe were used for some significant relationships. The majority of sample (%56.1) was nurses and worked in wards (%69.4). Most of them (%51) were working in either evening or night shifts and the duration of their contact with patients (%63.3) was too long. ANOVA test identified that just job category was related to the frequency (F= 7.61, P= 0.001) and intensity (F= 7.35, P= 0.001) of nurse's confrontation with intra-organizational factors. Finally, Scheffe test revealed that the difference was only significant for nurse assistants. The frequency and intensity of confronting with intra-organizational factors was only related to the job category, though other job characteristics made some changes in this variable, but they had no significant role. Accordingly the researcher's previous conceptualizations were modified.

Multiple structural factors preside over burn units influence nurse's quality of care and their activities. The complexity and multy-dimensional nature of nursing care in these units, creates many challenges. Understanding the perspectives of people's involved is recommended. This study, with a theory-to-research approach, was conducted to assess the frequency of confronting intra and extra organizational factors preside over burn units, the intensity of its related pressure, and correlations among these variables from nurse's perspectives. Methods & Materials: In this cross-sectional, correlational study, 98 nurses working in the Shahid Mottahari burn center were recruited by census. Data was collected using the intra and extra organizational factors instrument, provided based on the previous grounded theory study of the researchers. Intra-organizational factors questionnaire consisted of 58 Likert type statements in eight subscales and two dimensions of frequency (α=0.94) and intensity (α=0.96). Extra-organizational factors questionnaire consisted of eight Likert type statements (α=0.74). Data were analyzed using the SPSS version 14. The results revealed that the frequency of nurse's confrontation with factors related to environment and patients as well as its intensity were more than other factors. Moreover, the intensity of the whole factors was more than its frequency. All the extra- organizational factors were significantly correlated with all intra-organizational factors except for the "absence of employment permission" (P<0.05). This study explained the importance of intra-organizational factors of a burn center in inducing stress on nurses. In addition to verification of some relationships in the previous mid-range theory, the results of this study also modified some of its aspects. Therefore it added to the existing body of knowledge about organizational factors and job stress in burn units. Moreover, it produced some evidences to use in nursing administration and service, and finally it resulted in some directions to control stress in nurse's jobHAYAT2012;18(2): 11-26 Original Article[Frequency and Intensity of Nurse's Confrontation with Intra and Extra-Organizational Factors Governing Burn Centers][Article in Persian]Forough Rafii* (Ph.D) - Seyedeh Fatemeh Haghdoost Oskouie** (Ph.D) - Fahimeh Mohammadi Fakhar*** (MSc.) - Mohammadreza Zarei*** (MSc.) - Hamid Haghani**** (MSc.). * Dept. of Medical and Surgical Nursing, Center for Nursing Care Research, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran ** Dept. of Public Health Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran *** Dept. of Medical and Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran **** Dept. of Biostatistics, School of Management and Information Technology, Tehran University of Medical Sciences, Tehran, Iran Corresponding Author: Forough Rafii e-mail:[email protected] Received:February 4,2012Accepted: May 1,2012Available online:June 6,2012 Abstract: Multiple structural factors preside over burn units influence nurse's quality of care and their activities. The complexity and multy-dimensional nature of nursing care in these units, creates many challenges. Understanding the perspectives of people's involved is recommended. This study, with a theory-to-research approach, was conducted to assess the frequency of confronting intra and extra organizational factors preside over burn units, the intensity of its related pressure, and correlations among these variables from nurse's perspectives. Methods & Materials: In this cross-sectional, correlational study, 98 nurses working in the Shahid Mottahari burn center were recruited by census. Data was collected using the intra and extra organizational factors instrument, provided based on the previous grounded theory study of the researchers. Intra-organizational factors questionnaire consisted of 58 Likert type statements in eight subscales and two dimensions of frequency (α=0.94) and intensity (α=0.96). Extra-organizational factors questionnaire consisted of eight Likert type statements (α=0.74). Data were analyzed using the SPSS version 14. The results revealed that the frequency of nurse's confrontation with factors related to environment and patients as well as its intensity were more than other factors. Moreover, the intensity of the whole factors was more than its frequency. All the extra- organizational factors were significantly correlated with all intra-organizational factors except for the "absence of employment permission" (P<0.05). This study explained the importance of intra-organizational factors of a burn center in inducing stress on nurses. In addition to verification of some relationships in the previous mid-range theory, the results of this study also modified some of its aspects. Therefore it added to the existing body of knowledge about organizational factors and job stress in burn units. Moreover, it produced some evidences to use in nursing administration and service, and finally it resulted in some directions to control stress in nurse's job.

Patients with burns, experience high levels of anticipatory anxiety during dressing changes. Anxiety tends to increase after each dressing and during time; on the other hand this anxiety cannot be completely managed by anxiolytic drugs. Nurses contribute to pain management by using pharmacological and non-pharmacological interventions. Relaxation techniques are one of the most used approaches in pain anxiety management. However there is not enough information about the effects of these techniques on pain anxiety of these patients. The aim of this study was to determine the effect of jaw relaxation on pain anxiety of burn dressing. This study was a randomized clinical trial with control group. One hundred patients hospitalized in Shahid Motahari Burn Center in Tehran within July to December, 2009 were recruited by convenience sampling and were randomly assigned to either experimental or control groups using minimization. Experimental group practiced jaw relaxation for 20 minutes before entering dressing room. Data were assessed with Burn Specific Pain Anxiety Scale (BSPAS) and analyzed using descriptive statistics, Chi-Square test, dependent and independent t-test and Fisher’s exact test by SPSS-PC (17). Significant statistical difference was seen between the level of pain anxiety before & after intervention in experimental group. Moreover, after intervention there were a significant difference between the level of pain anxiety after dressing in experimental and control groups. There weren’t significant difference between pain anxiety after intervention, before and after dressing in experimental group. Nurses can independently decrease the pain anxiety of burned patients and its subsequent physical and psychological burden by teaching the simple and inexpensive technique of jaw relaxation. Further studies are suggested to assess the effect of this technique on pain anxiety of patients with other disease except burns who suffer from painful procedures.

The frequency of severe burn and the results of this injury in the form of death, mortality, illness and social and economical costs on society is an acceptable justification for special attention to the burn victims by health experts. This study was conducted to investigate the effect of jaw relaxation on dressing pain intensity of burn patients.

This study was a randomized clinical trial. One hundred patients referred to Shahid Motahari Burn Center in Tehran within July to December, 2009 were selected by convenience sampling and were randomly assigned to either experimental or control groups using minimization method. The experimental group practiced jaw relaxation technique for 20 minutes before entering dressing room. Data were collected using Visual Analogue Scale (VAS) and analyzed by SPSS 17 and independent t-test.

The mean burn dressing’ pain intensity score in experimental group was 45.93±24.97 and in control group was 48.05±25.61.There were no significant difference between the pain intensity after dressing in both experimental and control groups (p=0.676).

Regarding to ineffectiveness of jaw relaxation on burn dressing’s pain intensity, it is suggested that further relaxation practice sessions be held and continued in the dressing room and also the effect of this technique on residual, penetrating and procedural pain of burn patients be examined and compared.