فصلنامه حیات
سال بیستم شماره 1 (پیاپی 61، بهار 1393)

Nurses’ turnover phenomenon is a major concern in healthcare systems of many countries. In recent years, nursing shortages in Iran has become a major challenge for healthcare system managers. Based on the definition, “turnover” is a process in which employees leave an organization or transfer to other departments or units of the organization. However, in this definition it has not been specified whether members’ turnover is voluntarily or involuntarily (1). Also, nurses are vital components of healthcare systems, so that as the largest group, they constitute about 56% of the hospital staff (2). Lack of knowledge about nurses’ turnover makes it hard for managers of healthcare systems to recognize its effect; and it complicates the efforts to fill nurses’ vacancies (3). This complex issue has been affected by several factors. Turnover and relocation of nursing employees have affected medical expenses through impact on patients’ resultants.

Lack of knowledge about acute myocardial infarction and its treatment result in feeling anxious among the patients. Implementing appropriate educational methods can decrease anxiety in patients with acute myocardial infarction. This study was conducted to compare effects of two educational methods (face-to-face and electronic educational methods) on anxiety among patients with acute myocardial infarction. Methods & Materials: This was an experimental study in which 105 patients hospitalized with acute myocardial infarction in the "CCUs" of three educational hospitals were selected based on eligibility criteria and were allocated into three groups including face-to-face educational group, electronic education group, and control group using block randomized allocation. Data were collected using demographic check-list and the Spielberger state-trait anxiety inventory questionnaire. The level of anxiety was measured before and immediately after the interventions in all three groups. Data were analyzed in the SPSS-16. Both educational methods reduced anxiety significantly in patients with acute myocardial infarction. There were no significant difference between the two educational method groups in the anxiety level (P=0.94). Both face-to-face and electronic educational methods reduced anxiety in patients with acute myocardial infarction. It is recommended that nurses use one of these educational methods to reduce anxiety among the patients.

Patients with multiple sclerosis suffer from permanent pain. It is being increased to apply relaxation therapy to decrease patient's pain. The progressive muscle relaxation make the muscles feel more relaxed. The aim of this study was to assess the effect of progressive muscle relaxation on pain among patients with multiple sclerosis. Methods & Materials: A randomized controlled trial was carried out among 70 patients with multiple sclerosis selected from Hamadan Multiple Sclerosis Society patients. Inclusion criteria involved diagnosed with multiple sclerosis, 20-65 year old patients, having ability to do daily 20-minute exercises, feeling pain, having an EDSS score equal or less than 4.5. Patients were randomly divided into two groups of control and intervention. Patient's pain was measured using the VAS scale in the two groups at baseline. The relaxation training was implemented among intervention group patients and was repeated three times a week for four weeks. Each session lasted 40 minutes and the patients continued doing exercise at home for the other eight weeks. The control group patients were observed routinely. Patient's pain was measured eight weeks later in both groups. Data were analyzed using the paired independent t-test in the SPSS-16. Muscle relaxation had significant effect on pain among patients with multiple sclerosis (P<0.05). The mean of pain severity decreased from 4.60 ± 1.75 to 3.26±1.88 in the intervention group after the intervention. The mean of pain severity remained constant. This progressive muscle relaxation can be used for decreasing pain among patients with multiple sclerosis as a non-expensive, safe and simple method.

Technology advancement has increased the survival rates of premature infants. Preterm newborns frequently experience oral feeding difficulties due to lack of coordination in sucking, swallowing and respiration. This may negatively affect attainment of independent oral feeding skill and leads to longer hospital stays. This study aimed to examine the effects of non-nutritive sucking vs. oral massage therapy on attainment of independent oral feeding and length of stay in the NICU. Methods & Materials: This clinical trial was conducted on 72 premature infants (28-32 week gestational age) hospitalized in the NICU of Alzahra Hospital in Tabriz in 2013. The eligible infants were randomly allocated to one of the three groups: oral massage, non-nutritive sucking, and control groups. Newborn infants in the oral massage group received pre- and intraoral massage therapy (before gavage) for at least 10 days. The newborn infants in the non-nutritive sucking group were encouraged to suck on a finger of mother or the researcher before gavage. The control group received usual care. The time to attain independent oral feeding and length of stay in the hospital were compared in the groups. Compared to the control group, the time to oral intake was significantly shorter in both experimental groups (P<0.001). There was no significant difference between the duration to achieve independent oral feeding status among the groups (P=0.915). Length of stay in the hospital did not significantly differ among the three study groups (P=0.342). Findings indicated that both oral massage and non-nutritive sucking therapy groups could accelerate attainment of independent oral feeding in premature newborn infants.

Insertion of chest tubes is a necessary measurement in chest trauma. The trauma patients need specific skills for self-care. This study aimed to determine the effect of using supportive-educative system on self-care skills in trauma patients with chest drainage system. Methods & Materials: In this quasi-experimental study, 62 trauma patients with chest-tube were selected from three surgery wards of Besat hospital in Hamadan from December 2012 to May 2013. Two wards were randomly allocated into the experiment group (n=31) and one ward was allocated into the control group (n=31). Participants were selected using convenience sampling. The supportive-educative system was designed based on the patients’ needs and was implemented to the experimental group in three consecutive days. The study instruments included self-care needs assessment form and self-care skills checklist. Measurements were completed once the patients were admitted to the wards and three days later by an external observer. Data were analyzed using t-test, Chi-squared test, Mann-Whitney and Wilcoxon tests with a 95% confidence level in the SPSS-16. There were no significant differences between the two groups in the study variables at baseline (P>0.05). Although self-care skills in both control (P<0.01) and experiment (P<0.001) groups were improved, using educative-supportive system led to better self-care skills in the intervention group in compare to the control group (P<0.001). In general, self-care skills of patients with chest drainage system could be improved by supportive-educative system. The improvement in the control group can be attributed to self-care trainings conducted routinely by doctors and nurses.

Transition from studentship to working life is a stressful and challenging event. The concept of transition is important in nursing education, management, and practice issues. However, despite its supreme importance, there are certain ambiguities about the concept of transition in nursing. The aim of this study was to analyze the concept of transition in the context of nursing in Iran. Methods & Materials: We used the three-phase hybrid concept analysis model including the theoretical phase, the fieldwork phase, and the final analytic phase in this study. In the theoretical phase, we conducted an online literature search to find relevant articles published prior to 2012. In the fieldwork phase, five novice nurses, two experienced nurses, and one head-nurse were interviewed. Interviews were transcribed verbatim and analyzed using thematic analysis approach. During the final analytic phase, we compared the findings of the first two phases to provide a clear and comprehensive definition of the concept of transition. The findings of the theoretical phase revealed that transition was a process phenomenon having defined attributes such as detachment, individual perception, awareness, and human response patterns. According to the findings of the fieldwork phase, transition was an interactive, evolutionary, and time-bound phenomenon that embodies attributes such as socialization, unavoidability, and competence and ability development. In the final analytic phase, a comprehensive definition was provided for the concept of transition in the context of nursing in Iran. This study provided a comprehensive understanding of the concept of transition from nursing studentship to working life in Iran. The findings of this study can be used to develop theories, instruments, and criteria for evaluation of novice nurses’ transition to experienced nurses.

Previous studies have shown lack of appropriate inter-professional relationships between nurses and doctors and its negative impact on quality of provided care. This study aimed to determine nurse's attitudes on professional relationships between doctors and nurses. Methods & Materials: In this cross-sectional study, 228 nurses were selected from the internal-surgical and intensive care units of educational hospitals in Zanjan. Data were collected through the Jefferson scale of attitude toward physician- nurse collaboration. Descriptive (mean, median, standard deviation) and inferential statistics (independent t-test, ANOVA) were used to analyze data in the SPSS version 16. The situation of the inter-professional relationship between nurses and doctors was “high”. The maximum score belonged to the "care versus curing"; and the lowest score belonged to the "medical authority". There was a significant relationship between the mean score of the inter-professional relationship with nurses’ employment status (r=0.69, P<0.01). Perspectives of nurses on nurse-doctor relationship was high. Efforts should be made to achieve the ideal situation by paying more attention to nurse's professional roles and their autonomy, including inter-professional relationship subjects in Medicine and Nursing educational curriculum and creating team spirit between nurses and doctors.