فصلنامه حیات
سال بیست و یکم شماره 4 (پیاپی 68، زمستان 1394)

Teamwork (between obstetricians and midwives) is one of the main pillars of success in the provision of appropriate services in the maternity wards. Therefore, this study aimed to identify the factors influencing teamwork in a maternity ward in a public hospital in Tehran, Iran.
Methods & Materials: In this qualitative study, nine midwives and four obstetricians were selected through purposive sampling. Data were collected through semi-structured interviews from an affiliated hospital of Tehran University of Medical Sciences in 2013-2014. Data were analyzed using conventional content analysis.
Two themes including the teamwork barriers (four categories) and facilitators (three categories) were extracted from the data analysis. The main categories of teamwork barriers were the underlying issues (inter-professional conflicts, legal issues, and salary and financial issues), individual problems (physical problems, negative personality characteristics and domestic problems), lack of skills (lack of abilities and motivation, educational weakness and lack of experience) and the external management system (inappropriate policy making and planning, hierarchical structure, lack of team evaluation and lack of justice). The main categories of teamwork facilitators were the internal management of team (good leader or manager, appropriate workplace climate, values clarification of the team members’ practices, and proper implementation of regulations), cooperation, collaboration and empathy (help and cooperation and empathy and support), and essential personal qualities for teamwork (good communication and good personality characteristics).
In this study, the teamwork barriers and facilitators in the maternity wards were comprehensively identified at different levels. According to the results, interventions can be designed and implemented to enhance teamwork.

Maternal request for caesarean section due to fear of normal vaginal delivery (NVD) is one of the main reasons for the high rate of caesarean section. This study aimed to compare the fear of NVD and type of delivery between two groups of pregnant women attended childbirth preparation classes (CPC) and women received routine prenatal care (RPC).
Methods & Materials: In this prospective cohort study, 202 Primigravid women attended healthcare centers for prenatal care services in the East of Guilan were selected using convenient sampling in 2013-2014. Fear of NVD was assessed using a childbirth attitude questionnaire at two stages (before attending CPC or receiving RPC, then at the third trimester of pregnancy). Both groups were followed up to the delivery time. Data were analyzed using inferential and descriptive statistics (Chi square, paired t-test, ANOVA, t-test) through SPSS v.16. P There was no significant difference (P=0.23) in the mean score of fear of NVD between two groups before attending CPC (35.59±8.78) and receiving RPC (37.08±9.08). The comparison of the mean score of fear of NVD between two groups at the third trimester of pregnancy showed a significant reduction (P Results confirm the importance of CPC in decreasing fear of NVD and increasing the rate of NVD in primigravid women attended these classes. Therefore, women’s attendance at CPC is recommended to be encouraged.

Poor oral care for the ventilated patients in intensive care units (ICU) can result in the accumulation of pathogens and respiratory infections. In this regard, in addition to the chemical methods, a mechanical method has been recommended to be added. However, concerning its effect on pneumonia, different findings have been reported. Therefore, this study was conducted to compare the effects of chlorhexidine solution with or without toothbrushing on the development of ventilator-associated pneumonia among patients in ICUs.
Methods & Materials: This was a single-blind, randomized controlled clinical trial conducted in two selected hospitals of Ahvaz city in 2014. A convenience sample of 68 ventilated patients was randomly allocated to the toothbrush group (34 patients) or the gauze swab group (34 patients) using R software. Both groups received 0.2% Chlorhexidine solution. The intervention was performed in both groups for 3 minutes twice a day for five days. At the end of the fifth day, the development of pneumonia was assessed using the Clinical Pulmonary Infection Score (CPIS). Data were analyzed by Chi-square and t-independent test through SPSS v.16.
The two groups were similar for age, sex, cause of admission, level of consciousness, medication and tobacco use. The majority of patients (58.8%) were diagnosed with pneumonia (Group A: 55.9% and Group B: 61.8%). The Chi-square test showed no significant difference between the two groups for the development of pneumonia (P>0.05).
The use of Chlorhexidine solution with toothbrushing compared to using Chlorhexidine with swab could not reduce the development of pneumonia. However, due to its importance, further research is needed in this regard.

Medication errors are one of the most common medical errors and these errors have a double importance in neonatal intensive care unit. The aim of this study was to determine the frequency and type of medication prescribing errors in neonatal intensive care unit.
Methods & Materials: This study is a descriptive-analytical research. A census sample of 71 nurses from the neonatal intensive care unit of 5 hospitals in Yazd was included in study in 2015. The tools of data collection were the demographic and occupational data questionnaire and “medication errors” questionnaire. Data were analyzed by descriptive statistics and the Chi-square statistical test, using SPSS software v.18.
47.9% of nurses (34 persons) had made medication errors. 35.2% of samples had made 1-2 errors, and 51.51% of errors had occurred on the night shift. The most frequent nonparenteral medication errors were errors in drug calculation, drug dosage, the drug route of administration, and incorrect medication. In parenteral medications, errors in the drug infusion rate, drug calculation, drug dosage, and the Lack of attention to drug-drug interactions were frequently reported. Nurses declared that the large number of patients was the first main cause of medication errors.
Given the high frequency of medication prescribing errors particularly on the night shift, as well as considering the disproportionate nurse-to-patient ratio as a major cause of the errors, future research is needed to further evaluate the causes and prevention strategies of the medication errors.

Studies have shown that family caregivers’ attitude toward mental illness affects their caring to mental patients and may reduce the quality of caring to them. This study aimed to determine the effect of group psychoeducation on attitude toward mental illness in the family caregivers of patients with bipolar disorder.
Methods & Materials: In this randomized clinical trial study conducted in 2015, 74 family caregivers of the patients with bipolar disorder who had been hospitalized in the psychiatric wards of Razi hospital in Tabriz were selected by random sampling method. Then, they were randomly assigned into the experimental and control groups. The families of experimental group participated in 8 continuous 90-minute 2 times a week psychoeducational sessions. Family caregivers’ attitude toward mental illness was measured using the questionnaire of Opinion about Mental Illnesses (OMI) before and after intervention. Data analysis was conducted using descriptive statistics, Chi-square test, independent t-test, paired t-test and ANCOVA on SPSS software version 13.
The results revealed that there was no significant difference in mean score of attitude toward mental illness between the experimental group and the control group before intervention (92.54±8.51 vs. 90.52±9.43, P>0.05). But the mean score of family caregiver's posttest in the experimental group significantly increased compared to the control group (105.43±14.72 vs. 90.52±7.50, P The study results demonstrate that psychoeducational program improves family caregivers’ attitude toward mental illness. Training methods such as group psychoeducation can be effective in promoting positive attitude in the families of patients with psychiatric disorder.

Pap smear test is an effective screening method for early detection of cervical cancer. This study aimed to determine the effect of education based on the health belief model on women’s belief and practice regarding Pap smear test.
Methods & Materials: In this quasi experimental study, 100 married women under coverage of Bushehr health centers participated in the study in 2014-2015. The data collection instrument was a questionnaire consisted of demographic information, the questions concerning knowledge and the HBM constructs regarding Pap smear. The training program was performed in two group sessions. Three months after the intervention, women’s practice about Pap smear test was evaluated in both groups. After data collection, data were analyzed by descriptive statistics, repeated measure analysis of variance, independent t-test and Chi square on SPSS software v.20.

Before the study, both groups had not any significant differences in all variables and constructs. After the intervention, the mean scores of knowledge (P

Designing and implementing educational program based on health belief model can promote women’s awareness and reduce their perceived barriers and as well as enhance their practice regarding Pap smear test.

Although mechanical ventilation is a life-saving intervention for many infants with respiratory distress syndrome, it carries potential complications. One of these complications is prolonged duration of mechanical ventilation. More than 15 days of mechanical ventilation is associated with increased risk of cerebral palsy and attention deficit hyperactivity disorder among extremely low birth weight infants. The current study aimed to determine the relationships between the length of mechanical ventilation and its related factors in neonates with respiratory distress syndrome.
Methods & Materials: In this analytical study, a convenience sample of 60 premature infants of 33 weeks’ gestation or less with respiratory distress syndrome was recruited from three hospitals (Mahdieh, Mofid, and Imam Hossein) affiliated to Shahid Beheshti University of Medical Sciences in 2014-2015. Then, factors related to the length of mechanical ventilation such as sex, type of birth, birth weight, gestational age, Apgar score at the first minute, Apgar score at the fifth minute were assessed. The data were analyzed using descriptive statistics, Pearson correlation, independent t-test, and multiple regression analysis on SPSS software v.20.

The mean gestational age was 30.62±1.8 weeks and the mean weight of infants was 1510.33±390.940 grams. The mean length of mechanical ventilation was 3.58±2.97 days. There were not any correlations between sex, type of birth and the length of mechanical ventilation (P>0.05). Gestational age and weight were significantly correlated to the length of mechanical ventilation (P

The results of the current study revealed that among the studied factors, only gestational age was a factor affecting the length of mechanical ventilation.

Evidence-based practice (EBP) education is essential in nursing education. Therefore, identifying factors influencing nurse's adoption of EBP is very important to perform optimum quality nursing interventions. The aim of present study was to determine the factors affecting the adoption of EBP based on Roger's diffusion of innovations models in nurses.
Methods & Materials: This was a descriptive–analytical study. The research subjects were 130 nurses who worked in the hospitals affiliated to Tehran University of Medical Sciences in 2014. The research instruments were four questionnaires including demographic data; knowledge, attitude and the adoption of EBP; individual innovation and perceived attributes of EBP. Data were analyzed by descriptive and inferential statistics (Pearson correlation coefficient and path analysis) on SPSS v.19 and EQS.
The study findings showed that age and the working experiences of nurses had significant inverse relationships with knowledge of EBP (r=-0.809, r=-0.805). There was a direct relationship between individual innovation and knowledge (r=0.776). In addition, knowledge not only had a significant direct relationship with the adoption of EBP but also had the greatest impact on the adoption of EBP compared to other variables of model (r=0.937). Perceived attributes of EBP had significant direct relationships with attitude and the adoption of EBP (r=0.898, r=0.888 respectively). Attitude toward EBP also had a direct and significant relationship with the adoption of EBP (r=0.869). The results of the path analysis indicated the model variables to have an optimal fit (P The results of this study identify the factors affecting the adoption of EBP. Determining these factors can be an effective step to more adopt it in clinical environments.