فهرست مطالب سید حبیب الله حسینی

Endoscopy is one of the most common diagnostic and therapeutic methods in patients with gastrointestinal diseases. Anxiety and pain are associated with the patients. This procedure is unpleasant and intolerable. The present study was performed to determine the effect of the clinical Orientation Tour on the anxiety, pain, and satisfaction of patients who were candidates for endoscopy referred to Hospital in Rafsanjan in 2019. Hazrat Ali Ibn Abitaleb (AS) Hospital in Rafsanjan in 2019.

In this clinical trial study, 64 patients referred to the hospital were randomly divided into control and intervention groups. Demographic characteristics, Spiel Berger Anxiety Scale, Visual Analogue Pain Scale, and Modified Questionnaire (GHAA-9) were the data collection tools. The intervention was Orientation Tour with endoscopy and direct endoscopic observation. Patient's anxiety before and after the intervention, pain during endoscopy, and satisfaction after endoscopy were measured. Data were analyzed using paired t-test, independent t-test, Chi-square, linear regression, and Mann-Whitney tests. Analysis was done using SPSS software version 16.

The mean score of overt anxiety before the intervention was 56.78±7.32 and after the intervention was 35.19±12.52, latent anxiety ranged from 57.22±9.04 to 32.25±13.67, and total anxiety from 114.00±15.90 decreased to 67.44±25.76, which was statistically significant (P=0.0001). However, in the control group, it was associated with an increase in anxiety scores after the intervention. Pain during endoscopy was also statistically significant between the intervention and control groups (P=0.0001). But the mean satisfaction score after endoscopy was not significantly different between the two groups (P=0.161).

Clinical orientation training is effective in reducing anxiety and pain in patients undergoing esophagogastroduodenoscopy. It can therefore be suggested to reduce anxiety.

Reduced quality of life and self-efficacy are among problems of mothers of children with chronic diseases. This study aimed to determine the effect of empowerment based on the Gibson model on self-efficacy and quality of life in the mothers of children with thalassemia.

In this quasi-experimental study, the study population were the mothers of children with thalassemia referred to rare disease clinics in Rafsanjan and Kerman in 2020. The sample size was 25. Mothers were selected by the convenience sampling method and divided into two groups. In the intervention group, mothers participated in five training sessions based on the Gibson model, and in the control group, mothers received routine care. Data collection tools included the Zhang’s self-efficacy questionnaire and the SF-36 which were completed before the intervention and six weeks after the intervention. Data were analyzed using chi-square test, independent and paired t-test via the SPSS software version 18.

Before the intervention, the mean score of self-efficacy (P=0.31) and quality of life (P=0.47) were not statistically significant between the groups, but after the intervention, the mean score of self-efficacy in the intervention group (68.81±9.36) was significantly higher than that of in the control group (44.69±6.87) (P<0.001). But there was no significant difference in the mean score of quality of life between the intervention (60.64±10.08) and control (56.19±11.41) groups after the intervention (P=0.19).

According to the results, empowerment based on the Gibson model is an appropriate method for improving self-efficacy in the mothers of children with thalassemia. However, further studies are recommended about its effect on quality of life.

Anxiety has multiple effects on heart performance; there are various pharmaceutical and non- pharmaceutical methods to reduce anxiety. Since different colors and ambient light have multiple effects on the patients’ anxiety, this study aimed to determine the impact of color and ambient light on the patients' anxiety in the coronary care unit of Jiroft Imam Khomeini Hospital in 2018.

This experimental study was conducted in the coronary care unit in Jiroft, 2018. Participants (240) were divided into four intervention groups and two control groups. The participants were asked for consent then they were randomly divided into groups of intervention and control to compare the effect of orange, purple (intervention groups) and dark blue with sunlight (control group) on anxiety. Data were collected using the Spielberger situational anxiety questionnaire in two stages of hospitalization and discharging for each patient. Data were analyzed using the analysis of variance.

According to the results of this study, there was a significant difference in the average score of hospitalized patients’ anxiety in the purple units (p=0.03) and purple units with sunlight (p=0.01).

The findings of this study showed that using purple and the integration of purple and sunlight in the coronary care unit can be useful in reducing patients' anxiety. Accordingly, it is better to consider the effect of purple and sunlight in the design of the coronary care unit.

Ventilator-associated pneumonia (VAP) is considered a severe infectious disease in Intensive Care Units (ICUs). It seems that the teaching of nurses staff may improve the quality of care and reduce the VAP rate. This study is performed to determine the effect of education on VAP and nurses' performance in Rafsanjan ICUs.

The semi-experimental study was conducted on 62 intensive care nurses, who were selected through convenience sampling and inclusion criteria. VAP rate and nurses' performance were measured three months prior to intervention. Then, the necessary education about the methods of preventing such VAP took place. After three months, nurses' performance and VAP rates were measured again. Data were analyzed by SPSS software (V.18).

The results showed that the VAP rate changes before(97.8%) and after the intervention (89.2%)were not statistically significant(p=1.000).Nurses' performance on hand washing, suctioning, patient position change, scrubs wearing, mouthwash, and intubation improved after training and had a statistically significant difference  (p<0/05).

The study indicated that nurses' education on the prevention of infection and VAP could be effective although this intervention had only clinical impact.

Professional ethics is one of the requirements of any profession, which can have beneficial aspects like those of organizational, personal, social and economic. Anger is also one of the factors that can
have a negative impact on the professional functioning of individuals and it causes many physical, psychological and interpersonal problems that need to be controlled in any system.

The present study is an interventional study in which 80 pre-hospital personnel of Kerman city were entered by available sampling method. The subjects were equalized and randomly assigned to intervention and control groups. Data were collected through demographic characteristics checklist, Anger Control Questionnaire. Data were analyzed by SPSS software version 24 and independent ttest, Analysis of variance, paired t-test, ANOVA and Chi-square test.

Before intervention, there was no significant difference between the two intervention and control groups regarding the mean scores of anger control (p<0.89). But after the intervention, the mean score of anger control in the intervention group was significantly higher than that of the control group (p<0.000).

The results of this study showed that professional ethics education has increased the respect for human dignity in pre-hospital personnel. Therefore, the teaching of ethical principles is constantly and continuously necessary for staff in relation to the patient in the form of in-service training or during education.

To provide systematic and public palliative care in Iran, education this care for breast cancer patients can improve the quality of life of these patients, So the present study was conducted to determine “the effect of educating palliative cares on the quality of life in breast cancer patients”. In the present clinical trial 46 patients with breast cancer who referred to the oncology department of the Shahid Rajaei were selected and were allocated into two groups of control and intervention using simple randomization method. participants in the intervention group, received the 4-week designed intervention along with the routine cares. The Missoula quality of life index was completed by both groups before, right after and one month after the intervention. Mean score of quality of life of the patients in the intervention group had a significant difference before and after the intervention (P = 0.003); and its had no significant difference in the control group before and after the intervention (P = 0.67). there was a significant difference between the mean scores of the quality of life of the patients in the intervention and the control groups before, right after and one month after the intervention (P< 0.0001). Comparing the mean scores of quality of life between the control and the intervention groups showed that educating palliative care could improve the quality of life in the patients. Therefore, paying attention to palliative care programs and educating them constantly and applicably in the nursing care programs is recommended.

With the increase in the number of the elderly, the international community has paid special attention to improving quality of life in the elderly population. Educating healthy lifestyle behaviors can be effective in improving health indices; therefore, the present study was carried out to determine the effect of healthy lifestyle education programs on the quality of life and health indices of the elderly. This semi-experimental study was conducted on elderly people referred to four vocational gardens (parks) of the city of Rafsanjan. The data were collected using Richter sphygmomanometer, Easy-glucometer and Seca weighting devices and a demographic questionnaire. The intervention group (36 elders) received healthy lifestyle education during 8 sessions, each lasting one hour. The posttest outcomes were measured immediately and two-months after intervention the data were analyzed using version 18 of the SPSS18 by t-tests, fisher and chi-square tests. The mean of systolic blood pressure immediately (p=0.003) and two months after intervention (p=0.006) was significantly different. However, the mean of diastolic BP (p=0.003) and blood glucose (p=0.005) decreased significantly only two months after the intervention. Education can not only increase the knowledge but also improve the quality of life of elders. Therefore, it is suggested that healthy lifestyle education programs be conducted via relevant organizations for the elderly.

The ocean is a random medium having both deterministic and nondeterministic characteristics. This behavior often leads to the difficulty in performing such underwater applications as telemetry and tomography. Propagation of acoustic rays in the ocean depends on temperature, salinity and density (Frosch 1964). While pressure is primarily controlled by depth, temperature and salinity variations in the ocean due to currents, the surface mixed layer, eddies, internal waves and other oceanographic features. These features affect the structure of the temperature and salinity fields, which in turn determines the sound velocity fields. Furthermore, these features change both in time and space, modifying the temperature, salinity and sound velocity fields. Other oceanographic features which affect acoustic propagation are internal tides and waves. Internal tides are internal waves in the ocean with tidal frequencies. As they propagate they alter the temperature structure and consequently the sound velocity fields. A primitive-equation model (MIT General Circulation Model (MITgcm)) with tidal forcing provided the temperature and salinity fields, from which the horizontal and vertical dependence of sound speed fields of the Oman Gulf were generated. This model solves the fully nonlinear, non-hydrostatic Navier-Stokes equations under the Boussinesq approximation for an incompressible fluid with a spatial finite volume discretization on an orthogonal computational grid. The model formulation includes implicit free surface and partial step topography. The Makenzi formula for sound velocity was used to calculate the sound speed from the potential temperature, salinity and pressure fields. Using these sound speed fields and the Bellhop acoustic ray tracing software, the effect of internal tide on sound propagation was investigated. Both ray paths and Transmission Loss (TL) were analyzed for dependencies on the tidal cycles. This program traces acoustic rays along a 2-D sound speed field, which varies both horizontally and vertically. It was designed to “achieve fast, accurate wavefront, and eigenray travel time predictions” and is based on Bowlin’s RAY program (Dushaw and Colosi 1998). In the sill region, the topography is supercritical with respect to the M2 internal tides. The calculations of the sound field were performed for a harmonic source operating at frequencies of 100, 400,800 and 1500 Hz at a depth of 350m. In the different scenarios of simulations of propagation sound, the calculations were performed during a period tide cycly (at hours 3, 9, 15 and 21).
The results of the modeling of sound propagation with nonlinear internal waves impact on the sound propgation during the period tide is as follows (Freitas, 2008): 1- Propagation of the sound during a period of internal tide leads to energy of sound being expanded and compressed at some points. At a frequency of 300 Hz, the sound scattering occurs intensively in the environment, due to fact that the wavelength source of acoustic is order of wavelength of internal tide (fine structure). As a result, fewer blind spots are seen in the environment.
2- During a period of the internal tide, the basic structure of the sound velocity profile is not similar for all hours.
3- Internal tidal waves in the hours of 9, 15 and 21 over the hill lead to the, intensity of acoustic pressure increase and leading to the convergence of sound beams in this region.

Nurses are one of the largest service providers who face mental stress in their workplace. Moral distress causes the nurse avoid communicating with the patients and taking care of them. Along these, the basic and physical needs of the patients are not provided and when the nurse feels uncomfortable and injured and with the repetition of this issue, the nurse’s complacency and self-esteem, and the care provided by the nurse fail. This allows nurses to choose negative matching practices such as avoidance of the befallen situation, changing their hospital ward, and quitting their job. This study was conducted to determine the nurses’ perception of moral distress in nurses working in educational hospitals of Yazd city.
A descriptive cross-sectional study was conducted on 370 nurses working in educational hospitals in Yazd, 2012. Moral Distress Scale (MDS) with 95% validity and 97% reliability was used to measure the severity and frequency of moral distress in nurses. This standard questionnaire includes 38 items, each of which describes a stressful situation. This tool shows the frequency and severity of moral distress based on a 7-point Likert scale. To determine the severity of the distress, a score of 0 to 6 is considered for each score. The minimum score for MDS is 0 and the maximum score is 228. To measure repetition of moral distress, participants are asked to indicate the number of exposures to the described situation in the item by a score of 0-6. Sampling was done on a non-random basis. Data were analyzed using SPSS software version 18.
Ethical considerations: After obtaining the permission of the Ethics Committee of the Vice-Chancellor for Research and Technology, Yazd University of Medical Sciences, by the code 1395-132, and considering general code of research ethics, the participants’ consent was obtained after describing the objectives and the research process and ensuring confidentiality of information.
Findings: The age range of the participants was 22 to 52 years old, most of them were women, married and official employee. The mean score of nurses’ perceived moral distress was 3.41 ± 1.28 and the mean score of repeated severity of moral distress was 2.60 ± 1.1. Item No. 35 (working with physicians who do not have the required qualifications to meet the patients’ care needs) had the greatest severity and item No. 2 (pursuing the family request for continued patient life support, despite the patient’s request) had the lowest severity of moral distress. The highest frequency of moral distress was related to item No. 5 (initiation of resuscitation, while I believed it was inconclusive and only prolonged the death process), and the lowest frequency was related to item No. 29 (pursuing the patient’s request of helping him/her to commit suicide when the patient’s prognosis is poor).
There was a negative relationship between age and severity of moral distress (r = -0.1 and p = 0.04). Also, the marital status of participants had a significant relationship with moral distress severity (P = 0.001). There was no statistically significant relationship between the mean score of moral distress and other demographic characteristics (P≥0.05).
Regarding the moderate degree of moral distress in the participants, it is necessary for policymakers and nursing managers to take measures and strategies to reduce the severity of moral distress and also to identify its causes. Considering the destructive consequences of moral distress, including job dissatisfaction, avoiding nurses from presence at the patient’s bedside or leaving their job, it is suggested that workshops be held in this regard. Also, holding educational classes for managers and head nurses of the hospital wards, in order to prepare nurses and create appropriate patterns in dealing with problems happening in the clinic can reduce the severity and frequency of their moral distress.
Please cite this article as: Fazljoo E, Borhani F, Hoseini SH, Abbaszadeh A. Nurses’ perception of moral distress among nurses working in educational hospitals affiliated to Yazd University of Medical Sciences. Med Ethics J 2017; 11(41): 7-15.

The efficiency of a hospital in providing appropriate care services requires effective communication between managers and nursing staff. Emotional skills are an important factor in the effectiveness of leadership and organizational success of managers. Effective managerial emotional display can be effective in improving employee performance.
Aim: The purpose of this study was to determine the relationship between the emotional display of nursing managers and the performance of nursing staff.
A cross-sectional, descriptive, and correlational study was conducted in a teaching hospital in Tehran, 2015. The sample consisting 120 nurses and 15 nurse mangers was selected via convenience sampling method. The research instruments were the Dyndorff (2005) emotional display questionnaire and Paterson's (1990) job performance questionnaire, whose reliability was confirmed by Cronbach's alpha of 0.76 and 0.83 respectively in previous studies. Performance questionnaire was completed by staff (nurses and head nurses) and emotional display questionnaire was completed by managers (head nurses and supervisors) via self reported method. Data were analyzed by Spearman correlation coefficient using SPSS software at a significance level of 0.05.
The real and deep emotional display strategies of managers were in high level (66.7%) and the performance of nursing staff was in excellent level (90%). Among emotional labor strategies only the real emotional display of managers had a positive correlation with job performance of the nursing staff (P = 0.020, r = 0.203). The emotional labor strategies of managers and the job performance of nursing staff had no significant relationship with personal characteristics (P >0.05).
The high level of emotional labor strategies may cause emotional exhaustion and burnout in nursing mangers. So the health assessment and providing proper psychological interventions for managers are necessary. Also, emotional display strategies of nursing managers are measured in self-assessment. It raises the awareness of managers in this field, and helps them to apply effective emotional display strategies to develop staff performance.

Aim. This study was carried out to compare the effect of trinitroglycerin (TNG) spray and sublingual pearl on chest pain severity and some physiological indices of people with chest pain visited by emergency medical services.
Background. Glyceryl trinitrate is used as an anti-anginal vasodilating agent with various forms including spray and pearl with probable different therapeutic effects.
Method. In this quasi-experimental study, 80 patients with chest pain were recruited through convenience sampling and then allocated to pearl and spray groups by minimization method. After arriving at the patient's bedside, vital signs and chest pain severity were measured and recorded, then the drug was administered every 5 minutes for 3 times; thereafter, the measurements were repeated. The data analyzed in SPSS software 1) using descriptive and inferential statistics.
Findings. The results showed that after intervention, the mean score of pain in pearl and spray groups were 6.05±0.98 and 5.60±1.25, respectively. There was no statistically significant difference between groups in terms of pain score. Whereas after intervention, the mean systolic and diastolic pressure in pearl group was significantly lower than the spray group, the heart rate in both groups were increased.
Conclusion. Nitroglycerin in the pearl form has the same effect as spray form in relieving chest pain. According to the circumstances and drug accessibility, emergency staff might use every two forms of Nitroglycerin.

Hospital ethical climate is typically an organizational climate, comprising interpersonal relationships amongst treatment personnel as well as personnel’s rapport with patients and their families. Since ethical climate could be influenced by various working conditions and managerial policies, it may vary from one organization to the next. The present study was designed and implemented to investigate nurses’ perception of the ethical climate governing teaching hospitals in a centrally located town in Iran. This was a descriptive-sectional study using Olson’s hospital ethical climate questionnaire conducted on 370 nurses employed at selected hospitals in 2012.Study results revealed mean nurses’ perception of the hospitals ethical climates was (3/22±0/78). The most favorable climate was found among the management (3/56±0/98), and the least among doctors (2/83±0/78). Also, ethical climate significantly correlated with gender (P=0/05) and with marital status (P=0/001). Given the ethical climate score obtained in this study (that was lower than that obtained in previous studies), and given the importance of ethical climate and consequences of its deficiency, it is seems necessary for hospital officials and policy makers to adopt appropriate plans to enforce more favorable ethical climate in hospitals.

Narcotic addiction as a serious health problem in communities has economical and social effects as well as health and hygienic complications. Viral infection such as B and C hepatitis, and HIV may be transmitted by addicted persons. Identification and education of these patients is very important and this survey was carried out for determination of the prevalence of these infections in addicted persons. This descriptive study was conducted on 180 self referred addicted persons who were selected through convenience non-probably sampling out patient clinic in Rafsanjan. After taking consent of patients, serum samples were checked for HIV, B and C hepatitis by ELISA and Western blot tests. For data analysis, chi square and fisher tests were used. The results of this study suggest that the mean of subject's age was 29.3±5.3 years (%95.5 male and 4.5%female), %17.21 IV drug abusers. The rate of Viral infection was %11.7 (21 subjects) including 11 persons who were IV drug abusers this defference was statistically significant (p<0.0001), HIV test was positive in 3 persons (%1/66) and all of them were IV drug abusers. HCV in 13 persons was positive that 5 persons were IV drug abusers. HBV markers were detected in 5 persons (2.7%) including 3 IV drug abusers. The findings of this study revealed that there was a high rate of viral infection in addicted persons especially in IV drug abusers. This suggests the need for more attention and education for preventing the occurrence of these problems.

Fragile X syndrome (FXS) is the most common cause of inherited mental retardation. Patients are identified with different levels of mental disabilities, elongated ears, prominent foreheads and chins, enlarged testes, large skull and obesity. This syndrom is generally associated with a break on X chromosome (Xq27.3), which can be observed in cultured chromosomes in specific culture media at metaphase stage. Prevalence rates of FXS in different ethnic groups have been estimated to be about one per 1500 in males and one per 2500 in females. The aim of this study was to determine FXS prevalence in moderate mental retarded students of Zohreh Shamsaei school in Rafsangan city. Fifty two students with moderate mental retardation (IQ=55-75) who were clinically suspicious to have FXS were screened for fragile X chromosome by using cytogenetic methods. Blood samples were collected and cultured in specific culture media. G-Banding method was used for karyotyping. Patients consisted of 37 males (71.2%) and 15 females (28.8%) with mean age of 12.7 years (ranged 7-17 years)�and mean IQ 65.3 (ranged 55-74). 8.1% of male students and 6.6% of female students were found to have fragile X site at Xq27.3 (in total 7.7%). The frequencies of fragile X-positive cells in males and females were 8-52% and 12-27%, respectively. The frequency of fragile X positive cases found in this study is equal to that is reported by other investigators who studied the frequency of fragile X syndrome in preselected patients.

Many arteries are responsible for nutrition of brain tissue that one of them is the middle cerebral artery with its branches (perforating arteries). The collapse or injury in each of these branches lead to brain stroke or pathologic injury in brain so perforating arteries has anatomic importance and also it is necessary to recognize these arteries therefore we decided to measure length, outer diameter and number of these vessels in middle cerebral artery. In this descriptive study 26 Brains (21 male and 5 female) of people who were dead by non brain problems causes were surveyed using usual dissection method. The brains were taken out in Kerman forensic medical center and dissection of the brains were performed in Depatment of anatatomy, Kerman faculty of medicine. The length, diameter and number of perforations were measured in middle cerebral artery (MCA). Data were analysed by t-test. Results showed that the main number of perforating artery branches was 6.03 in right and 6.57 in left the differences between two parts were not significant. The mean length was 13.61±0.05 in right and 13.72±0.51 in left that were not significantly different. The mean outer diameter was 0.49±0.01 in right and 0.58±0.03 in left the difference was significant (p<0.05). This study sshowed that the outer diameter of perforating arteries in MCA were significantly differente in right and left brain, but the other variables were not significantly different in right and left brain.