fatemeh haji abadi

Clinical education is the basis of nursing education. In addition to the educational environment, a supportive environment may also help achieve the goals of internships and student's satisfaction with the acquisition of clinical skills. The present study was designed to determine the impact of a supportive clinical environment on nursing students' satisfaction.

This quasi-experimental study with post-test and control group was performed in Mashhad teaching hospitals in the academic year 2018-2019 with the participation of 60 nursing students who were randomly assigned to two equal intervention and control groups. For the students of the intervention group, the supportive clinical environment program, which included three components of knowledge, skills and learning context, was held for two weeks (50 hours). After the intervention, their satisfaction was measured with a clinical education satisfaction questionnaire. Data were analyzed using SPSS 16 software and independent t-test and chi-square. The significance level was considered 0.05 in all tests.

The mean and standard deviation of the students age was in the intervention group (20.9 ± 0.8 years) and control (20.3 ± 1.1 years) (p=0.232). The result of independent t-test showed that after the intervention, the mean of the total satisfaction score of the students in the intervention group [85.4 ± 11.4] was 26.9% higher than the control group (67.3 ± 15.8) (p < 0.001). Also, the highest satisfaction score was related to the performance of the instructor in the intervention group and the lowest satisfaction score was related to the scope of dealing with the student in the control group (P <0.05).

Creating a supportive clinical environment enhances students' satisfaction, especially in the area of ​​instructor performance and dealing with students, and it is recommended to pay more attention to it in planning nursing clinical education.

patients hospitalized in ICU experience considerably discomfort due to special condition of ICU and particular situation of their illness but these patients cannot express their discomfort. Therefore, this study was conducted aimed to determine the rate of discomfort and its related factors in patients hospitalized in ICU.

this descriptive cross- sectional study was conducted on 220 hospitalized patients in state hospitals of Mashhad from September 2012 to September 2013 through accessible sampling. Perceived discomfort, the most important experienced discomfort and its rate during hospitalization were measured before discharge of ICU by an open-ended question and a researcher made questionnaire. Data were analyzed by SPSS: 11.5.

minimum score of discomfort was 61 and maximum score was 210. The mean of discomfort was 86.54± 17.5. Therefore around 100% of participants experienced some extent of discomfort in ICU. More than 50% of patients reported the frequent blood sampling, feeling of thirst, feeling of loneliness, Pain, limited visiting, insomnia, hospitalization expenses, anxiety and fatigue as sources for their discomforts.

As to the finding, discomfort incidence in hospitalized patient in ICU is high. As the sources of discomfort such as frequent blood sampling, feeling of thirst, feeling of loneliness, pain, limited visiting etc could be modified, it is recommended to use effective strategies in order to decrease and modify these factors by managers, administrators especially nurses of ICU.Key words: Patient, intensive care, Discomfort factors

Evidence shows that most diseases, including heart disease, cancer, pneumonia, and health inequalities, are all strongly influenced by social characteristics. Therefore, this study was conducted to determine the relationship between social participation and general health of the elderly in Mashhad

The present study was a cross-sectional descriptive analysis for which 350 elderly retirees (employees) and retirees of the Social Security Organization (workers), based on a multi-stage method ((class, systematic random access and available) based The proportions were proportionally selected.The data were collected using the elderly demographic information questionnaire, GHQ general health questionnaire and social participation questionnaire.The data obtained using SPSS-v24 software and using correlation tests, independent t-test, one-way analysis of variance And multiple linear regression was analyzed.

The mean and standard deviation of age of the research units was 68.91 7 7.62 years. The mean scores of general health and social participation were 15.19 and 31.71, respectively. The variables of social participation along with age, marriage, gender, employment, source of income, income satisfaction, illness and life companions as independent variables predicted 15% of general health (P <0.05).

In this study, no significant results were observed between the relationship between social participation and public health in retired elderly. Further research focusing on more individual factors such as age, marital status, gender, employment, source of income, income satisfaction, illness, and life companions can be useful for planning and implementing comprehensive and effective strategies.

The cut-off point in a test is the score that divides test takers into different classes (such as rejection-acceptance). The process of determining the cut-off point is frequently used in educational tests. The cut-off point should be based on a generally accepted methodology and reflect the judgment of competent and qualified individuals. The aim of this study was to determine the basics of determining the cut of point in academic achievement tests.

 The present study is a review study in which all articles related to the purpose, using keywords of standardization of the test and determination of the cutting point in reputable Persian and English scientific sites were searched..

 In the search, it was found that there was no reliable Persian scientific source in determining the cutting point. However, English articles and books in this field were carefully studied.

Despite the importance of determining the correct cut point, especially in academic achievement tests, but Persian texts contain few resources in the field of principles and foundations for doing this and probably the lack of these resources makes researchers less familiar with the correct process of determining the point. Their inclination and tendency to use unscientific methods to do it in their studies. This article can be a useful tool as a guide to the basic principles of determining the cut-off point in academic achievement tests, which puts more emphasis on using the cut-off point for important decisions.

Breast cancer is the most common cancer and the second leading cause of death in women worldwide. The aim of this study was to analyze the trend and predict the incidence of breast cancer using time series analysis.

In this study, data on breast cancer incidence in Qazvin province between 2007 and 2016 were analyzed using time series analysis with autoregressive integrated moving average (ARIMA) modeling to forecast the future pattern. The Box-Jenkins time series model and its diagnosis and evaluation methods were used to show the trend and forecasting the next year new cancers. To describe and fit the appropriate models, R statistical software version 3.6.3 was used.

Between 2007 and 2016, a total number of 1229 new patients had been registered (monthly mean [SD]: 10.24 [1.03]). Although the overall trend in the raw number of new breast cancer cases has been increasing over time, the change in observations over time has been increasing and decreasing. According to Bartlett test results, the variances of the data were not constant. Also, according to the results of Kolmogorov-Smirnov test, breast cancer series data were not normal. Among the studied models, ARIMA (1, 1, 1) was selected due to lower AIC criteria than other models, and this model was selected as the final model for predicting breast cancer for the next year. The confidence interval of the predicted values ​​was relatively narrow, which indicates the appropriateness of the final model in the prediction.

Time series analysis is an efficient tool to model the past and future data on the raw number of new cancer cases, and the goodness-of-fit indicators of the model showed that the Box-Jenkins model is a reliable model for fitting similar data.

Peripheral intravenous catheters (PICs) patency techniques such as flushing are being developed. According to some studies, flushing can be used continuously or in pulsatile forms. This study aimed to compare the effects of pulsatile flushing (PF) and continuous flushing (CF) on time and type of PICs patency.

In this double-blind randomized clinical trial, 71 patients were randomly assigned into two groups of PF (n=35) and CF (n=36). The PF protocol was performed as successive injections of 1 mL normal saline (N/S) per second (sec) with a delay of less than 1 sec until the completion of 5 mL of solution. However, CF protocol was performed by injecting 5 mL N/S within 5 sec without any delay before and after each medicine administration. Data related to the time and type of PICs patency were collected using a patency checklist every 12 hours (h) up to 96 h. The statistical analysis was done by R statistical software (Version 3.5.1).

The results showed that the number of PICs remaining open was not significantly different between PF and CF groups during 96 h. The highest number of PICs excluded from the study was related to the time of 96 h as a result of partial patency in the two groups.

There was no difference between CF and PF regarding the time and type of PICs patency. Thus, both techniques can be used to maintain the catheter patency.

Clinical education is a stressful experience, especially in the nursing profession that they deal with human lives. Therefore, identifying the stressful factors of clinical education is a necessity. The aim of this study was to investigate the stressful factors of clinical education of nursing students in different semesters.

 In this descriptive cross-sectional study, the research sample consisted of 131 nursing students of Mashhad University of Medical Sciences who were selected by census method in 2016. Data collection tools was a researcher-made questionnaire that included the stressful factors of clinical education in six domains related to the nature of the discipline (4 items), the instructor (9 items), the clinical environment (9 items), the patient (12 items), student (16 items) and educational system (4 items) were examined.

 Based on the findings of this study, the highest stress of subjects was in the field of instructor (15.2 ± 20.6), clinical environment (12.9 ± 5.9) and student (12.1 ±6.8). There was no statistically significant difference between students of different semesters in the nature of the field, but this difference was significant in other areas (p < 0.001).

The stressors have a negative effect on students' academic performance, physical and mental health. Therefore, it seems necessary for managers to understand the stressors in clinical education and act properly to reduce it, such as familiarization of students with the concept of stress and ways to confront with it like relaxation, exercise and music from the beginning of the course through educational programs, academic and psychological counselling, change the structure of teamwork, managerial reforms, and increase social support.

Conscious mechanically ventilated patients are not able to communicate due to the internal tubes and many other reasons which cause them to experience many difficulties. In this regard, the present study aimed to explore the experiences of conscious mechanically ventilated patients, such as speech impairment and discovery of nonverbal communication used by them for the expression of their needs.

This qualitative content analysis was conducted on 15 conscious mechanically ventilated patients admitted to the intensive care unit in Iran during 2016. The required data were collected through semi-structured interviews and observations and the subjects were selected using the purposive sampling method from patients with enough experience in this regard. Moreover, the collected data were analyzed using conventional qualitative content analysis methods.

Based on the results of data analysis, four main themes were found in the deep descriptions of the participants. These themes were the inability to speak as the root of problems, inconvenient blockage of communication channels, unsuccessful nonverbal communication, and attempt for communication.

Conscious patients in the intensive care unit have many communication problems while undergoing mechanical ventilation. Therefore, they are not able to express their own needs and this leads to fear and disappointment in them. These patients use different methods, such as communicating via signs, tapping on the bed, lip reading, and writing to express their needs.

Delirium is a disorder in the ICU and sleep disorder can be a risk factor for it. Therefore, it is important to take non-pharmacological measures that are within the scope of the nurse's authority and that can promote sleep as a potential strategy to reduce delirium. The aim of this study was to determine the effect of using earplugs and eye mask during sleep on the delirium of patients in the intensive care unit.

This experimental study was conducted on 73 patients hospitalized in ICU that they were selected by available method for 6 months randomly then allocated in two groups of control (37 patients) and mirror therapy (36 patients). In the intervention group, earplugs and eye mask was used for 3 consecutive days at 22 to 6. Patients before and after intervention were evaluated using NeeCham Delirium scale, a valid and reliable instrument. Delirium score and its domains in different stages in two groups were compared by repeated masseur ANOVA.

The results showed that the use of earplugs and eye mask and time both had a significant effect on total score of delirium (p<0.05). In the process and behavior domain of the effect of time, group and interaction, there was a statistically significant difference (p<0.05). However, in the physiologic domain, the effect of group and total effect did not show a significant relationship (p>0.05).

Earplugs and eye mask as a non-pharmaceutical and independent nursing care can be a useful, inexpensive and affordable tool to prevent confusion or delirium. But the relationship between sleep, sound and light and delirium requires more research.

Drought is a natural and continuous climatic phenomenon which usually occurs in all areas of the world, but its characteristics, type and intensity is different regionally. It is also a progressive phenomenon so that its start and end is not clear and its influence intensity is low but, it encompasses more areas compare to other disasters such as flood, earthquake and etc. which is finally caused more losses rather than other disasters. Drought threshold considering spatial condition is different, therefore, point statistics of one station as an index station of each region is useable for removing spatial effects. In this study, by use of a software which is designed for calculating Palmer Drought severity Index, this index is calculated and presented for Birjand synoptic station during 1985-2014 statistical period in annual and monthly scale. Also, drought process is studied by use of Mann- Kendal and Petit statistical test. Spi drought index is also presented and an analysis has taken concerning drought indexes and relative yield of rain-fed wheat crop relationship by use of Birjand rain-fed wheat yield data during foregoing statistical period. While the air temperature and precipitation data were homogeneous, Based on statistical tests, it was identified that the 30-year period is enough for drought monitoring and analysis. Results showed that sudden changes of annual and monthly spi time series are significant at 5 percent and its change point is May 1998. Also, about annual and monthly pdsi index, results indicate that sudden changes of annual pdsi time series are significant at 5 percent and its change point is February 2000. Spi and pdsi indexes also had a trend consistent with the relative yield crop index of rain-fed wheat and after change point; the pdsi index correlation coefficient was obtained for rain-fed wheat relative yield equal to 0.7 and the spi index correlation rate for rain-fed wheat relative yield equal to 0.55.

Visiting family members is one of the basic human needs; however, there is contradictory evidence about the advantages and disadvantages of the existing visiting systems. Therefore, the investigation of patients’ preferences for the visiting strategies, and achievement of their authentic experiences can significantly contribute to decision-making about the type of acceptable and approved policies in this domain.
Aim: The aim of this study was to explain the experiences of conscious patients undergoing mechanical ventilation in Intensive Care Units regarding their visits with their family members.
This qualitative study was conducted on 15 conscious mechanically ventilated patients admitted to the Intensive Care Unit in Iran in 2017. The data were collected using semi-structured interviews and observations. The sampling was performed through purposive sampling technique, which was continued until data saturation to select the individuals with rich experiences about the subject under investigation. The data were analyzed through the conventional type of qualitative content analysis.
Out of the initial 385 codes, 11 subthemes and 5 main themes were extracted during the analysis process, all of which were placed under the general concept of “the elixir of visiting”. The five main themes included visiting as a healing agent, visiting as an agent for the enhancement of perceived support, visiting as an agent for gaining hope, visiting as the patient’s urgent need, and preference for planed visiting.
Implications for Practice: The results of the present study showed that visiting was like an elixir for the conscious patients undergoing mechanical ventilation in the Intensive Care Units. This practice could allay lots of their pains and lead to numerous valuable effects, such as elimination of loneliness and sadness, increased hope for survival and recovery, and enhancement of a sense of support. Therefore, nursing authorities and managers are required to take steps in terms of redefining visiting rules and regulations in line with patients’ preferences, and thereby move towards the promotion of patient care.

Different approaches are available to irrigate the arterial catheter, such as continuous and intermittent techniques. However, there is a disagreement regarding the most appropriate method.
Aim: this study aimed to compare the effect of two continuous and intermittent irrigation methods on complications of arterial catheter and partial thromboplastin time (PTT) in patients with coronary artery bypass (CABG) surgery.
This randomized clinical trial was conducted on 60 participants undergoing coronary artery bypass grafting surgery in open-heart surgery ICU at Imam Reza hospital in Mashhad, Iran, in 2016. In continuous group, the arterial catheter was continuously irrigated with heparin solution at the rate of 2cc/h, and in the intermittent group with a syringe containing 5cc heparin solution every 3 hours. In both groups, catheter was monitored and recorded every 3 hours (until 48 hours and 3 times from enrollment) in terms of complications of partial thromboplastin time. Data were analyzed using SPSS version 16.
The findingsof independent t-test showed that the two groups are homogeneous in age (P =0.48). The result of Fisher's exact test revealed no significant difference between the two groups in terms of average incidence of complications during the first 24 hours (P=0.55) and second 24 hours (P=0.55) after catheterization. Also during the 48 hours after surgery, independent t-test results showed no statistically significant difference in partial thromboplastin time (P=0.53) between the two groups.
Implications for Practice: According to the results of the research based on the lack of difference between continuous and intermittent irrigation methods up to 48 hours after catheter replacement in terms of arterial catheter complications, further long-term follow-up researches are recommended.

Background and Despite the high prevalence of chronic obstructive pulmonary disease, There haven,t been definite curative treatment for the disease and focus of treatment has directed towards pulmonary rehabilitation as an effective non-drug treatments. this study were performed to determine the effect of motivational abdominal breathing device on breathing pattern and dyspnea of chronic obstructive pulmonary disease
This study is a clinical trial done in 2015 on 70 patients with chronic obstructive pulmonary disease admitted to Samen alaeme hospital, CHENARAN city. Patients were assigned to two groups of 35 persons, Intervention and control. groups did exercises at home twice a day for two weeks. The dyspnea, respiratory rate and depth of breathing, before, seventh day and after the intervention was measured by spirometry and dyspnea NRS scale. Data analysis was performed by SPSS version 11.5 using t-test, Mann-Whitney and repeated measures analysis.
The results showed that difference in respiratory rate before and after intervention (P=0/78) did not change significantly between two groups. But difference before and after the intervention, depth of breathing and before and after intervention of dyspnea were significantly changed in both groups (P The results of this study showed that motivational abdominal breathing device has a more positive effect than the abdominal breathing normally on respiratory status and thus can be used as effective rehabilitation techniques.

Particular circumstances in the intensive care unit have led the patients to experience significant levels of pain and discomfort. On the other hand, these patients cannot express their discomfort due to several reasons.

to develop the causes of discomfort in the intensive care units.

In order for assessing the causes of discomfort, the initial questionnaire was extracted with 60 items and its content validity was then confirmed by experts. Questionnaires were completed for 220 patients hospitalized in intensive care units of Imam Reza and Ghaem hospitals of Mashhad, in 1392. The exploratory factor analysis was used to determine the discomfort factors. The reliability coefficient of the questionnaire was applied by Cronbach’s alpha and approved by inter-raters agreement. Data analysis was performed with SPSS version 14.

Factorial analysis showed that the components of the 30-item questionnaire of discomfortfactors in the intensive care units was identified in 5 domains including: isolation and loneliness (7 questions), anxiety (6 factors), the ICU environment (6 factors), treatment (6 factors), and pathophysiologic factors (5 factors). The range of Cronbach’s alpha coefficient for sub-scales of the questionnaire of discomfort factors in the intensive care unit was between 0.65 and 0.85, and cronbach’s alpha coefficient for the whole tool was 0.86.

the questionnaire of discomfort factors is designed to assist the nursing staff of the intensive care units to identify discomfort factors in patients and ultimately improve the quality of care for them. The psychometric characteristics of this questionnaire confirm its validity and reliability, so that it can be used to determine the source of discomfort among the ICU patients.

the gap between theory and practice in nursing lead to Inconsistency between what is learned and what is done in practice. One component that is causing these problems is nursing education field. This study examines these issues through a comprehensive study has been done in this field. A literature search is based on data base consisting of Persian and English. Website such as Magiran, SID, SCOPUS, Pub Med, respectively searched. First, using the key words "nurse" or "Gap between Theory and Practice", then the eligible articles were selected based on set criteria. Criteria, including the existence of causes and lotion strategies in gap between theory and practice. 85 articles examining various causes and solutions are obtained. Reflective clinical practice and training to students aspiring to lifelong learning, role models, using clinical nursing professors, clinical teaching based on needs, Curriculum reform, and update the knowledge of teachers and nurses, equipping clinical skill lab, better ways to engage teachers and nurses were the most important in this study were obtained. Many factors can influence to gap between theory and practice in nursing, the most important of them are give correct method in training students, effective teaching, and attention to need of society

Despite the fact that evaluation is the most important part of effectiveness of clinical education، evidences show the inefficiency of current evaluation methods. Common evaluation methods are restricted in subjective information and in addition to failure in evaluating students’ clinical skills precisely، they are not considered as learning instruments. Therefore، this study was conducted to determine the effect of DOPS evaluation method on learning clinical skills of emergency medicine students. This two group quasi experimental study of before and after design was carried out in surgery wards of Ghaem & Emam Reza hospitals of Mashhad University of Medical Sciences within 2008 and 2009 academic years. Study population included all emergency medicine students of the second semester that were divided into two groups (n=25 in experiment and n=21 in control group). Data collection method included observation and completion of a researcher made checklist before and after clinical course. Tool credibility was confirmed using content validity and its reliability was approved through inter-rater reliability (r=0/89). Data were analyzed using descriptive statistics، independent t-test، and paired t-test. There was no significant difference between groups regarding demographic variables. The mean of pretest in two groups showed no significant difference before intervention (p=0. 18 and t=-1. 3). This is while case group showed higher mean scores compared to control group after intervention (via DOPS evaluation) and this difference was significant (p=0. 0001، t=4. 9). It seems that employing new methods of evaluation such as DOPS as an objective، valid، and highly applicable method in clinical evaluation solely or along with other common methods، can result in the improvement of clinical skills and more effective learning among students.

An important part of nurse’s professional behavior forms during academic education and develops throughout professional career. Therefore comparing professional behavior of freshmen and seniors at graduation with that of nurses can illustrate the formation and development of professional behavior at the time of formal and informal nursing education. This study was conducted to compare professional behavior of nursing students to that of nurses employed in Mashhad University of Medical Sciences. In this descriptive cross-sectional study of trend type، study population included all freshmen and senior nursing students of school of nursing and midwifery in Mashhad University of Medical Sciences as well as nurses employed in hospitals affiliated to this university in year 2011 (n=322). Professional behavior of these students and nurses was assessed using modified “nursing student professional behavior” questionnaire of Goze. The validity of the questionnaire was confirmed using content validity index and its reliability was confirmed using Cronbach''s alpha coefficient. Data was analyzed using descriptive statistics، Kruscall-Wallis، and Spearman correlation coefficient. 72 freshman students of clinical nursing (64%)، 40 senior nursing students (35%)، and 322 nurses formed the sample. The mean score of professional behavior of freshman students was 110/3±17. 3 out of total score of 135 and this mean score was 107±12/8 for senior nursing students and 109±12/6 for clinical nurses. The result of Kruscall-Wallis test showed no significant difference among these three groups (p=0. 2). Although basic nursing educations prior to clinical education has lead to development of a desirable level of professional behavior in junior nursing students، development of these behaviors did not have an appropriate trend among senior students and employed nurses. Further studies using other ways of assessment are needed to assess nursing students and clinical nurses'' professional behavior considering factors promoting professional behavior.