kian norouzi

In nursing homes, intergenerational relationships has of particular importance because people of different ages and from different generations interact with each other. Health care workers, including nurses, can cover a wide range of intergenerational relationships in the form of care provided to the elderly. Despite the importance of intergenerational relationship among the elderly, the related challenges in nursing homes in Iran have not been studied yet. Therefore, this study aims to identify the factors affecting intergenerational relationships in nursing homes in Iran.

 This is a qualitative study that was conducted in three nursing homes in Tehran, Iran using the grounded theory method. Participants were 13 older residents and 8 employees working in nursing homes (Five nurses, one supervisor, one psychologist and one nursing home manager) who were recruited purposively. Semi-structured interviews were used to collect data and sorted by constant comparison method. Data analysis was performed using Strauss and Corbin’s grounded theory method.

 Data analysis yielded five main categories. “Intergenerational tensions” was the main variable. The causal condition for this variable was titled “Tensions based on psychological factors”. The contextual factors in nursing homes were in a group titled “defective platform of intergenerational relationships”. The intervening factors included facilitators of and barriers to intergenerational relationships. Strategies was titled “Efforts to preserve existence” and consequences were titled “living with insecurity”.

 Generational differences between nursing home residents and staffs make it difficult to establish effective relationships between them which can cause poor quality care. The findings can help nursing home managers to apply strategies to remove barriers to intergenerational relationships and know how to improve these relationships and create greater cohesion between generations so that it can lead to better care and subsequently improved quality of life in the elderly.

This study was conducted to investigate the relationship between health literacy and the quality of life of hemodialysis patients.

The present study was conducted by descriptive-correlation and cross-sectional method in 1399 in Ardabil, Iran. The statistical population included 450 hemodialysis patients covered by Ardabil University of Medical Sciences, from which a sample of 140 people was selected based on Cochran's formula. Patients who were treated more than 3 a month, having hemodialysis one to three times a week were included. Failure to respond to all items of the questionnaire and reluctance and lack of motivation to respond to the questionnaires were the criteria for exclusion. Data collection tools included health literacy and quality of life questionnaires. The collected data were analyzed using SPSS software version 20.

39% of patients had low health literacy, 41% had moderate and only 20% of patients had high health literacy, also 35% of patients had low quality of life, 42% had a moderate quality of life, and 23% had a high quality of life. The results of the Pearson and Spearman tests showed that there is a significant relationship between health literacy and the quality of life of hemodialysis patients (P <0.05).

The results of this study showed that the level of health literacy is insufficient and there is a significant relationship between health literacy and the quality of life of hemodialysis patients; Therefore, due to the insufficient level of health literacy among patients, it is necessary to pay more attention to health literacy in quality of life improvement programs.

ObjectiveDue to the growing uncertain discounts in Iranian businesses, this study seeks to investigate the effect of discount uncertainty on the intention to buy among Iranian customers. Therefore, we initially attempt to compare uncertain discounts (ambiguity in the amount of discount) and certain discounts (a definite amount of discount) focusing on the source of uncertainty. Then, we should examine the effect of the design and introduction of uncertain discounts on the customers' preference. For this purpose, eight uncertain discounts were used, including four odds-based discounts (with probability of winning and different discount rates), three pull-down discounts (with different discount intervals), and one skill-based discount. In the third step, we will examine the effect of product type (utilitarianism and hedonism) on customers' preferences. Consequently, all decisions will be displayed once for a utilitarian product and then for a hedonistic product. MethodologyFor this purpose, an online within-subject full factorial experiment was designed and performed, where 59 people were faced with 72 decisions. In order to design this experiment, JavaScript programming language and jsPsych library 1.6 were used. Moreove, the JATOS platform 3.5.3 was employed in order to load the test and generate the link and run it on the server. Then, participants were asked to choose between one of the two types of discounts based on their preferences. Nine discounts (eight uncertain discounts and one certain discount) were used for two products: a powerbank (utilitarian) and tablecloth (hedonism). All participants were randomly assigned to those decisions. FindingsIranian customers acted based on risk-resisting ideology in choosing between discounts based on chance and skill compared to normal discounts; thus, they preferred certain discounts. However, there is no significant difference between the choice of individuals when facing tensile discounts. In odds-based discounts, people prefer to win less amount of discount compared to the lower chance of winning big discounts. In tensile discounts, the upper margine of the certain discount has a positive effect and the lower margine has a negative effect on the customets’ desire to choose a discount. Therefore, there was no difference between the type of product (hedonistic or utilitarian) in people's decisions. ConclusionIn designing discounts with uncertainty, marketers should consider customers' preferences over certain discounts and attempt to increase the attractiveness of such discounts by addressing other aspects of these discounts, such as creating a fun, exciting, and enjoyable experience. Regarding tensile discounts, marketers should be aware that the upper margine of the discount has a greater impact on customer attraction compared to the lower margine.

In the last days of life, home‑dwelling terminally‑ill older patients have complex care needs. End‑of‑life (EOL) care for these patients is usually delivered at home. However, there is limited information about the barriers to EOL care delivery to home‑dwelling terminally‑ill older patients.

This study is aimed to explore the barriers to EOL care delivery to home‑dwelling terminally‑ill older patients.

This qualitative study was conducted in 2017–2018. Ten family caregivers and ten health‑care providers were purposively selected. The main inclusion criterion was the experience of EOL care delivery to home‑dwelling terminally‑ill older patients. Data were collected through semi‑structured interviews and were analyzed through conventional content analysis. In total, 23 interviews were held with twenty participants.

The barriers to EOL care delivery to home‑dwelling terminally‑ill older patients were categorized into the following three main categories and ten subcategories: inappropriate community‑based healthcare context (subcategories: lack of public home care services, lack of palliative/hospice care services, legal/ethical dilemmas, and wrong cultural beliefs leading to wrong EOL care), unsupportive healthcare providers (subcategories: limited preparation for EOL care delivery, negligence towards appropriate home care delivery, and indifference to patients’ and their families’ rights), and inappropriate family conditions (subcategories: families’ lack of care‑related knowledge and skills, families’ poor financial status, and tension in families).

There are different familial, financial, professional, organizational, and social barriers to EOL care delivery to home‑dwelling terminally‑ill older patients. Culturally‑appropriate policies and strategies are needed for operationalizing EOL care, integrating it into the public health‑care system, and preparing healthcare providers and family caregivers for its delivery.

Elderly Demographic change will have a significant impact on societies. Locomotive disorders are common and important cause of disability and reduced quality of life in old age. Recognizing screening methods, can be early detection Locomotive syndrome (LS), prevented the incidence, prevalence and disability caused by this syndrome. The aim of this study is to integrative review of screening methods for LS in the elderly.

In this review study, searches in international and national databases and journals: Science Direct, PubMed, Scopus, Irandoc, SID, with keywords Locomotive syndrome, Locomotive disorder, screening tool, assessment tool, physical performance test, from 2000 to 2018were extracted and reviewed.

from 70 related articles, 19 English articles were reviewed. Methods and tests used to assess, evaluate and LS screening in 19 Articles related to the purpose of this study include evaluation method of 9 - Physical and 3 questionnaire or Evaluation Checklist. These include: stand up test, one-leg standing test (with open eye), two-steps test, 5-times-sit-to-stand test, 6-walking time, the 10-m gait time, measuring back muscles strength and grip strength, timed up-and-Go (TUG Test), maximum stride, self-check list (Loco-check), questionnaires GLFS-25 and GLFS-5.

In this study, screening methods of LS described. Because of the importance of the LS, using the perfect screening methods recommended in elders, for timely detection of LS.

Medication adherence (MA) has a crucial role in controlling of hypertension (HTN). A difference was observed in the prevalence of anti-hypertensive MA reported in different studies in Iran, so we aimed to determine the overall prevalence of MA. Using the English and Persian keywords extracted from Mesh, the databases of MagIran, Barakat Knowledge Network System, Scientific Information Database (SID), Web of Sciences, PubMed, Science Direct, and Google Scholar were reviewed from 2000 to 2018. The overall prevalence of MA was estimated using Random effect mode. The I2 and Egger’s tests were used to assess heterogeneity and publication bias, respectively. Meta-regression and subgroup analysis were conducted based on variables such as age, marital status, regions, and tools. The overall prevalence of MA was 33%. Moreover, the prevalence of MA based on ‎the 8-Item Morisky Medication Adherence Scale‎ (MMAS-8), Hill-Bone Medication Adherence (HBMA) scale, researcher-made tools, and self-care tools, were 13%, 34%, 48%, and 47%, respectively. A higher MA prevalence (38%) was observed among older adults compared to other age groups, and married patients (32%) compared to single (23%) individuals. The highest MA prevalence (50%) was related to region 5 of the country. Meta-regression results showed a significant relationship between the used tools and MA prevalence. The overall prevalence of MA is low in Iran. Furthermore, MA was measured using different questionnaires, such as standard international scales and researcher-made tools. It is proposed that a standard international questionnaire should be used in future studies.

Improving living conditions and increasing longevity and life expectancy has led to the phenomenon of aging in societies. This incremental rate causes a serious challenge for organizations that provide health and therapy services. In association to the mentioned challenge, the purpose of this study was to study Stauts and determiants of health services utilization among elderly elderly rural hubitant in Semnan City (Iran) in 2016. This was a cross-sectional study in which 395 elderly people in Semnan City were studied and the collected information was performed by using a structured questionnaire. Between the whole cases, 54% (224 people) used outpatient services. In outpatient services, 14.4% consult with specialists and 13.7% used services from educational hospital. 26% of the other cases used in patient services. That service from 56% among them used educational public hospitals. The related factors of the utilization rate of outpatient health service were: age (p=0.02), gender (p=0.02), marital status (p=0.01), income status (p=0.01), education (p=0.01). The related factors of the utilization rate of inpatient health service were: age (p=0.02), gender (p=0.03), marital status (p=0.05), income status (p=0.02). Obtaining benefit from health services has a meaningful relationship with various socio-economic factors such as sex and age, and income and education status, each of which can affect the level of health benefits of individuals. It also seems that multiplier is a multi-factor issue, and therefore proper planning for this growth demand is necessary.

Hypertension is one of the major causes of disability. Illness perception is an important predictor for adherence to therapeutic regimens. The current study aimed at determining the relationship between adherence to a regimen and illness perception among elderly with hypertension.
The current descriptive, analytical, cross sectional study was performed on 325 elderly people with hypertension referring to the elderly health centers of Tehran, Iran, selected via the random cluster sampling method in 2016. The data gathering instrument was the demographic questionnaire, Morisky medication adherence scale (MMAS), and illness perception questionnaire-revised (BIPQ-r). Data were analyzed using descriptive statistics, Pearson correlation coefficient, and regression coefficient with SPSS version18.
Pearson correlation coefficient showed that there was a significant direct correlation between perceived disease and adherence to treatment in the elderly with hypertension (P The results showed that there is a significant relationship between adherence to a regimen and illness perception. Therefore, strengthening the perception of the disease in order to increase adherence regimens in patient is considered as an important strategy in educational interventions.

A preterm neonate puts the mother in complicated conditions, and affects the natural process of neonatal care as well as parental role, particularly the mother’s role. Self-efficacy is a factor that significantly influences the proper function and responsibility of mother, and also is a determining factor in the evolution of mother’s performance and has a close relationship with the growth and development of infant. On the other hand, quality of life (QoL) is related with self-efficacy. The current study aimed at determining the relationship between self-efficacy and QoL in mothers with preterm neonates in Kamali Hospital, Karaj, Iran, in 2015.
The current cross sectional, descriptive-analytical study was conducted using the convenience sampling method on 115 mothers with preterm neonates. Data were collected using a demographic questionnaire, perceived maternal parenting self-efficacy (PMP S-E), and the Persian version of quality of life questionnaire. Then, the relationship of QoL with self-efficacy and some relevant factors was assessed.
In the current study, by increasing the self-efficacy, the QoL also increased. In other words, by one point increase in self-efficacy, the QoL increased 0.5 point. Level of income and maternal education were considered as the factors significantly influencing the increase of self-efficacy and QoL. In this regard, it seems that the employment of the mother and unwanted pregnancy were the indices that affected the reduction of self-efficacy and QoL scores.
According to the positive and direct relationship between self-efficacy and QoL that plays a significant role in different aspects of individuals’ social life, targeted therapeutic programs to promote self-efficacy and QoL in mothers with preterm infants should be planed.

Self-care in chronic diseases includes the study and control of the disease, compliance of the medication regimen, and maintaining a healthy lifestyle and daily function. The aim of this study was to examine the effect of self-care education by Mobile on self-efficacy and adherence to the medication regimen in adolescents with epilepsy referred to Iran Epilepsy Association.
This clinical trial study was conducted on 60 adolescents (age range, 12-18 years) with epilepsy registered in the Iran Epilepsy Association. The participants were randomly divided into two groups of intervention and control. Data were collected using the demographic questionnaire, eight-item Morisky Medication Adherence Scale (MMAS-8) and self-efficacy questionnaire. The educational messages were sent during 3 months for the intervention group and for the control group did not send any messages. After 3 months, all patients completed the questionnaires again. The data were analyzed using the SPSS software.
Before the intervention, there was no significant difference in demographic variables, self-efficacy and adherence to medication regimen between the intervention and control groups (P > 0.05), but after the intervention, the mean scores of the variables in the intervention group were significantly increased and significant differences were found between the two groups (P The results of this study showed benefits of educational messages, adopting self-efficacy and adherence to the medication regimen among patients with epilepsy.

Awareness of nurses’ experiences is helpful to identify current problems in providing services during disasters. In this regard, better planning and preparation may reduce the problems of this large group of health care providers. This study aimed to investigate the experiences of female nurses in providing services during disasters.
This is a qualitative study with content analysis approach. The participants comprised 15 nurses with experience in providing healthcare services during disasters. Samples were recruited by purposive sampling method and sampling was continued until data saturation. Data were collected through semi-structured interviews, then analyzed by manifest content analysis.
Based on experiences and perceptions of nurses, three main categories found out of analyses of the obtained data were as follows: “the importance of paying attention to the specific needs of female nurses,” “places for female nurses during disastrous period,” and “the importance of the presence of female nurses in providing services.”
Many factors affect the services delivered by female nurses. The results of this study showed that the specific needs of female nurses, who are the main body of Iranian nurses, could maximize their performance and minimize their psychological and emotional damages.

Patient safety is crucial for promotion of healthcare quality and is monitored as an important parameter by all healthcare provider organizations worldwide. Nurses play a major role in maintaining and promoting patient safety due to the nature of their work. The purpose of this study was to compare the effect of patient safety education program on patient safety culture among nurses working in Ilam education-treatment centers.
In this experimental study, 40 nurses were selected from Ilam educational-treatment centers and randomly allocated to two groups of virtual patient safety education and lecture-based education. Hospital Survey on Patient Safety Culture questionnaire was completed by nurses of the two groups before and after patient safety education program. Statistical analysis was performed using Kolmogorov-Smirnov, independent t-, and paired t-tests. The significance level was considered less that 0.05.
Patient safety culture was significantly improved in both virtual and lecture groups after educational intervention (p The findings of this study indicated that educational programs could be used by administrators of health service providers to improve patient safety culture among nurses. Also, providing patient safety educations as virtual or lecture both will be helpful.

Medical emergency staff complete understanding of the nature of resiliency in burn events is a prerequisite for improving the quality of clinical service delivery in pre-hospital burn events.. The present study aimed to describe resiliency in view of medical emergency staff in burn events.. The present qualitative study was performed using a content analysis method. In total, 18 Iranian emergency care personnel participated in the study. A purposeful sampling method was applied until reaching data saturation. Data was collected using semi-structured interviews and field observations. Afterwards, data was analyzed by face content analysis.. By analyzing 456 primary codes, four main concepts including: 1) scene safety/security, 2) effective clinical decision making, 3) self-efficacy and 4) religious support were extracted through content analysis from experiences of pre-hospital emergency personnel during burn care.. Different factors affect resiliency improvements in medical emergency staff and consequently the quality of pre-hospital burn care. This study showed that various factors such as scene security/safety, effective decision making, self-efficacy and religious support are effective in the improvement of resiliency and the quality of pre-hospital emergency care..

The severity of illness scoring systems have been used to predict mortality rate in patients who were admissions with a wide variety of diagnoses in the Intensive Care Unit. The aim of this study was to compare the APACHE IV and SAPS II in predicting mortality rate in intensive care unit patients. In this cross- sectional study, all patients who admitted to the intensive care units of two teaching hospitals of Mashhad, Iran were included in the study over three months. We collected data from 150 patients with demographic characteristics questionnaire, APACHE IV and SAPS II. The data were analyzed using standard methods. The mortality rate was 33.3. Mean and SD of APACHE IV in patients who survived and patients who died were 51.60 ± 20.23 and 77.96 ± 19.38 respectively (p =0.001). The predicted mortality rate was 22.61 for APACHE IV and 27.17 for SAPS II. Logistic regression results showed that with increasing every point in predicted mortality rate based on the APACHE IV and the SAPS II, the chance of observed mortality was increased by 8 percent (OR = 1.082) and 4 percent (OR = 1.048) respectively. The results showed that the APACHE IV and SAPS II were able to predict mortality rate in the intensive care unit patients but APACHE IV was more effective and useful tool.

In old age depression is common problem. Its rate at elderly residing at nursing homes is %30-50. Several types of medications are used to treat depression. However because elderly use many drugs due to their numerous problems, non pharmacological methods such as pet therapy can be considered. So the present study intended to assess the effectiveness of pet therapy on elderly depression. A quasi-experimental study was conducted with 60 elderly living at nursing homes. The elderly were randomly placed at two groups: intervention group (N:29) and control group (N: 31). In both groups Geriatric Depression Scale(GDS) and a questionnaire for demographic characteristics were used to collect data. Then research intervention including animal care program over a six-week period was performed. And the control group did not receive this intervention. Both groups were assessed by The Geriatric Depression Scale after the intervention period. Pretest score and posttest score were compared. To analyze the collected data Chi-square and independent t-test were used and the dependant t-test was applied to analyze the variables. Findings of this study showed that depression of elderly of intervention group decreased from 8/55 before intervention to 4/79 after intervention (P<0/001). But no significant difference was observed in the control group. The comparison of depression scores mean in both groups before intervention shows no significant statistical difference (p=0.531) while the mean after the intervention in control group was significantly higher (P=0.001). Considering the results of this study, it can be suggested that pet therapy has positive effects on reduction of elderly depression. Therefore, non-invasion interventions such as keeping pet by nurses can improve elderly depression and can cause their active participation. It is strongly recommended to use this intervention widely at nursing homes. In addition, this study provided a new field for research and nursing services.

Patients with multiple sclerosis experience hospitalization several times in their lives. Certainly, providing efficient and high-quality care by healthcare professionals is not possible unless the experiences of patients’ hospitalization are taken into consideration. This qualitative study was aimed to identify experiences of patients with multiple sclerosis in their hospitalization. A qualitative content analysis method was used to conduct this study. The study participants were 25 patients with multiple sclerosis, who were chosen by purposeful sampling. Data were collected through non-structured interviews. The analysis resulted in the emergence of 4 themes and 11 subthemes. The main themes were: Religiosity, emotional reactions, seeking support, and feeling of being in a cage. Awareness of families and healthcare providers of the reactions of patients with multiple sclerosis to hospitalization will help them to deal effectively with patients and to improve relationships with them. However, by understanding the patients’ experiences, the practitioners gain expertise and can join in the patients’ health journey in a therapeutic way during the hospitalization period. In addition, the findings can serve to create a framework for developing nursing care processes including informational and supporting programs for multiple sclerosis patients during hospitalization while taking into consideration patients’ needs and cultural backgrounds.

Multiple sclerosis is one of the most common chronic diseases in Central Nervous system. its chronic nature، absence of known cure and onset in young adults results in deteriorating effect on the heath of these people. This study was carried out to determine the effect of self-management program on Health Status of patients with multiple sclerosis (­MS). the participants of this pre-experimental study were 82 MS patients referring to Iranian society of MS in Tehran selected via convenience sampling. ­The data was collected by a demographic data sheet and the health status questionnaire، and analyzed by descriptive and inferential statistics. Before intervention، the mean of health status subscales show that there is no significant difference between two groups of case and control، While after intervention and two months later (except of pain and social function)، there are significant differences in the health subscales of two groups (p≤0. 05). Furthermore، in three times of measurement، there is a meaningful difference between two groups. the results show that the self-management program ­results in improving the health status of patients with multiple sclerosis; therefore، application of this supportive method could be useful to empower the MS patients and help them to manage their problems.

In recent years a variety of system models for providing community based health care services for the elderly has been envisioned and implemented in the developed countries which meet the special care needs of different groups of elders. In Iran as a developing country, a considerable percentage of old people live in the society need to receive specialized care and health services. In order to respond to these care needs, developing and implementing health and social care systems with consideration of relevant factors such as: existing and available resources and facilities (financial and human resources); social and cultural issues and characteristics of each groups of elders(healthy elders, frails,home bounds, …)  seem to be necessary. At the development phase of the care model in this study Ellowing methodological triangulation must be considered: 1) Comprehensive review of current and related literature, 2) Conduction of an ethnographic study on a number of Tehranian elders and their families, 3) Seeking opinions of a group of experts on this issue using nominal group technique, and analysis as well as synthesis of the collected data were employed to develop a community based care system for elders. The preliminary results of employing this care system and examination of expected outcomes such as promoting quality of life and expectancy in elders reflects the efficiency of this system, although further complementary studies and particularly cost benefit analysis are strongly recommended.