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Introduction: Swallowing disorder or dysphagia is a common complication after conventional total thyroidectomy. Traditional dysphagia therapy (TDT) has long been a routine rehabilitation program for patients with dysphagia; however, there is no evidence to support the efficacy of this approach in patients with post-thyroidectomy dysphagia. Regarding this, the purpose of the current study was to explore the effectiveness of TDT in swallowing dysfunction in patients suffering from post-thyroidectomy dysphagia. Materials and Methods: This pilot clinical trial was conducted on 21 patients with post-thyroidectomy dysphagia. The study population was randomly assigned into two groups of TDT and control. The patients in the TDT group received 18 treatment sessions for 6 weeks, 3 times a week. The Swallowing Impairment Score (SIS-6), Functional Oral Intake Scale (FOIS), and Persian Dysphagia Handicap Index (P-DHI) were the outcome measures. The outcome variables were assessed at the baseline, at the end of the treatment, and after a 6-week follow-up. The main effects of time and group and their interaction effect on SIS-6 and P-DHI scores were examined using repeated measures ANOVA. In addition, the intergroup comparison in terms of the FOIS score was analyzed using the Mann-Whitney U test. The Cohen's d effect size was also measured to ascertain the effects of the treatment. Results: According to the results, the TDT group showed a significant improvement in the SIS-6, FOIS and P-DHI scores over time (P

Background & Aim: Infant hospitalization in the intensive care unit is stressful for parents so that it affects their parental role. Nurses, due to their special situation, can play an important role in reducing parental stress. This study aimed to determine the effect of parental role training by a nurse on stress in the parents of hospitalized newborns in a neonatal intensive care unit. Methods & Materials: A quasi-experimental study (IRCT201605131788N17) was conducted on 72 parents (36 couples in the intervention group, 36 couples in the control group) of hospitalized newborns in the neonatal intensive care unit of Ali-Asghar hospital in 2016. The intervention group received the parental role training based on their needs. Their stress level was compared with the control group using the Parental Stress Scale. Data were analyzed by descriptive statistics, chi-square test, paired t-test, independent t-test and Fisherchr('39')s exact test using the SPSS software v.16. Results: Before the education, there was no significant difference in the stress level between the two groups (P>0.05). After the education program, the stress level in the intervention group fell on the tenth day compared to the control group (P

Background & Aim: Patient falling is one of the most important indicator of patient safety. Nurses have an important role in the prevention of patient falls and the improvement of patient safety standards. The current study aimed to determine the relationship between the incidence of patient falls and nurses’ professional commitment. Methods & Materials: In this cross-sectional study,300 nurses employed in hospitals affiliated to Tehran University of Medical Sciences, were selected through a proportional stratified sampling method. Data were collected by a three-part questionnaire consisted of the demographic data, the Nurses’ Professional Commitment Scale and the reports on the number of patient falls in the past three months. Data were analyzed on SPSS software using statistical tests including Pearsonchr('39')s correlation coefficient, Kruskal-wallis and independent-t test. Results: The mean score of patient falls in the past 3 months was 6±1.61(moderate) for each nurse and the mean score of nurseschr('39') professional commitment was 86±8.61 (committed).A significant and reverse relationship was observed between the incidence of patient falls and nurses’ professional commitment (R= -0.51; p

Background & Aim: Anxiety is associated with postpartum mood disorder; and is increased with birth of high risk neonates. Foot reflexology is a nursing intervention that can be used to reduce anxiety. T he aim of this study was to evaluate the effect of foot reflexology on anxiety in mothers with high risk neonates after Cesarean section s . Methods & Materials: In this non-randomized clinical trial, 99 mothers having high risk neonates were recruited from the Women's General Hospital and Valieasr Hospital . The participants were allocated into three groups (n=33/group) using convenience sampling method . The group I received foot r eflexology for 40 minutes ; group II received leg massage ; and the control group received usual care after the Cesarean section. The Spielberger questionnaire was completed at baseline and three days after the interventions by the participants . Data were analyzed using the r epeated measure ANOVA and Chi-Squared in the SPSS-16 . Results: At the baseline, there were no significant differences between the three groups in terms of demographic characteristics and the mean scores of anxiety . After the interventions, the mean score of anxiety was significantly lower in the reflexology and placebo groups than the control group (P0.05). Comparing the mean score of anxiety between the reflexology (14.7±7.2) and placebo (9.4±8.5) groups indicated that the reflexology intervention was more effective in reducing anxiety . Conclusion: The use of foot reflexology was effective in reducing anxiety. Nurses should use this non-pharmacologic method to control the symptoms of anxiety among mothers . &nbsp

Background & Aim: Thecentral venous pressure measurement is a common and important care provided by nurses in intensive units. The measurement should be according to the pre-defined standards. The purpose of this study was to evaluate the effect of using a checklist in measuring central venous pressure by nurses . Methods & Materials: This was a nonequivalent group design on 70 nurses working in ICUs. T he quality of measurement of central venous pressure by recruited nurses were measured via direct observation in the control (n=35) and experiment (n=35) groups. The intervention group nurses were recommended to use a performance checklist in each measurement of central venous pressure for one month. At the end of the intervention, the performances of both groups were evaluated through observation. Collected data were analyzed using the Chi-squared test, paired and independent test in the SPSS-17 . Results: At b aseline, the mean scores in both groups were not statistically significant (P=0.7) The mean performance score of the control group at the beginning and one month later were 7.64±2.33 and 7.65±2.28, respectively (P=0.6). In the experiment group, the mean performance score was 7.85±2.29 before the intervention and 9.28±3.16 after the intervention (P=0.001). T he difference between the scores before and after the intervention were significant (P=0.001) in the intervention group . Conclusion: Using checklist by critical care nurses could enhance their performances in measurement of central venous pressure. This method can be used as an accessible, inexpensive, and simple method to improve quality of nursing practices . &nbsp

Background & Aim: Medication usage is the bases of disease management in patients who undergo hemodialysis. Non-adherence to medication regimen increases the incidence of complications among the patients . The aim of this study was to investigate the effect of a cognitive-behavioral intervention on medication adherence in patients undergoing hemodialysis . Methods & Materials: In this clinical trial, 70 patients were selected from Imam Reza and Valiasr hospitals. Patients were assigned into two intervention (n=35) and control (n=35) groups. The intervention group received a cognitive-behavioral intervention including six steps: 1) Identifying the problem; 2) Creating confidence and commitment; 3) Increasing awareness of behavior; 4) Developing and implementing the action plan; 5) Evaluating the plan; and 6) Maintaining the desired behavior. Adherence to medication regimen was assessed using a self-report questionnaire before and immediately after the intervention. Data were analyzed using the independent t-test . Results: At baseline, there was no significant difference in adherence to medicine regimen between the intervention (20.77 ± 4.56) and control (22.34 ± 3.65) groups (P=0.1). After the intervention, significant difference was observed between the two groups in adherence to medication regimen (P

Background & Aim: Demographic transition and aging are global conditions result in increased risk of disability and chronic diseases such as diabetes. Considering stress as having mutual interaction with different aspects of health is vital in treatment of common disorders among older adults with diabetes. This study aimed to assess the relationship between the perceived stress with spiritual health among older adults with diabetes registered to the Association of Diabetes Prevention and Control in Babol . Methods & Materials: In this cross-sectional (descriptive- analytical) study, 194 older adults aged 60-75 years old were selected using convenience sampling from the Association of Diabetes Prevention and Control in Babol. Data were collected using the demographic form as well as the Perceived Stress Scale (PSS) and the Spiritual Well-being Questionnaire (SWB). The validity and reliability of the scales were confirmed previously. Data were analyzed using descriptive and inferential statistics including ANOVA, Chi-Squared tests, t-test and Pearson correlation coefficient in the SPSS-21 . Results: The study findings showed that perceived stress was low in a substantial percentage of the elderly (74.2%) with the mean ± SD of 22.52±8.06. Also, the levels of spiritual health were medium to high among most participants (97.72 ± 11.51). Interestingly, there was a significant negative relationship between the perceived stress and spiritual health (r=-0.48, P

Background & Aim: Governing organizational culture in hospitals can affect patients’ safety through establishment of behavioral norms among nurses. This study aimed to determine the relationship between nurses’ perception of organizational culture and their performance about patients’ safety . Methods & Materials: In this cross sectional, descriptive-correlation study, we used stratified sampling method to recruit 250 nurses working in general wards and emergency departments of general hospitals in Babol, 2013. Data were collected through questionnaires and were analyzed using the descriptive and inferential statistic tests including the Pearson test, ANOVA test and T-test in the SPSS . Results: Nurseschr('39') perception of organizational culture was "fairly desirable" (54.5%). Performance of the nurses in the field of patientschr('39') safety was "desirable" (88%). The Pearson test showed that there was a positive and statistically significant correlation between nurses’ perception of organizational culture and their performance in the field of patients’ safety (P

Background & Aim: The nature of clinical practice has altered in recent years. It has been affected by different kinds of problem-solving modelschr('39') so, the problem-solving skill is necessary in practice for nurse practitioners. Besides assertiveness is a critical element which persuades nurses and nursing students to establish good relationships and use their knowledge and professional skills effectively. The aim of this study was to assess the relationship between problem solving and assertiveness skills among undergraduate nursing students . Methods & Materials: This was a descriptive correlational study. The study was carried out in the School of Nursing and Midwifery at Iran University of Medical Sciences. The study population included all students enrolled in the four-year nursing program in 2009-2010. Data were collected using the Heppner and Petersen’s problem solving inventory and Rathus assertiveness schedule. Data were analyzed using the ANOVA, independent sample t-test and Pearson Correlation Coefficient tests in the SPSS . Results: Three hundred and twenty two students participated in this study. The studentschr('39') problem-solving skill (mean=89.5) and assertiveness (mean=12.1) were moderate. The study showed that last year students reported higher assertiveness skill than the freshmen (F=2.85 P≤0.037). The level of assertiveness was correlated with the level of problem-solving skill . Conclusion: Educational programs should provide opportunities for nursing students to enhance life skills such as problem solving and assertiveness skills. Nursing schools should improve studentschr('39') skills in clinical approaches to be better care professional .

Background & Aim: An important goal of nursing care in the Neonatal Intensive Care Unit (NICU) is to provide holistic care as well as the best possible outcome. Understanding perceived needs of mothers is valuable to achieve these goals. This study aimed to compare perceptions of nurses and premature infants’ mothers about mothers’ needs in the NICUs. Methods & Materials : This was a cross-sectional study in which 63 nurses and 63 mothers with premature infants were selected from the NICUs of four educational hospitals affiliated to the Mashhad University of Medical Sciences through stratified sampling method in two months. Data were gathered using the NICU Family Needs Inventory of Ward and were analyzed using descriptive-analytical statistical methods in the SPSS v.16. Results: Among the subscales related to family needs, the following items were reported to be important by mothers: Proximity (95.3%), Assurance (94.1%), Information (91.1%), Support (79.7%) and Comfort (72.8%). On the other hand, nurses believed that the following items were the most important needs of the mothers: Assurance (80.3%), Proximity (75.2%), Information (70.8%), Comfort (66.3%) and Support (64.8%). Conclusion : According to study findings, nurses should periodically assess needs of the mothers in the NICUs to be aware of the actual needs instead of placing subjective assumptions on mothers needs. This can improve effective communication and interaction with mothers and enhance satisfaction of the mothers with care.

Background & Aim: The effect of perceived stress on students’ health depends on their coping abilities. Resilience is a coping strategy for dealing with the stress. The aim of this study was to determine the relationship between the perceived stress with resilience in undergraduate nursing students . Methods & Materials: In this cross-sectional study, 309 undergraduate nursing students of Tehran University of Medical Sciences were selected during the first semester of 2012-2013 using the stratified sampling method. Data were collected using the Perceived stress scale and the Connor-Davidson Resilience Scale (CD-RISC). The data were analyzed using descriptive and inferential statistics in the SPSS-14 . Results: Findings revealed that most of the students (99.3%) had a moderate or high perceived stress. There was a statistically significant relationship between the perceived stress with the resilience (P £ 0.001, r=-0.38) . Conclusion: The school of nursing should provide facilities and opportunities for students in their 4-year educational program to learn stress management strategies including increasing resilience ability.

Introduction: Coronary artery disease (CAD) is the leading cause of dead and a major health priority among women. It has influence on physical, mental and social aspects of health and individual’s perception of wellbeing. This study aimed to investigate the general health and related factors in women with CAD. Materials and Methods: In this cross-sectional descriptive study, 200 women with a diagnosis of CAD who were referred to Shahid Rajaei Cardiovascular Medical & Research Center (Tehran) were selected through convenience sampling method. The data were collected using General Health Questionnaire (GHQ-12).Results: The mean (SD) score of the general health was5.85±3.32(range: 0-12). 72.5% of patients (n=145) hadunfavorable general health. The women with lower educational level (P=0.004) andeconomical status (P

Background & Objective: Hospitals and healthcare centers, like any other organizations, have some common norms and beliefs called as organizational culture. Organizational culture plays a key role in organization&aposs and staffs&apos performances. Nurses&apos perspectives on the organizational culture affect the way they play their role in. This study aimed to investigate the role of organizational culture from perspectives of nurses working in selected hospitals at Tehran University of Medical Sciences. Methods & Materials: In this cross-sectional study, 230 nurses working in different wards of selected hospitals of Tehran University of Medical Sciences were recruited to the study. Data were collected using a demographic characteristics checklist as well as the nurse and organizational culture questionnaire extracted from the Robbins criteria. Data were analyzed using descriptive statistical indexes, independent t-test, Pearson correlation coefficient and regression in the SPSS v.17. Results: Results showed that the existing organizational culture in the selected hospitals was in a moderately good level from nurses&apos perspectives. From the scores obtained for various dimensions of the organizational culture, the highest and lowest scores were for control (44.2%) and conflict tolerance (31.8%), respectively. Conclusion: The level of the organizational culture from the nurses&apos perspectives might lead them to decrease the quality of their performance. Optimizing the organizational culture can improve nurses&apos performance and motivate them to increase their quality of work.

Background & Aim: Lack of knowledge about coronary angiography may cause anxiety and stress in patients. Implementing appropriate educational methods can be effective in decreasing the level of anxiety among these patients. This study aimed to compare the effects of face-to-face with group education on anxiety and knowledge of patients undergoing coronary angiography. Methods & Materials: This quasi-experimental study was conducted in Shaheed Rajaie Cardiovascular Center affiliated to Tehran University of Medical Sciences in 2012. Through consecutive sampling method, 84 hospitalized patients who were candidate for coronary angiography were selected and allocated into two educational groups. Data were collected using a demographic data sheet, the knowledge assessment questionnaire, and the Spielberg state-trait anxiety inventory. Patients in both groups received same educational content. The patients' knowledge and anxiety were assessed before and after the intervention. Data were analyzed using descriptive statistics and independent t-test and paired t-test. Results: The finding showed that both face-to-face education and group education were effective in enhancing the knowledge of the patients. However, group education was more effective than the face-to-face education in reducing the patients' anxiety (P=0.049). Conclusion: Health professionals, particularly nurses, can use group education as an effective and appropriate strategy to improve patients' knowledge and to reduce the anxiety among patients undergoing coronary angiography.

BACKGROUND AND OBJECTIVE: Neonatal intensive care unit (NICU) induces high level of anxiety for parents, especially primipara mothers. So strategies are necessary to reduce parent anxiety. Intervention that suggested in this situation is presence and participation of parents in the care of infant. Therefore, the aim of this study was to evaluate the effectiveness of participatory care program on maternal state anxiety that have preterm newborns hospitalized in NICU.METHODS: The design of this study was a randomized clinical trial. The study participants included 100 mothers with preterm newborns (30-37 weeks) hospitalized in NICU of Akbarabadi hospital in 2010. Samples divided by consecutive sampling method and randomized to two experiment and control groups (n=50 in each group). The interventional program was conducted for experiment group in the form of an individualized educational session and presence and active participation of mothers in their newborn’ care in NICU. The state anxiety scale score was classified based on Spielberger, average to above, high anxiety, average to low and low anxiety. The data were collected at the pre-test (24 hours after admission of the infants) and post-test (discharge phase) and then compared.FINDINGS: At pretest, the findings showed no significant difference regarding state anxiety between two groups (control= 63.8±8.1 and experiment= 65.08±8.48) (p=0.84), whereas at posttest, significant reduction in maternal state anxiety was seen in the experiment group (29.96±6.31) compared to the control group (52.80±10.37) (p

Background & Aim: Moral distress, a major issue in nursing, affects nurses in all healthcare sections. The existence of such distress and its consequent job dissatisfaction may pose a threat to nurses' physical and mental health, as well as their quality of life; and hinder their accomplishment of individual and social goals. The aim of this study was to determine the relationship between the moral distress and job satisfaction In nurses. Methods & Materials: This cross-sectional correlational study was conducted on 210 nurses employed in the selected healthcare centers of Tehran University of Medical Sciences in 2009. Data were collected using a questionnaire consisting demographic characteristics, the Corley's moral distress scale, and the Minnesota Satisfaction Questionnaire. Data were analyzed using descriptive statistics and independent t-test, analysis of variance, Wilcoxon test and Pearson's correlation coefficient in the SPSS v.14. Results: According to the findings of the study, the mean of the moral distress was 1.77 out of four; and the mean of the job satisfaction score was 3.17 out of 5; indicating a moderate job satisfaction among the nurses. A significant relationship was observed between the moral distress and nurses' job satisfaction in the present study, indicating that by decreasing moral distress, job satisfaction increases. Conclusion: Although numerous factors govern nurses' job satisfaction, the observed relationship between moral distress and job satisfaction indicates that identifying and limiting factors influencing these distresses can lead to improved job satisfaction for nurses.

Background & Aim: Despite technology development, rate of infants&apos hospitalizations is still high, which endures emotional and economic burden to families. The aim of this study was to investigate the effect of mothers&apos participation in care of preterm infant on readmission rate. Methods & Materials: In this randomized controlled trial, 100 mothers who had preterm infants (gestational ages: 30-37 weeks) with respiratory distress syndrome were recruited. Samples were selected using continuous random assignment. Collaborative programs for the intervention group were implemented in the form of an information session and presence and participation of mothers in their infants care. One month after discharge, readmission check list was completed. Data were analyzed using Chi-square and paired t tests. Results: Results showed that readmission rate was lower in the intervention group compared with the control group. The average length of stay in hospital was 6.96 in the intervention group and 12.96 in the control group (P

Background and Aim: Neonates ' reaction to pain is more severe than adults. Therefore, recognition and application of pain control strategies by health care workers is necessary. Immunization is a common painful event during infancy, which is typically performed without pain control. The aim of this study was to examine the effect of distraction technique and oral sucrose on reducing vaccination pain. Material and Methods: this randomized clinical trial was performed on healthy infants referring to the health centers of Tehran University of Medical Sciences in west of Tehran by their mother for DPT technique vaccination. Healthy infants groups (n=114) were randomly assigned to distraction (n=38), oral sucrose (n=38) and routine care (n= 38) groups. Infants in distraction group, were provided with a (rattle), 30 seconds before, during, and 15 seconds after the injection. Infants in sucrose group received 2 ml oral sucrose 2 minutes before injection and the control group received routine care (just lying on examination table). Pain symptoms were measured by Modified Behavioral Pain Scale (MBPS) during 5 seconds before to 15 seconds after vaccination. Descriptive and inferential statistics (independent T-test) were used to analyze data using SPSS-PC. Results : MBPS scores in distraction group and sucrose group were significantly lower than the control group (P= 0.0001). No significant difference was seen between oral sucrose group and distraction group (P= 0.581). Conclusion: Distraction technique and oral sucrose are recommended as easy to use, inexpensive and effective measures for immunization pain management of neonates

Background: Coronary heart disease is one of the most important problems of public health. One risk factor is dyslipidemia. Evidence from molecular and animal research and epidemiologic investigations indicate that calcium intake may influence lipid metabolism.But intervention studies have produced conflicting results.Objective of this study was to determine the effects of calcium supplementation on serum lipid profiles in the face of caloric restriction in obese adults."nMethods: A double blind randomized placebo-controlled trial on 40 adults with Body Mass Index (BMI)>25kg/m² was con­ducted in Iran University of Medical Sciences in 2006.Subjects were maintained for 24 weeks on a balanced deficit diet (-500 kcal/d deficit) and randomly assigned to two groups with 1000 mg ca/d as calcium carbonate, or placebo. A General Linear Model was used for the analyses."nResults: There were no significant differences in variables at the 12th and 24th week between the two groups (P> 0.015). But the total cholesterol, LDL-C decreased significantly at the 12th and 24th week in the two groups compared to the initial values (P< 0.05). Ratios of TC/HDL-C,TC/LDL-C and LDL-C/HDL-C decreased significantly at the 12th and 24th week compareddto baseline only in the calcium group (P< 0.05). Similarly, TG and VLDL-C decreased significantly at the 24th week compared to baseline only in the calcium group (P< 0.05)."nConclusions: Twenty four weeks of supplementation with 1000 mg ca/d did not have any effect on serum lipoprotein beyond what can be achieved in an energy restricted diet

"nBackground: Chronic obstructive pulmonary disease (COPD) is considered a major public health problem in the world. Weight loss, muscle and fat mass depletion are common nutritional problems in COPD patients and are determinant factors in pul­monary function, health status, disability and mortality. In the present study, we assessed nutritional status in COPD pa­tients."nMethods: This cross-sectional study was performed in the Rasul-e-Akram Hospital, Tehran, Iran on 63 COPD patients with mean age (SD) of 67.6 (9.4) years. All subjects were diagnosed by a pulmonary specialist and based on a spirometry test. They were divided into three groups (2, 3, 4 stages of disease). Anthropometric and biochemical indices, body composition analy­ses by bioelectric impedance, spirometry test and determination of disease severity were performed for all subjects. All analy­ses were performed using the SPSS 14. All data presented as means (± sd)."nResults: Reduction of body mass index (BMI), Mid-Arm Muscle Circumference (MAMC) and Fat-Free Mass (FFM) were ob­served alongside an increase in disease severity but it was not significant. Significant reduction of Fat Mass (FM) (P= 0.007), Fat Mass Index (FMI) (P= 0.03) and biochemical indices like Albumin (P= 0.000) and Total Protein (P= 0.04) were associ­ated with an increase in disease stages."nConclusion: It is suggested that in addition to BMI, other nutritional status indices like MAMC, FFM and FM should be used for early diagnosis of malnutrition before weight loss occurs.

Urinary tract infection UTI(s) is one of the most common types of infection in young women and is a public sanitary problem of many countries. It is estimated that 20-30 percent of women with a first UTI will have recurrent infection. The incidence is mostly in young women, and the disease can not be explained by underlying functional or anatomical abnormalities. So many researchers have focused on the habits, behavioral or genetic factors. Therefore, inorder to evaluate the individual factors predisposing to UTI(s) in married Women, a case- control study was carried out, and data wase gathered through questionnaires. Selected through a continuous sampling method, 400 women between the age of 14-45 were the contributers of this study. Through which, 200, belonged to the case group, and the rest were considered as the control group. As a result, meaningful statistically relationships were found between history of UTI diagnosis (P=0.001), and also previous use of antibiotics within 15-30 days prior entering the study (P=0.003) with the existed UTI. Overall, considering that the previous UTI diagnosis, and also usage of antibiotics were found to be the predisposing factors, it is recommended to list them as health teaching issues by the authorities, furthermore, other studies should be conducted to reveal the factors which cause first and recurrent UTI(s) separately. A prospective cohort study, by record information about individual predisposing factors in daily diaries is suggested.

Nowadays IUD(s) are the most commonly used reversible contraceptive in the world. More than 130 million women are thought to use it, while a large number of them put this method away because of some medical reasons. While a comprehensive patient’s screening may highly decrease it’s side effects, a historical cohort retrospective study was performed to determine the side effects of pregna after 21st month of insertion. In order to gather the data all 1008 files of patients which refferd to one of the health centers in karaj were studied. Findings revealed that after 21st month of insertion patients suffered from expulsion (8.3%), unintended pregnancy (0.6%) dysmenorrhea (2%), heavy bleeding (7.1%)., long lasting bleeding (3.1%), spotting and intermenstural bleeding (11.1%), infection (39.6%), missed period, (1.9%), lost IUD thread (1%) and low back pain (0.4%), meanwhile during the first year of insertion, side effects were as follow, unreasonable bleeding (7.7%), infection 32%, heavy bleeding 6.5%, long lasting bleeding (2.7%), spotting and intermenstural bleeding (9.5%) and dysmenorrhean (1.9%). To sum up, there were not any differences between the results of this study and other similar ones. It can be said that the side effects will decrease as the years pass. We also recommend a prospective study for determination of the side effects in long term period (more than 21 months).

As basic coordinators between families and the health care units, midwives have important roles in the reproductive health of the community. Being able to prevent any problem in the course of their professional life, they must be aware of the legal aspects of their occupation. Therefore, inorder to determine the knowledge level of the midwives about the proceeding trial for disciplinary violations a cross-sectional study was conducted, in which the data were collected by self-report questionnaires. The sample consisted of 274 midwives including faculty members of nursing & midwifery schools (N=18) and evenly distributed midwives employed in the university hospitals and health centers (N=256). The results of the study showed that the mean knowledge level of the employed midwives was weak. Significant relations were obtained between knowledge of the proceeding trial for different disciplinary violations and the place of employment (on midwifery ethics) and also secondary employment in the private sector (on reproductive healthcare) respectively (P=0.04) and (P=0.031). So, according to the findings only 2.2% of the Midwives had a good knowledge of the proceeding trial for different disciplinary Violations. Therefore it is recommended to revise the syllabus of the course "Midwifery History, Ethics and Regulations" in order to include topics of the kind, discussed in this study and enhance the level of medico-legal knowledge of the midwives. Presentation of different rules and regulations in a simple language to all emplgees, emphasizing on violation penalties is another suggestion.

Background: Intrauterine fetal death is a traumatic event for the family which occurs in about 1% of all pregnancies. In comparison with other countries this rate is increasing in Iran. Statistical reports from health centers of Firoozabad estimated the rate of 2.2% per year. Although obstetrical management has improved significantly, more than 50% of these cases are still unexplained. Objective: To determine maternal risk factors for intra uterine fetal death. Design: This research was a case-control study. A standard questionnaire was designed consisting of two major parts: maternal characteristic and pre pregnancy and prenatal events. The questionnaire was filled by using medical records, between 1996-2000. And for each given case two controls were chosen simple randomly at the same day. Sample: Samples included 450 records, of which, 150 were case (IUFD) and 300 considered as control group (non IUFD). Results: Findings suggested that, illiterately (P=0.000), gestational age lesser than 37 wk (P=0.000) and consanguinity (P=0.000) were maternal factors. History of stillbirth (P=0.005) and premature rupture of membrane more than 12 hours (P=0.007) were the risk factors related to pregnancy events. Conclusion: According to the results of this study, illiterately, low gestational age, consanguinity, history of stillbirth and premature rupture of membrane were found as maternal risk factors for IUFD, however consultation, prenatal care, early diagnosis of complications, and careful evaluation may decrease the incidence of IUFD. Educating women for IUFD risk factors and use of preventive modalities is also recommended.

Background: Teaching is an important intervention in patients under hemodialysis, because they have to cope with different drug therapies, specific diet regimen and limitation of fluid intake. In order to prepare them physically and mentally to adjust to these changes, teaching plays an important role to increase their knowledge, improve their sense of responsibility to follow up diet regimen and limitation fluid intake and finally the better consequences of hemodialysis. Objective: To study the impact of teaching about diet regimen on laboratory index and weight gain between two sessions of hemodialysis. Design: This study was a randomized clinical trial. Sample: 76 patients were selected and randomly were put into two groups of experimental and control. Results: Findings indicated a meaningful statistical difference between level of phosphorus and weight again in experimental group before and after teaching P=0/000, and also between experimental and control groups P=0/001 Conclusion: According to this research teaching about diet regimen in patients under hemosialysis has an impact on phosphorus level and weight gain. So proper and serious teaching sessions provided by nurses in health centers is recommended.

Background: Placing I.U.D is a very effective method in the prevention of pregnancy, which has increasingly became popular. Women have found it an effective, safe and comfortable method all over the world. I.U.D is also a safe and suitable anti- pregnancy device for breast feeding period. However some reports concerning its’ effects on breast feeding period are available. Objective: Determination of I.U.D complications’ and its’ impacts on breast feeding at time of placement. Design: This was a field study in which the complications of I.U.D were assessed and compared in breast feeding and non breast feeding mothers. Sample: All 731 women which were undergone I.U.D placement, were selected through a census method, among those 451 were breast feeding mothers and the rest did not breast fed their babies. Results: Findings showed that the complication of I.U.D placement were respectively as follow: infection(43.7%), spotting between menstruation cycles (2304%) and cervicitis (22.2%). Also there were significant relation between menstruation bleeding amount (P= 0.001), the menstruation time period (P= 0.00), cervicities (P= 0.005) and breast feeding situation at the time of I.U.D placement. Overall, the result indicated that the impacts of I.U.D placement in breast feeding period are very slight. Conclusion: More investigations are suggested to clear the safety of I.U.D in breast feeding and nonbreast feeding mothers. Improvement of programs such as consultation, riddling, treatment and training of mothers using this device is also recommended.

Background: Increased serum level of catecholamines due to anxiety, has deleterious effects on pregnancy outcome. While, one of the causes of anxiety during pregnancy is fear of unknowns and childbirth process, especially among primigravida mothers, we assumed that, viewing videotape about childbirth may reduce their anxiety. Objective: To determine the effect of viewing videotape about childbirth on anxiety level of primigravida mothers. Design: This was a field trial study with control group. Sample: 62 primigravida mothers with 37-40 weeks of gestation receiving prenatal care, were selected and assigned randomly to experimental and control groups (31 in each group). Result: There was no significant difference between two groups considering level of anxiety. Conclusion: Although, there was no significant difference between two groups considering level of anxiety, the results showed reduction of the level of anxiety in experimental group, after one week and this finding support viewing of childbirth process. Overall, in order to increase the position effects of this kind of films it is recommended to provide sessions of prenatal teachings on respiratory exercises, during delivery, and attitude modification toward childbirth process.

Background : Hospitalization is an anxiety producing event for children and their families, There are many strategies to reduce the anxiety of hospitalized child one of which is play. Objective : To determine the effect of Play on the anxiety of hospitalized children. Design : This study was a randomized clinical trial with control group. At the beginning of trial the anxiety of both groups were measured by "spiel Berger's questionnaire". Then the children of trial group had the chance of playing in play room for half an hour. One and five hours after playing both groups completed the same questionnaire again. Samples : 92 school age children in hospital were randomly assigned in two groups. 46 in control group. Results : The findings indicated that the play reduced the anxiety of children in case group after one hour, but the effect of play did not last long (5 hours afterwards).. Conclusion : We can decrease the anxiety of hospitalized children by providing play room. Nurses should provide opportunity for hospitalized children to play. For the continuity of play it is suggested that the hospitals' play rooms be active during day. It id recommended that effect of play on anxiety of hospitalized children who are isolated or on complete bed rest or are in ICU be assessed

Background : Pregnant women with high level of anxiety are likely to give birth to babies who are irritable, restless, have sleep disorders and low birth weight. Objective : To determine the relation of psychosocial status of women during pregnancy and pregnancy outcomes. Design : This was a comparative study. Data were collected using a questionnaire. Samples : 360 subject nuliparas to multiparas 4, were selected through consequative sampling, 180 in each group (appropriate and inappropriate psycholocial status). Results : There was a relation between psychosocial status of mothers and LBW (p=0.005), IUGR (p=0.028) and preterm labor (p=0.000). Conclusion : Emotional support by family and health care providers should be targeted at women with poor psychosocial status during pregnancy in order to decrease their emotional distress and to enhance their self- esteen and self- confidence.

Background : Disorder in diffusion of blood gases almost always is clue to collection of secretion in respiratory airways. So protecting the airway, correct suctioning to remove the secretion and maintenance of air way potency are necessary interventions in patient with end tracheal tube . Objective : To determine and compaire arterial blood gas in patient with open heart surgery with and without use of normal saline in suctioning end tracheal tube. Design : The study was a single group clinical trial. The end tracheal tube of each subject were suctioned once with normal saline and once without it. The arterial blood gases were compaired before and after each suctioning. Samples : 40 patient with open heart surgery were selected according to research purpose. Results : Instillation of normal saline bolus prior to end tracheal tube suctioning has an adverse effect on oxygen saturation (p=0.01) but it's effect on pao2 and paco2 was not significant. Conclusion : Use of normal saline in suctioning of end tracheal tube may cause disorder in gas exchange and tissue oxygenation. It is recommended that normal saline be used in low dose and only when there is a need for stimulation of cough reflex.

Background : Child hospitalization is one of the anxiety producing factors for both the child and his/her parents. Anxiety will delay the child recovery and decrease the parent's abilities in caring for their children. The anxiety may be present long after discharge. Objective : To determine the level of maternal anxiety after child's hospitalization and also before and after child's discharge from hospital. Design : This was a longitudinal study. The level of mother's anxiety was measured using spilbarger questionnaire at three stages of after hospitalization, before and after child's discharge . Samples : 70 mothers of hospitalized children (age 1-3) were selected through continuo's sampling. Results : There was a significant difference between the level of mother's anxiety after child hospitalization and before and after his/her discharge (PV= 0.000). Conclusion : According to mother's anxiety in three stage (after hospitalization, before and after discharge) researcher recommend that nurses, take a complete demographic history of mothers at the time of admission so that they can plan a program to decrease mother's anxiety and also provide them with a telephone number so that in case of any question they can in touch after their child's discharge.

Background : Nocturnal enuresis is one of the most prevalent and troublesome disorders in children which may affect their self steem. The problem of swnsing a full bladder capacity is present in many enuretic children which may be overcome by increasing bladder capacity. Objective : To determine and compare the effect of urine control training on bladder capacity in two age groups of children (4-5 and above 5) with nocturnal enuresis. Design : In this clinical trial study the effect of urine control training were measured in two groups of children, age 4-5 and more than five, and then compared. Samples : 60 children with nocturnal enuresis participated in this study voluntarily. (30 children in each group). Results : The urine control training increased the bladder capacity of children in both groups. Also the result showed no difference regarding the age groups. Conclusion : The urine control training in children suffering from nocturnal enuresis can be used to increase their bladder capacity.