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Baekgrouund & purpose: The purpose of this study was comparing the motor and cognitive development of urban and rural preschool children in Semnan, Iran.
Materials and Methods: 97 healthy preschool children participated in the study, including 57 urban (n1=57) and 40 rural (n2=40) children. 6 assessment methods including equilibrium on one leg, drawing a man, Juorchin, fekr-e-bekr, equilibrium board and the test of easy fine motor, were employed to evaluate the motor and cognitive development in the participants. For analysis of the obtained results t tests was used to determine significant differences between the two groups.
Results:equilibrium on one leg and the test of easy fine motor, considering there was significant differences between, urban and rural groups. In the other four tests there was no significant differences between the two groups.
Conclusion: the findings indicated that the rural children have more success in motor skills when compared to urban children, while in cognitive tests the two groups showed the same results, indicating. That revision is required for the preschool programme.

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Background and purpose: Inhaled drugs increase the effect of medications prescribed in the treatment of chronic airways diseases with fewer side effects compared to other methods. There are many users of metered dose inhaler (MDI), but the rate of improper use in patients, nurses and general practitioners is high. The purpose of this study was a) to assess the rate of MDI misuse in patients compared to nurses and b) to evaluate the effect of verbal and practical education in the use of MDI in nurses.
Materials and Methods: Following ethical approval from Medical Ethics Board of the Mazandaran University of Medical Sciences, the present study was carried out in two separate stages. In the first stage which was a cross-sectional study, 110 subjects (55 nurses and 55 patients) were recruited from Mazandaran University Hospitals through a non-randomly and purposeful sampling method. A 0 -100 scale check list was used to measure the skill of nurses and patients in the use of MDI. In the second stage, a randomized clinical trial was designed to assess the effect of verbal and practical education in the use of MDI on 55 nurses (experimental group=25, control group=30). Nurses in the experimental group only, received the education and they were then asked to administer MDI after three weeks.
Results: The mean score for patients' skill was 63+37 which was not significantly correlated with age. The two lowest scores were related to slow inspiration (52.7%) and coordination between inspiration and using MDI (52.8%). The mean score for nurses' skill was 51±21/2. The lowest score was related to performance of a deep exhalation and holding the spray at 2.5-5cm distance (21.8%). Data analysis indicated that there was a significant difference between pre and post education score in the experimental group using paired t-test (P=0.0001, T=16.26). There was also a significant difference between the experimental and control group on MDI skill using t-test (p=0.0001, T=-8.19).
Conclusion: The results of this study demonstrate that patients had higher score compared with nurses in the use of MDI. It is also shown that educational program may have an important role in improving nurses' skill in the administration of MDI.

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Background and purpose: Discharge is one of the most important and unique parts of nursing profession. Since patients in burn units need care and rehabilitation services after discharge, it seems that having a fundamental plan for the discharge of these patients is essential. This research is conducted to determine the nurses’ viewpoints toward the existing problems and barriers in implementing the burn unit discharge planning.
Materials and methods: For this descriptive research, 90 nurses among those working in Ïmam Reza Hospital in Mashhad, and Zare Hospital in Sari were selected through simple non-probabilistic sampling. To collect data, the participants filled in a questionnaire including demographic data, and questions in Likert scale about the existing problems and barriers in discharge planning implementation in the burn units.
Results: Ït was found that the most crucial barriers for implementing the discharge planning included nurses’ heavy workload due to difficult conditions in their workplace, shortage of time, not having enough knowledge about discharge planning, lack of financial and mental support systems for the patients in the society, lack of instructional packages and standard discharge planning.
Çonclusion: Based on the findings of this research, it is recommended to hold continuous education for nurses, provide instructional packages and standard programs for the patients’ discharge, and increase the number of the nursing personnel based on the world standards so that suitable conditions for the implementation of discharge planning can be provided.

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Background and purpose: Nursing is a profession that establishes various cultural and social communications in the context of work environment. The purpose of this study was to determine the description and perception of the nurses working in educational hospitals about the professional communication experiences.
Materials and methods: This study is a qualitative research using phenomenology method. Thirteen semi-structured interviews were carried out with 11 female and 2 male nurses. They described their experiences related to professional communication. The interviews were recorded and transcribed and the data were then analyzed using the Çolizzii analysis method.
Results: Seven themes emerged from the data showing the nurses perception and description of the communication with patients, colleagues, nursing supervisors and physicians. The following themes showed the experienced patterns of communication by the nurses: being special, altruism, psychosocial support, updated knowledge and skills for interactions management, reaction to actions related to different factors, complement of patient-physician communication deficiency, and professional identity and socialization basis of communication.
Çonclusion: The findings revealed a clear image of participants’ experiences of communication in their profession. Recognition of nurses, description and perception of communication can present valuable data for professional planning and decreasing or eliminating the communication problems. Âlso improving the professional communication can guarantee the quality of professional services to the patients.

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Background and purpose: To know about the outcomes of self- learning education as compared to lecture is highly influential in training and increasing nurses, competency. The aim of this study was to compare the effect of the lecture and self-learning modules on the nurses’ teaching competency to cardiac patient education. Material and Methods: In this randomized controlled trial study 60 nurses in were selected using the convenience sampling and through blocking-random allocation method and divided them inot two groups of learning module and lecture. In the lecture group, the intervention consisted of a 2h-4 sessions. The other group received learning module. A week after the intervention, post-test was performed. Data were collected by written-test and Observation and Self Assessment. Data were analyzed by SPSS version 16 and descriptive and inferential statistics (independent t-test, paired t-tests, Chi-Square). Results: Both the self-learning modules (P<0.001) and lecture (P<0.001) were effective on the promotion of nurses’ teaching competency, and the effect of the two methods in teaching competency was not statistically meaningful (P= 0.11). The difference of Written-Test in Lecture and Learning Module Group Were Repeating 3.87±1 and 4.63±1.43 (P= 0.02). The difference of self -assessment in the Lecture and Learning Module Group Were Repeating 0.25±0.42 and 0.02±0.21 (P=0.03). The difference of observation in the Lecture and Learning Module Group Were Repeating 1.21±1.07 and 1.41±1.05 (P=0.46). Conclusion: Self-learning modules seem to be as effective as the lecture in the competency of nurses and in providing useful training programs.

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Background and purpose: Utilization of evidence-based research can increase the validity and quality of nursing care and nurses’ responsibility. In order to have research based performance by nurses, identifying the barriers to utilization of research findings is essential. This study aimed at recognizing these barriers from clinical nurses’ prospective. Materials and methods: A cross-sectional study was carried out on 313 nurses working in three hospitals of Babol University of Medical Sciences in 2011. In this study a questionnaire containing two sections was used in which first part questioned scientific and professional knowledge of subjects, and the other part was extracted from Funk’s barriers scale. Results: Four dimensions were identified using factor analysis. These were report, research, nursing and organization. Important barriers were insufficient time to study for implementing new ideas, lack of timely and fast publication of research papers, and lack of physicians’ collaborations in implementing the results of nursing researches. These were classified in a different dimension. Some barriers were not included in any dimensions, such as low trust of nurses to research findings, unjustified conclusions drawn from researches, conflicting results, and English publication of most studies. Conclusion: The important finding of this study was that the subjects identified the barriers in nearly all dimensions. According to the first three barriers, authorities should provide nurses with facilities to utilize and implement research findings. Moreover, they should promote educational programs to develop knowledge, skills and positive attitude to research among nurses.

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Background and purpose: Implementing medical ethics rules and patients’ bills of right are necessary in achieving high quality health care services. The present study was performed to assess the implementation of patients’ bills of right from the physicians and nurses’ viewpoints, working in Mazandaran University of Medical Sciences Educational Hospitals. Materials and methods: This descriptive-cross sectional study was done using stratified random sampling in 487 physicians and nurses working in four educational hospitals in Sari, 2012. The data was collected using a two-section questionnaire including demographic characteristics and likert-type scale regarding implementation of patients’ bills of right. Analytical tests including Mann–Whitney U and Kruskal-Wallis were performed to analyze the data. Results: The mean score for patients’ bills of right was 2.65 ± 0.83 from their own points of view. The least score was for respecting the patients, their privacy and indiscrimination (2.09 ± 1.03) and the highest score was seen in the right to choose and making decision freely (2.82 ± 0.94).There was a significant difference between the physicians and nurses’ mean scores for implementation of patients’ bills of right in which physicians believed in poor implementation (P=0.006). The implementation of patients’ bills of right was followed the least in internal ward (2.30 ± 0.72) and the most in psychiatry ward (2.85 ± 0.99) (P=0.003). Conclusion: The patients’ bills of right is not fully implemented by physicians and nurses working in educational hospitals. Therefore, necessary actions are needed to remove barriers against patients’ bills of right and to facilitate its implementation in hospitals.

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Introduction: Nurses are the largest group of professionals in the health care systems whose the most important aim is enhancing patients’ quality of life, but nurses’ own quality of life and health promoting behaviors are the issues that have not been dealt with sufficiently. The present study was performed to measure the amount of health promoting behaviors of nurses working in educational hospitals of Sari affiliated to Mazandaran University of Medical sciences 2013. Material & Methods: The present research is a descriptive cross- sectional study which was done through using stratified random sampling in 226 working nurses in four educational hospitals in Sari city in 2013.Data were gathered using a two-section questionnaire including demographic characteristics and 52 likert-type (from 0 to 4 score) questions which was based on Health Promoting Lifestyle Profile-HPLP- II and its validity and reliability were confirmed. Data analysis was performed using T-test and One-way ANOVA tests. Results: The mean score of HPLP- II was 135.33±18.55 (the total score is 208). The highest score was in the area of nutrition (25.53±4.37) and the least score was in the area of physical activity (16.85±5.05).The total score of HPLP- II and all its area except nutrition were higher in the male nurses than that of female nurses, but the significant difference was observed in the area of physical activity (p=0.001). Conclusion: Nurses should obey health promoting behaviors in a high level and this study is a beginning of increasing researchers and hospital managers’ knowledge to implement health promoting plans among the working nurses in the hospitals to achieve a desirable level of health promoting behaviors especially in the physical activity domain.

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Background and purpose: Burnout is one of the most important factors in reducing productivity in organizations and involves physical and mental signs, especially in the human service professions. This research was carried out to examine the relationship of occupational burnout and communication skills in nurses in educational therapeutic hospital of Sari, Iran. Materials and methods: In this descriptive cross-sectional study, the population included all nurses in educational therapeutic hospital of Sari. Total number was 900. The sample size was 230. They were selected by stratified random sampling. We used three instruments in this study: demographic characteristic questionnaire, Maslach burnout inventory (MBI), and Queendom communication skills inventory. For analyzing the data, descriptive and inferential statistics including one sample size t and Pearson and Spierman correlation coenfficient tests were used. Results: The nurses were moderately high levels of communication skills. Using the MBI subscale, we found moderate levels of emotional exhaustion, low levels of depersonalization and low levels of sense of personal accomplishment. The communication skills had relation with the burnout in personal accomplishment (P < 0.001). Conclusion: We can take improving communication skills in nursing workplaces, in order to reduce the nurses' burnout.

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Background and purpose: The need for privacy is a basic human right. Nurses are expected to respect the patients’ privacy. This study investigated the viewpoints of patients and nurses regarding keeping the patients’ privacy during nursing care. Materials and Methods: In this cross sectional study 127 nurses and 384 patients meeting the criteria for study were selected through randomized sampling. Data was collected by a questionnaire designed by Heydari (2000) and analyzed using t-test and ANOVA in SPSS ver.18. Results: The results showed a significant difference on average score of the realm of human between nurses and patients (P<0.05). According to the studied population the levels of paying respect to human realm and private space in hospital were moderate. Significant relationships were seen in viewpoints of nurses’ considering their gender and educational level. We also found a significant correlation between the patients’ viewpoints and their level of education and place of residence. Conclusion: To enhance the quality of services provided by nurses they should consider patients’ right to privacy and care for them while respecting their privacy.

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Background and purpose: Female nurses are exposed to many problems due to their working situation. This will make them vulnerable to stress, burnout, and emotional exhaustion. In this study we structurally analyzed burnout among nurses while considering acceptance, commitment, and emotion regulation. Material and Methods: This descriptive-correlational study was conducted in May 2013 and included 180 nurses working in a hospital located in city of Isfahan. A total of 119 cases was randomly selected using Morgan table. Maslach Burnout Inventory (MBI), Acceptance and Commitment Therapy (ACT), and Cognitive Emotion Regulation Questionnaire (CERQ) were used to collect the data. Data was then analyzed using SPSS and Lisrel program. Results: The results indicated a significant correlation between burnout, emotion regulation, and acceptance and commitment. Structural equation modeling showed direct relationships between burnout and ACT and emotion regulation and ACT. We also found ACT with a mediation effect in the relationship between burnout and emotion regulation. Conclusion: This study showed emotion regulation and ACT as the main indicators for burnout.

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Background and purpose: Nurse managers are responsible for creating and maintaining a professional work environment and their leadership styles are of great importance in reinforcing effective environment for promoting clinical competence. The purpose of this study was to explain the ward management concerns or self-protection as a paradox of ward management by head nurses. Materials and methods: In a qualitative research, 22 head nurses participated. Data was collected through unstructured interviews and purposive sampling which continued until data saturation. Conventional content analysis was applied to analyze the data. Results: During data analysis, three main themes resulted including "negligence and indulgence" with self-protection and patient protection as the subcategories, "communicative capability" with interpersonal relationship and relationship between occupational groups as the subcategories, and "management competencies" with providing the ward necessities and creating confidence in nurses as the subcategories. The experiences and functioning dimensions of head nurses were found as the concerns in managing the ward or self-protection in the clinical management. Conclusion: This study indicated that the communication and management abilities were not practically effective, probably due to lack of applied management knowledge and also inappropriate structure and performance of the organization which causes unsatisfactory managerial behaviors and negligence and indulgence. Therefore, promoting communicative abilities and professional management in practice are inevitably necessary by head nurses.

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Background and purpose: Human dignity is amongst the main human rights and violence in workplace is a worrying issue for every person. The prevalence of violence in medical staff led the authors to study about violence in nurses and related factors in critical care units in educational hospitals affiliated to Mazandaran University of Medical Sciences. Materials and methods: A descriptive-analytical study was carried out in 2014 in which 481 nurses were recruited using stratified random sampling. Data was collected through Dumont Horizontal Violence Questionnaire (including 49 questions) and analyzed in SPSS v.21. Results: Among the participants 16.6% had shown violent behavior towards their colleagues. It was also found that 34.9% of nurses have been exposed to violence at least once a month. The findings showed that head nurses were exposed to violent behaviors from hospital managers and physicians more than others. Data analysis indicated that peer violence was more prevalent in hemodialysis unit, while in CCU and ICUOH nurses were involved in violence from hospital managers and physicians. Conclusion: This study demonstrated that many nurses are exposed to violence, therefore, educating and training hospital personnel on anger management could reduce the rate of violent behavior.

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Abstract Background and purpose: Interpersonal conflicts in clinical environments wastes many resources and have adverse effects on professional communication. Assertiveness skill is an important component of communication skills that helps in reducing interpersonal conflicts. This study was conducted to determine the effect of assertiveness training on nurses’ interpersonal conflicts. Materials and methods: In this experimental study, 60 nurses in Imam Reza Hospital in Mashhad were randomly assigned into either intervention or control groups. A two-day workshop was held for intervention group in which assertiveness skills were taught, while the control group did not receive any training. Assertiveness skills and conflicts level in both groups were measured before and 40 days after the intervention by Bar-on assertiveness questionnaire, Golparvar and Vaseghi Interpersonal conflict at work scale, and Jex and Spector's Interpersonal Conflict Scale. Results: Before the intervention, there was no significant difference between the two groups in nurses’ mean score for interpersonal conflicts (P=0.346) but after the intervention, this mean score decreased significantly in the group that had assertiveness training (11.6±5.9 vs.19.0±8.4, P<0.0001). Conclusion: In this study assertiveness skill training was found to have considerable effect on reducing the level of nurses’ conflicts, therefore, it is suggested to provide nurses with assertiveness training so that they could manage workplace conflicts appropriately.

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Background and purpose: Moral distress is a common phenomenon in nursing professional and burn nurses are constantly faced with making different moral decisions for patients who are in terrible conditions. Therefore, nurses in burn units experience moral distress as mental tension. This study was conducted to determine the severity of moral distress and the factors associated with that in burn nurses. Materials and methods: A descriptive- analytical study was conducted using census sampling on 172 nurses working in Mazandaran burn center, 2014. Data was collected through identifying demographic and occupational characteristics of the nurses (using relevant questionnaires) and Corley’s Moral Distress Scale. Data analysis was performed applying Mann-Whitney and Kruskal-Wallis test. Results: The mean score for moral distress was 105.65±52.39 which indicates a moderate level experienced by nurses. Kruskal-Wallis test showed a significant positive correlation between educational level and level of moral distress (P=0.011). There was no significant association between moral distress and other individual and professional characteristics (P>0.05). Conclusion: Moral distress is accompanied by many complications that have direct effects on nurses’ professional practice. Therefore, nurse managers should consider this issue and plan for programs on appropriate coping strategies.

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Background and purpose: Anxiety is a normal reaction to stress influencing behavioral, physical and mental aspects of human life. This study aimed to apply Neuman Systems Model in reducing the patient's anxiety level before surgery. Materials and methods: In a randomized controlled trail, 104 patients undergoing orthopedic surgery in Imam Ali Hospital, Bojnourd were studied. Data was collected using a demographic questionnaire and the Spielberger State-Trait Anxiety Inventory (STAI). Intervention was performed according to Neuman Systems Model that includes assessing the actual and potential stressors, identifying the objectives and strategies for action, and strengthening the defense and the natural flexibility. Assessment of anxiety was done in two groups (the experimental group according to Neuman Systems Model and the control group without any intervention) before and after the intervention. Data was analyzed by Chi-square test, t-test, and paired t-test using SPSS V. 16. Results: The results showed no significant difference in the level of anxiety before the intervention between the two groups. But after the intervention the anxiety level reduced significantly in experimental group (-18.94±16.1, P<0.001). A significant increase in anxiety was seen in control group (+12.73±9.98, P<0.001). Conclusion: The Neuman Systems Model was found to be efficient in reducing the level of anxiety before orthopedic surgical procedures. This study supports the role of Neuman Systems Model in reducing anxiety before orthopedic surgery, so, this model could be applied in both educational and clinical settings.

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Background and purpose: Musculoskeletal disorders (MSDs) are the most common occupational health problems that have high costs and lead to productivity loss in nurses. On the other hand, work-related stress is another important factor that could result in reduced productivity in organizations and may lead to physical and mental problems in personnel. This study aimed to evaluate the prevalence of MSDs among nurses and its relationship with occupation-related stress.

Materials and methods: This descriptive-analytical study was performed in 940 nurses in Sari hospitals. Census sampling was used to select the subjects. Data was collected using Nordic Musculoskeletal Questionnaire (NMQ) and the HSE Indicator Tool. Data was then analyzed by ANOVA, t-test and Pearson's correlation in SPSS V.18.

Results: The results showed low back disorders were the more prevalent (60.9%) disorders in nurses. Significant association was found between work-related stress and musculoskeletal disorders (P<0.05). MSDs were significantly associated with age, gender, body mass index, and educational level. Also, there was a significant relationship between work experience, marital status and working system (different shifts or stable hours) with occupation-related stress (P<0.05).

Conclusion: In this study, nurses had a relatively high prevalence of musculoskeletal disorders. Most of them had moderate levels of work-related stress. So, any intervention for preventing MSDs and job stress should focus on reducing physical and psychological pressures and lead to involvement of nurses in decision-making processes.

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Background and purpose: Intensive care unit (ICU) nurses play an important role in non-pharmacological prevention of ventilator-associated pneumonia (VAP). The aim of this study was to assess the knowledge of nurses in ICU about non-pharmacological prevention of ventilator-associated pneumonia.

Materials and methods: In a descriptive cross-sectional study, 120 ICU nurses were studied in teaching hospitals of Mazandaran University of Medical Sciences, 2015. Demographic information of nurses were recorded including age, sex, duration of being in ICU and their educational level. An authentic multiple-choice questionnaire was administered to assess the nurses' knowledge about the prevention of VAP.

Results: 120 nurses including 96 females and 24 males (mean age: 32.39±5.57, mean work experience: 5.94±4.5 years) were studied. The average number of beds in the studied ICUs was 9.53±1.97 beds (Median=9). Percentage of correct answers of nurses on the oral route for intubation, frequency of ventilator circuit changes, type of airway humidifier, frequency of humidifier changes, type of suction system, frequency of change in suction systems, drainage of subglottic secretions, kinetic vs. standard beds, and patients positioning were 81.7%, 53.3%, 42.5%, 6.7%, 62.5%, 38.3%, 30%, 46.7%, and 85.8%, respectively. The average score of the participants was 4.48±1.69 out of 9.

Conclusion: ICU nurses' knowledge about the type of humidifier, switching frequency of humidifier, switching frequency of suction system, subglottic secretion drainage, and the type of bed was found to be very low. These findings call for continuous training and assessment to promote the knowledge of nurses in ICUs for non-pharmaceutical prevention of VAP

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Background and purpose: High quality of working life (QWL) is recognized as a fundamental factor in empowerment of human resources and health care system. Nursing is a profession in which having a good quality of working life plays a major role in delivering good quality care to patients. The aim of this study was to evaluate the QWL and related factors in critical care unit (ICU) nurses.  

Materials and methods: We conducted a descriptive-analytical study in 180 nurses working in intensive care unit in Sari teaching hospitals affiliated to Mazandaran University of Medical Sciences (2016) via quota sampling. The most important inclusion criterion was one year working experience in ICU. Data was obtained using demographic questionnaire and Walton’s quality of work life. Data was analyzed by descriptive statistics, one-way ANOVA, and t-test.

Results: The nurses were relatively satisfied with most components of their work life; low, medium, and high levels of QWL were reported by 27.2%, 66.1%, and 6.7% of the participants, respectively. QWL was found to be significantly associated with hours of overtime, frequency of night shifts per month, and income (P<0.001).

Conclusion: In this study nurses reported medium levels of QWL. But, they were dissatisfied with unfair salary and benefits payments and lack of a safe and healthy environment, low promotion and job security, constitutionalism in the work organization, and social dependency.

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BBackground and purpose: Professional quality of life is a concept felt by an individual in relation to their jobs. Positive and negative aspects of a job influence professional quality of life. Evaluation of professional quality of life requires reliable scales. The current study aimed at translating (into Persian) and examining the psychometric properties of professional quality of life scale for health care service providers.
Materials and methods: This methodological research was conducted in 464 physicians, midwives and nurses working in hospitals of Qazvin province, using convenience sampling. Based on permission from the developer of the scale, it was back translated. Face validity, content validity, and exploratory and confirmatory factor analyses were tested. Test-retest and internal consistency were used to evaluate the reliability of the questionnaire.
Results: Confirmatory factor analysis showed that items 1, 4, 15, 17, and 29 did not present significant factor loadings (<0.3), therefore, they were discarded. Factor loadings for other items varied from 0.32 to 0.69. Goodness of fit measures was as follows: Normed Fit Index (NFI(: 0.93; Non Normed Fit Index )NNFI(: 0.95; Goodness of Fit Index )GFI(: 0.84; Comparative Fit Index (CFI:(0.95; X2/ Degrees of freedom )X2/df(:2.9, and Root Mean Square Error (RMSE(: 0.07 (P<0.001). Intra-class reliability of the scale was 0.96. Also, reliability of the scale was 0.73 based on internal consistency (Cronbach's alpha).
Conclusion: Present study showed that the modified Persian version of Professional Quality of Life Scale (ProQOL) consisting of 25 items could be used as a valid and reliable instrument in assessing professional quality of life in physicians, midwives, and nurses.