Association between Newborns' Breastfeeding Behaviors in the First Two Hours After Birth and Drugs Used For Their Mothers in Labor.

OBJECTIVE: Use of narcotics to relieve pain in labor affects neurobehavioral and nutritional conditions of newborns after birth. However, there are inadequate data on the effects of drugs currently used in labor. This study was performed to examine the association between newborns' breastfeeding behaviors in the first two hours after birth and drugs used for their mothers in labor in Isfahan, central Iran, from 2014 to 2016. MATERIALS & METHODS: In this descriptive-analytical study, 300 women were selected who had vaginal delivery in the Labor and Gynecology Wards of Al-Zahra and Shahid Beheshti hospitals, Isfahan, Iran from 2014 to 2016. Data were collected by a demographic questionnaire and the Newborn Breastfeeding Behaviors Tool completed by the researcher as she observed the newborns during breastfeeding after birth. The data were analyzed by one-way ANOVA, chi-square test and Kruskal-Wallis test in SPSS 20. RESULTS: There was no significant difference between demographic characteristics of the studied groups (P>0.05). In addition, there was significant difference in breastfeeding behaviors between groups. More clearly, breastfeeding ability was higher in the infants of the women administered with no drug than those of the women in the group (P=0.000). CONCLUSION: Physicians, nurses, and midwives can be informed about the side effects of the drugs used in labor on the newborns' breastfeeding, and improve their breastfeeding outcomes by decreasing the dose of used drug and the duration of the women's treatment with these drugs.

Gap between the Expectations and Perceptions of Students regarding the Educational Services Offered in a School of Nursing and Midwifery.

INTRODUCTION: Awareness of students' opinions about the various aspects of training provided is an essential factor to evaluate the quality of education. AIM: The aim of this study was to determine the gap between the students' expectations and perceptions from the educational services provided to them in the School of Nursing and Midwifery in Shahrekord University of Medical Sciences. MATERIALS AND METHODS: In this cross-sectional study, 320 students were selected by stratified random sampling method and data were collected by SERVQUAL questionnaire to examine the areas of assurance, responsiveness, empathy, tangibles and confidence. Data analysis was conducted by descriptive (frequency, percentage, mean±SD) and analytical (paired t-test, independent t-test and One-Way ANOVA) statistics in SPSS 20. RESULTS: The mean scores of the students' expectations and perceptions of the educational services delivered to them were 4.34±0.63 and 3.56±0.68, respectively, with a significant, negative gap (-0.77±0.77, p<0.001). The lowest gap of quality was derived for assurance (-0.65) followed by reliability (-0.69), accountability (-0.74), and empathy (-0.81), and the greatest gap observed in tangibles (-0.96). CONCLUSION: A negative gap was observed between the students' expectations and perceptions of the quality of educational services delivered to them. This means that the quality of services delivered to students was less than what they expected. The highest gap was related to the tangibles. In order to improve the educational services, paying attention to different areas of quality of educational services, especially, the tangibles, is necessary.

The Effects of Fetal Movement Counting on Pregnancy Outcomes.

INTRODUCTION: Counting fetal movements may lead to timely assess fetal health and prevent the adverse effects of pregnancy. AIM: The aim of this study was to determine the effect of fetal movement counting on pregnancy outcomes. MATERIALS AND METHODS: In a randomized controlled trial, 208 women with singleton pregnancy were randomly divided into two groups of fetal movement counting and control. Pregnancy outcomes were compared between the two groups. Data were analysed with SPSS and p<0.05 was considered significant. RESULTS: There was no significant difference in the mean maternal concern (p=0.36), admission to hospital due to the decreased fetal movements (p=0.99), birth weight (p=0.21), Apgar score (p=0.51), the mean of gestational age at the time of decreased fetal movements (p=0.49) and mode of delivery (p=0.69) between the two groups. There were no cases of premature labour, intrauterine growth retardation and fetal death in the two groups. CONCLUSION: Pregnancy outcome was similar in the two groups of fetal movement counting and control. Further studies are needed to evaluate the effect of fetal movement counting on the major outcomes of pregnancy such as intrauterine fetal death.

Comparison of indomethacin suppository and lidocaine cream on post-episiotomy pain: A randomized trial.

BACKGROUND: One of the most important problems after episiotomy is perineal pain which is more severe on the first day of postpartum period. The aim of this study was to compare the analgesic effects of indomethacin suppository and lidocaine cream in the management of post-episiotomy pain. MATERIALS AND METHODS: In a randomized, controlled trial, 60 primiparous women who had mediolateral episiotomy received 50 mg indomethacin suppository (n = 30) or 2% lidocaine cream (n = 30) in the postpartum period in Hajar Hospital in Shahrekord (Iran). The mean severity of post-episiotomy pain was assessed with the first complaint and at 6, 12, and 24 h after the delivery, and compared in the two groups. The visual analog scale (VAS) was used for pain recording and data were analyzed with independent-samples t-test, χ(2), and Fisher's exact tests, and significance was defined as P < 0.05. RESULTS: With the first complaint of pain, the mean intensity of pain was 4.9 (1.9) in the indomethacin group and 4.9 (1.8) in the lidocaine group, and the difference was not significant (P = 0.25). Six hours after birth, it was 3.3 (1.3) in the indomethacin group and 3.2 (1.9) in the lidocaine group, and there was not a significant difference between the two groups (P = 0.90). No significant difference was found between the two groups at 12 h after birth [2.3 (1.7) vs 2.5 (1.7); P = 0.59]. Also, the difference was not significant at 24 h after birth [1.5 (1.3) vs 1.8 (1.3); P = 0.31]. CONCLUSIONS: It was concluded from the study that indomethacin suppository and lidocaine cream have similar efficacy on episiotomy pain relief on the first day of postpartum period.

Comparing the Effect of Concept Mapping and Conventional Methods on Nursing Students' Practical Skill Score.

BACKGROUND: Development of practical skills in the field of nursing education has remained a serious and considerable challenge in nursing education. Moreover, newly graduated nurses may have weak practical skills, which can be a threat to patients' safety. OBJECTIVES: The present study was conducted to compare the effect of concept mapping and conventional methods on nursing students' practical skills. PATIENTS AND METHODS: This quasi-experimental study was conducted on 70 nursing students randomly assigned into two groups of 35 people. The intervention group was taught through concept mapping method, while the control group was taught using conventional method. A two-part instrument was used including a demographic information form and a checklist for direct observation of procedural skills. Descriptive statistics, chi-square, independent samples t-tests and paired t-test were used to analyze data. RESULTS: Before education, no significant differences were observed between the two groups in the three skills of cleaning (P = 0.251), injection (P = 0.185) and sterilizing (P = 0.568). The students mean scores were significantly increased after the education and the difference between pre and post intervention of students mean scores were significant in the both groups (P < 0.001). However, after education, in all three skills the mean scores of the intervention group were significantly higher than the control group (P < 0.001). CONCLUSIONS: Concept mapping was superior to conventional skill teaching methods. It is suggested to use concept mapping in teaching practical courses such as fundamentals of nursing.

Giving bad news: a qualitative research exploration.

BACKGROUND: The manner in which healthcare professionals deliver bad news affects the way it is received, interpreted, understood, and dealt with. Despite the fact that clinicians are responsible for breaking bad news, it has been shown that they lack skills necessary to perform this task. OBJECTIVES: The purpose of this study was to explore Iranian mothers' experiences to receive bad news about their children cancer and to summarize suggestions for improving delivering bad news by healthcare providers. MATERIALS AND METHODS: A qualitative approach using content analysis was adopted. Semi-structured interviews were conducted with 14 mothers from two pediatric hospitals in Iran. RESULTS: Five major categories emerged from the data analysis, including dumping information, shock and upset, emotional work, burden of delivering bad news to the family members, and a room for multidisciplinary approach. CONCLUSIONS: Effective communication of healthcare team with mothers is required during breaking bad news. Using multidisciplinary approaches to prevent harmful reactions and providing appropriate support are recommended.

Comparison of the students' satisfaction about the performance of academic advisors before and after the advisor project in Shahrekord University of Medical Sciences.

INTRODUCTION: Inappropriate advice interferes with the students' achievement of educational and professional goals and they may fail to use proper resources for their educational needs. The present study was carried out to compare the students' satisfaction about the performance of academic advisors before and after the advisor project in Shahrekord University of Medical Sciences. METHODS: This longitudinal study was carried out using census report on 244 students in different courses at Shahrekord University of Medical Sciences in two stages at the first semester of 2010-2011 and first semester of 2011-2012. To collect the data, we used a self-designed questionnaire including individual and educational information and 10 multiple-choice questions with Likert scale to assess the students' satisfaction about the advisors' performance. Data were analyzed in SPSS 14 using paired t-test, qui-square test. P<0.05 was considered significant. RESULTS: Of the ten items of satisfaction, there was only a significant difference in "accessibility to an advisor before and after the advisor project in students of nursing and midwifery school (p=0.010), and the difference was not significant in other items in these students. No significant difference was found in ten items of satisfaction in students at other schools before and after the advisor project (p=0.010). CONCLUSION: It seems that the implementation of advisor project could not provide a satisfactory position for students. Adequate supervision of university officials on proper implementation of the advisor project, supporting faculty advisors and strengthening their position can help to improve the process.

The effect of olive oil and the Saj® cream in prevention of striae gravidarum: A randomized controlled clinical trial.

OBJECTIVE: To compare the clinical efficacy of olive oil and the Saj(®) cream on the occurrence and severity of striae gravidarum. DESIGN: Parallel randomized controlled clinical trial. SETTING: West Health Centre, Lolagar and Akbarabadi Hospitals, Tehran, Iran. INTERVENTIONS: 360 Nulliparous women at their second trimester of pregnancy randomly (simple randomization) allocated into three groups of olive oil, the Saj(®) cream, and control that finally 150 of them (50 subjects in each group) completed the study. Control group did not receive any medication/intervention. At gestational age of 38-40 weeks the participants were evaluated regarding the occurrence of striae on abdominal skin and its severity that were primary outcome of the study. RESULTS: In the olive oil group, striae occurred in 72% of the participants, which were mild, moderate, and severe in 32%, 26%, and 6% of the cases, respectively. In those who received Saj(®) cream, striae occurred in 64% of the cases, which were mild, moderate and severe in 16%, 34%, and 14% of the cases, respectively. With regard to the control group, striae occurred in 60% of the participants, among which striae were mild, moderate, and severe in 22%, 24%, and 14% of the cases, respectively. There were no statistically significant differences among the three studied groups regarding the incidence or severity of striae. CONCLUSION: Neither olive oil nor the Saj(®) cream were effective in preventing the occurrence of striae gravidarum or affecting its severity. Further studies to examine the effect of other herbal/chemical preparations on occurrence of striae gravidarum are recommended.

Effects of nurses' practice of a sedation protocol on sedation and consciousness levels of patients on mechanical ventilation.

BACKGROUND: Providing high-quality care in the intensive care units (ICUs) is a major goal of every medical system. Nurses play a crucial role in achieving this goal. One of the most important responsibilities of nurses is sedation and pain control of patients. The present study tried to assess the effect of nurses' practice of a sedation protocol on sedation and consciousness levels and the doses of sedatives and analgesics in the ICU patients. MATERIALS AND METHODS: This clinical trial was conducted on 132 ICU patients on mechanical ventilation. The patients were randomly allocated to two groups. While the control group received the ICU's routine care, the intervention group was sedated by ICU nurses based on Jacob's modified sedation protocol. The subjects' sedation and consciousness levels were evaluated by the Richmond Agitation Sedation Scale (RASS) and the Glasgow Coma Scale (GCS), respectively. Doses of administered midazolam and morphine were also recorded. RESULTS: The mean RASS score of the intervention group was closer to the ideal range (-1 to +1), compared to the control group (-0.95 ± 0.3 vs. -1.88 ± 0.4). Consciousness level of the control group was lower than that of the intervention group (8.4 ± 0.4 vs. 8.8 ± 0.4). Finally, higher doses of midazolam and morphine were administered in the control group than in the intervention group. CONCLUSION: As nurses are in constant contact with the ICU patients, their practice of a sedation protocol can result in better sedation and pain control in the patients and reduce the administered doses of sedatives and analgesics.

Comparing the Effects of Echinophora-platyloba, Fennel and Placebo on Pre-menstrual Syndrome.

INTRODUCTION: Premenstrual syndrome (PMS) is a condition characterized by a number of behavioral, psychological and physical symptoms recurring cyclically during the luteal phase of the menstrual cycle. The uncertainty in the pathogenesis of PMS has led to many treatment protocols being suggested as possible therapies. The present study was carried out to compare the effects of echinophora-platyloba and fennel extracts on the PMS against placebo in students of Shahrekord University of Medical Sciences in 2008. METHODS: In this single-blind randomized clinical trial, 90 students with moderate to severe PMS enrolled in the study and were randomely divided into three equal groups. The first group received echinophora-platyloba extract, the second group received fennel extracts and the third group received placebo. The severity of PMS was measured by Daily Record of Severity of Problems (DRSP) questionnaire at the end of the first and second menstrual cycles before the intervention and the results were compared with them after the intervention. Data was analyzed using Dunn, Kruskal Wallis, and Pearson correlation tests by SPSS (v. 11.5) and p < 0.05 was considered statistically significant. RESULTS: There were not any significant differences in the means of premenstrual syndrome scores before the intervention among the three groups (100.8±22.1 in echinophora-platyloba group, 101.3±27.1 in fennel group and 104.3±19.5 in placebo group, p > 0.05), but the differences were significant after the intervention (49.7±23.2 in echinophora-platyloba group, 64.4±27.5 in fennel group and 79.1±28.1 in placebo group, respectively, p < 0.001). No significant differences were seen between the echinophora-platyloba and fennel groups. CONCLUSION: The echinophora-platyloba and fennel extracts could reduce the severity of PMS. The effects of echinophora-platyloba and fennel were similar and greater than the placebo. Administration of the extracts of these herbs is suggested for relieving the signs and symptoms of PMS.