Mashhad University of Medical SciencesEvidence Based Care2008-24875420160101The Effects of Field Massage Technique on Bilirubin Level and the Number of Defecations in Preterm Infants716605710.22038/ebcj.2015.6057ENSoheila KarbandiEvidence Based Care Research Centre, Instructor of Nursing, Department of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranMaryam LotfiMSc in Neonatal Intensive Care Nursing, Nursing and Midwifery School, Mashhad University of Medical Sciences, Mashhad, IranHasan BoskabadiAssociate professor of Neonatology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, IranHabibollah EsmailyAssociate Professor of Biostatistics, Neonatal Research Center, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20150712<strong>Background:</strong> Hyperbilirubinemia is a common physiological problem in approximately 80% of preterm infants during the first week after birth. Increase in bowel movements reduces enterohepatic circulation and increases bilirubin excretion. <br/><strong>Aim: </strong>This study aimed to evaluate the effects of Field massage technique on bilirubin level and the number of defecations in preterm infants <br/><strong>Method: </strong>This clinical trial was performed on 80 preterm infants aged 30-36 weeks, who were hospitalized in neonatal intensive care units of Qaem, Imam Reza, and Ommolbanin hospitals of Mashhad, Iran, in 2011. The enrolled infants were randomized into intervention and control groups. The control group received the routine care, and the intervention group received a 15-minute massage twice a day (morning and evening), for five consecutive days. Field massage technique was applied by the researcher. The number of defecations and cutaneous bilirubin level were recorded on a daily basis until the sixth day after birth. Independent t-test and Mann-Whitney U test were performed to analyze the data, using SPSS version 14. <br/><strong>Results:</strong> The mean age of the intervention and control groups was 17.2±4.5 and 17.1±4.5 hours, respectively. The mean level of cutaneous bilirubin in the intervention and control groups on the first and sixth days were not significantly different (10.7±1.5, 10.8±1.4, 13.4±2.0, and 13.4±2.6, respectively; the first day: P=0.67, the sixth day: P=0.98). The number of defecations on the fourth (P=0.01), fifth (P<0.001), and sixth (P=0.005) days in the intervention group was significantly more than the control group. <br/><strong>Implications for Practice:</strong> The five-day massage using the field technique could not reduce the level of bilirubin in preterm infants; however, it increased the number of defecations during the bilirubin peak days in preterm infants (fourth-sixth days), which can decrease bilirubin level in preterm infants. Mashhad University of Medical SciencesEvidence Based Care2008-24875420160101Effects of Motor Development Stimulation on Anthropometric Indices of Infants Aged 1-12 Months in Foster Care Homes1724586510.22038/ebcj.2015.5865ENArezou NikNezhad JalaliInstructor of Nursing, Department of Pediatric Nursing, School of Nursing and Midwifery, Sabzevar University of Medical Sciences, Sabzevar, IranAkram RezaeianEvidence Based Care Research Centre, Instructor of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran0000-0003-0100-2764Hamidreza Behnam VashaniEvidence Based Care Research Centre, Instructor of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran0000-0002-9076-2900Seyedreza MazlomEvidence Based Care Research Centre, Instructor of Medical-Surgical Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranElahe GhayebieMS in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranJournal Article20150723<strong>Background:</strong> The first three years of life have a pivotal role in growth and development of infants. Extra-uterine environment largely affects brain development of infants during the first year of life.However,no specific programs are available for brain development stimulation in foster homes. <br/><strong>Aim:</strong> This study aimed to evaluate the effects of motor development stimulation package on anthropometric indices of infants staying in foster homes. <br/><strong>Method: </strong>This experimental study was conducted on 50 infants aged 1-12 months at Ali Asghar foster home of Mashhad, Iran in 2013. Infants were randomly divided into two groups of intervention (n=25) and control (n=25). Motor development stimulation packages were used for intervention group three times a week for eight consecutive weeks (24 sessions, two hours each). Anthropometric indices of infants were evaluated using standard instruments before and after intervention. Data analysis was performed in SPSS V.11.5 using independent T-test and Mann-Whitney U test. <br/><strong>Results:</strong> In this study, mean age of infants in intervention and control groups was 6.04±3.48 and 4.3±3.70 months, respectively. In total, 68% of infants were male, and 32% were female. After intervention, Mann-Whitney test results showed no statistically significant difference in height (P=0.47) and head circumference (P=0.11) of infants between the groups. However, independent T-test showed a statistically significant difference in body weight of infants (P=0.007) between the groups after intervention with the stimulation care package. <br/><strong>Implications for Practice:</strong> According to the results of this study, use of evidence-based motor development stimulation package for eight weeks resulted in increased weight of infants, while it had no effect on height and head circumference. Therefore, it is recommended that complementary studies be conducted in this regard.Mashhad University of Medical SciencesEvidence Based Care2008-24875420160101Comparison of the Effects of Play Dough and Bubble Making Distraction Techniques on Venepuncture Pain Intensity in Children2532627910.22038/ebcj.2015.6279ENShahrokh MaghsoudiEvidence Based Care Research Centre, Instructor of Nursing, Department of Management Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran0000-0003-2818-2128Zahra SajjadiMSc in Pediatric Nursing, Nursing and Midwifery School, Mashhad University of Medical Sciences, Mashhad, IranHamidreza Behnam VashaniEvidence Based Care Research Centre, Instructor of Nursing, Department of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran0000-0002-9076-2900Seyed Mohsen Asghari NekahAssistant professor, Department of Education, Faculty of Education and Psychology, Ferdowsi University of Mashhad , Mashhad, Iranhttps://orcid.org/00Zahra Sadat ManzariEvidence Based Care Research Centre, Assistant Professor of Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran0000-0001-8270-7357Journal Article20151016<strong>Background:</strong> Venepuncture is a minimally invasive procedure, which is commonly performed in hospitals; if the pain is inadequately managed, it can cause negative feelings in children. Distraction can reduce pain through affecting the central nervous system and releasing neurotransmitters that inhibit pain. <br/><strong>Aim: </strong>In this study, we aimed to compare the effects of play-dough and bubble making as distraction techniques on the intensity of venepuncture pain in children. <br/><strong>Method: </strong>In this randomized, controlled, clinical trial, 90 children aged three to six years old, were randomly allocated to the three groups of play dough, bubble making, and control (n=30 for each group). This study was performed in Qaem, Imam Reza, and Dr. Sheikh hospitals of Mashhad, Iran, in 2015. The interventions consisted of using play dough and bubble making, which were started five minutes before venepuncture. Following the intervention, pain assessment was performed using Wong-Baker Faces Pain Rating Scale. Chi-square, Fisher’s exact, and One-way ANOVA tests were performed to analyze the data, using SPSS version 16. <br/><strong>Results:</strong> The mean of pain intensity in the play dough, bubble making, and control groups was 5.1±1.8 6.2±1.4, and 8.2±1.5, respectively (out of ten). One-way ANOVA reflected a significant difference between the three groups (P<0.001). Tukey’s post-hoc test showed that there was a significant difference between the play dough and control groups (P<0.001), bubble making and control groups (P<0.001), and bubble making and play dough groups (P=0.009). <br/><strong>Implications for Practice:</strong> Use ofplay dough could reduce the children's pain during venepuncture more effectively. Thus, use of such simple, inexpensive, and easy to access techniques might relieve pain in children. Mashhad University of Medical SciencesEvidence Based Care2008-24875420160101The Effects of Scheduled Visitation on the Physiological Indices of Conscious Patients Admitted at intensive Care Units3340629110.22038/ebcj.2015.6291ENHojat RezaieCritical Care Nursing Student, Nursing and Midwifery School, Rafsanjan University of Medical Sciences, Rafsanjan, IranTabandeh SadeghiAssistant Professor of Nursing, Department of Pediatric Nursing, Nursing and Midwifery School ,Rafsanjan University of Medical Sciences, Rafsanjan, IranFatemeh AbdoliInstructor of Nursing, Department of Community Health Nursing, Nursing and Midwifery School, Rafsanjan University of Medical Sciences, Rafsanjan, Iran0000-0001-6097-0031Journal Article20151031<strong>Background:</strong> Visitation of patients admitted at intensive care units (ICUs) is a controversial issue in the field of health care. It is commonly believed that the presence of family members might bring about physiological changes, such as tachycardia and hypertension, in ICU patients. <br/><strong>Aim: </strong>This study aimed to evaluate the effects of scheduled visitation on the physiological indices of conscious patients at the ICU. <br/><strong>Method: </strong>This experimental study was conducted on 90 conscious patients admitted at the ICU of Ganjavian Hospital in Dezful, Iran in 2014. Patients were randomly divided into two groups of intervention and control. In the control group, patient visits were carried out in accordance with normal procedures of the ward. In the intervention group, patients were visited by relatives and family members for 30 minutes, preferably in evening shifts. Physiological indices of the patients were recorded before, during and after scheduled visitation. Data analysis was performed in SPSS V.18 using independent T-test and one-way ANOVA with repeated measures. <br/><strong>Results:</strong> In this study, mean age of patients in the intervention and control groups was 42.1±19.1 and 39.4±19.6 years, respectively. In the intervention group, systolic blood pressure had a more significant reduction at 10 and 30 minutes after visitation compared to the control group (independent T-test, P<0.05). However, no statistically significant difference was observed in other physiological indices of the study groups (independent T-test, P>0.05). <br/><strong>Implications for Practice:</strong> According to the results of this study, scheduled visitation by family members caused no significant differences in the physiological indices of ICU patients. It is recommended that future studies be conducted as to confirm this finding and revise patient visitation policies in hospitals.Mashhad University of Medical SciencesEvidence Based Care2008-24875420160101Effects of Patient Educational Programs on the Headache Caused by Spinal Anesthesia4150629210.22038/ebcj.2015.6292ENReza AberomandCritical Care Nursing Master of Science Student, School of Nursing and Midwifery, Rafsanjan university of Medical Sciences, Rafsanjan, IranAli RavariGeriatric Care Research Center, Assistant professor, Rafsanjan University of Medical Sciences, Rafsanjan, IranTayebeh MirzaeiGeriatric Care Research Center, Assistant professor, Rafsanjan University of Medical Sciences, Rafsanjan, Iran0000-0001-8897-3744Mohsen SavaieSchool of Medicine, Assistant professor, Ahvaz Jondishapoor university of Medical Sciences, Ahvaz, IranJournal Article20151101<strong>Background:</strong> Headache is the most common complication caused by spinal anesthesia. Systematic educational programs about conservative treatments could be effective in the reduction of headache after spinal anesthesiz.
<strong>Aim: </strong>This study aimed to evaluate the effects of training programs on the headache of patients after spinal anesthesia.
<br/><strong>Method: </strong>This empirical study was conducted on 120 patients within the age range of 16-40 years who were candidates for general, orthopedic and urology surgeries in Dr. Shahidzadeh Hospital of Behbahan, Iran in 2015. Patients were randomly divided into two groups of intervention and control. Scheduled training was provided for the intervention group, and the control group received routine training. Intensity of headache was recorded using the visual analogue scale (VAS). Data analysis was performed in SPSS V.14 using Chi-square and independent T-test.
<br/><strong>Results:</strong> In this study, Chi-square test showed a statistically significant difference between the groups in terms of incidence and time of occurrence of headaches. In total, eight patients (25.8%) in the intervention group and 23 patients (74.2%) in the control group had headaches (P=0.001). In the first 48 hours after anesthesia, all patients in the intervention group and 11 patients (47.8%) in the control group had headaches (P=0.03). Moreover, independent T-test revealed a significant difference between the mean of pain intensity in patients of the intervention (5.0±1.8) and control groups (7.1±2.1) (P=0.01).
<strong>Implications for Practice:</strong> According to the results of this study, systematic education of patients could effectively reduce the occurrence and intensity of headaches after spinal anesthesia. Therefore, it is recommended that patient training be included in the preoperative preparation program in order to prevent headaches after surgery.Mashhad University of Medical SciencesEvidence Based Care2008-24875420160101Comparison of the Effects of Healthy Lifestyle Education Program Implemented by Peers and Community Health Nurses on the Quality of Life of Elderly Patients with Hypertension5160638010.22038/ebcj.2016.6380ENElham Khoshraftar RoudiMSc in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranHamidreza Behnam VoshaniEvidence Base Caring Research Center, Instructor of Nursing, Department of Pediatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran0000-0002-9076-2900Amir Emami ZeydiPhD Candidate in Nursing, Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranZahra Askari HoseiniMSc in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranMahbubeh MovahedifarMSc in Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, IranZahra Emami MoghadamEvidence Base Caring Research Center, Instructor of Nursing, Department of Community Health and Psychiatric Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran0000-0001-5142-0329Journal Article20141228<strong>Background:</strong> Considering the global rise in the elderly population and the common complications of this group (especially chronic diseases), significant attention is being paid to improving their quality of life (QOL). <br/><strong>Aim: </strong>This study aimed to compare the effectiveness of a healthy lifestyle education program, implemented by peers and community health nurses in improving QOL among elderly patients with hypertension, who were referred to healthcare centers of Mashhad, Iran in 2014. <br/><strong>Method: </strong>This experimental study was conducted on 60 elderly patients with hypertension, referring to healthcare centers of Mashhad, Iran in 2014. The subjects were selected via random cluster sampling. The control group does not receive any intervention at all, while the two other intervention groups received healthy lifestyle education by their peers or community health nurses for one month; the subjects were followed-up for one month after the intervention. Data were collected by the 36-item short-form health survey (SF-36) questionnaire and analyzed, using SPSS version 16.0. <br/><strong>Results:</strong> No significant difference was observed between three groups in overall QOL score and its domains before the intervention (P=.91). After intervention, a statistically significant difference was observed in the overall QOL score between three groups (P<.05). The results of one- way ANOVA revealed significant differences among groups in terms of role limitations due to physical health (p=04), physical functioning (p<.001), bodily pain (p<.03), role limitations due to emotional problems (p=.01), and emotional well-being (p<.04) after intervention. Post-hoc test showed that there was no significant difference between the nurse and peer groups (p=1.00), but the difference between the nurse and control groups (p=.04) and peer and control groups (p=.04) was statistically significant. <br/><strong>Implications for Practice:</strong> Based on the findings, education by peers and healthcare workers plays an important role in the adaptation of elderly patients to a healthy lifestyle. Therefore, it seems that using these two strategies can improve the overall health status as well as QOL for older adults. Mashhad University of Medical SciencesEvidence Based Care2008-24875420160101The Sources of Stress in Renal Transplant Patients6164637810.22038/ebcj.2015.6378ENNajmeh ValizadehEvidence Based Care Research Center, Instructor of Nursing, Department of Operating Room, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran20181014041342N1Eesa MohammadiProfessor of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran0000-0001-6169-9829Kourosh ZareiChronic Disease Care Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IranFatemeh KhorashadizadehAssistant Professor of Nursing, North Khorasan of Medical Sciences, Bojnurd, IranSima Oudi AvvalBS Nursing, Center of Organ Transplant, Montaserieh Hospital. Mashhad University of Medical Sciences, Mashhad, IranJournal Article20160116<strong>Introduction</strong>
Renal transplant is the best treatment of choice for patients with end-stage renal disease (1). Annually, about 17000 patients receive deceased or living donor transplants, which help them promote health and self-efficacy (1-2).
However, despite advances in transplant technology, patients face a number of post-operative challenges, which might lead to stress in patients, including uncertainty about future health, costs and finances, side effects of medicinal treatment and medical follow-up; these factors might lead to low quality of life (3).
Previous studies demonstrated differences in transplant-related stressors. According to study by Veroux (2010), these stressors are perceived physical appearance, issues related to sexuality, anxiety, and even feeling guilt (4). Gill (2012) stated that concern over transplant outcome is another stressor for patients even years after transplantation (5).
Another study suggested that uncertainty about future and concern over the impact of transplant on physical and physiological health are the main stressors among patients. These stresses continue several years after transplant and lead to fear of graft rejection and hopelessness (6).
Several studies were conducted on the effects of stress on renal transplant outcome (5-10) based on which it is necessary for nursing staff to consider stress-generating factors to provide appropriate care for renal transplant patients and as a result, promote nursing clinical performance (7).
Culture and politics of care can affect type of stress; however, there is a scarcity of reports on this issue regarding renal transplant in Iran.Therefore, this study was conducted to evaluate the source of stress in renal transplant patients.
1. Evidence Based Care Research Center, Instructor of Nursing, Department of Operating Room, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
2. Professor of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
3. Chronic Disease Care Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
4. Assistant Professor of Nursing, North Khorasan of Medical Sciences, Bojnord, Iran
5. BS Nursing, Center of Organ Transplant, Montaserieh Hospital. Mashhad University of Medical Sciences, Mashhad, Iran
*Corresponding author, Email: Valizadehn2@mums.ac.ir
<br/><strong>Methods</strong>
This descriptive study was conducted on 236 patients in the Montaserieh organ transplant hospital in Mashhad, Iran, during December 2014-May 2015. The participants were chosen through convenience sampling. The sample size was calculated according to rate of transplant rejection that was 44% (9).
The inclusion criteria were aged>18 years, not being hospitalized for transplant rejection, and two-month interval since renal transplant.
The data collection instrument was Transplant-Related Stressors Scale. The 17-item scale was developed by Frazier et al (1995). Before initiating the study, the scale was translated into Persian based on forward-backward method(11).
Items of this scale are categorized into five subscales assessing future health, finances, side-effects of medicinal treatment and physical limitations, interpersonal relations, and following the medical regimen. Patients are were asked to determine each item stressful on a scale ranging from 1 (not stressful) to 5 (extremely stressful); therefore, the scoring range is 17- 68 (8).
Validity and reliability of the scale were established by Weng (2008) and Achille (2004) with CVI=0.9 and Cronbach’s alpha=0.86 (3, 12). For the Persian version of the instrument, as estimated by expert panel, S-CVI score and Cronbach’s alpha were 0.89 and 0.89, respectively.
The obtained data were exported into SPSS, version 15; the data were analyzed using descriptive and inferential statistics (analysis of variance and independent t-test).
To ensure confidentiality, participants’ names were removed from the questionnaire and the questionnaires were coded by numbers.
<strong> </strong>
<br/><strong>Results</strong>
The majority of the subjects (65%) were male, aged between 18 and 60 years old (mean: 37±11.38 years), married (71.6%), and had basic education. Mean duration of being on renal transplant list was 38±44.71 months. Most subjects (56.8%) had undergone transplant less than two years before.
The most common stressor was fear of graft rejection and the least common stressor was getting medical questions answered (table 1).
The mean stress score in the male patients was 39.99±0.65 and in female was 38.40±9.98. This study used independent t-test to determine the effect of demographic variables on stress level. There were no significant differences between stress score and duration of being on the transplant waiting list (F=0.104, P=0.9) and duration of dialysis (F=0.694, P=0.5). However, there was a significant difference between stress score and age ((F=4.48, P=0.01) and marital statue (t=2.876, P=0.004) The highest stress scores were in ages less than 33 years old and the lowest stress scores were in ages more than 50 years.
<strong>Table1: Mean and standard deviation of the stressors in renal transplant patients</strong>
<strong> </strong>
Standard deviation
Mean
Items
0.92
3.37
Fear of graft rejection
1.00
3.01
Financial pressure
1.04
2.68
Uncertainly about future health
1.25
2.60
Travelling for check-up
1.05
2.43
Physical limitation
0.98
2.39
Medicinal side effects
1.01
2.38
Lack of social support
1.10
2.32
Dietary restriction
1.01
2.30
Handling insurance
1.15
2.24
Dependency on medical personnel
1.06
2.17
Weight gain
0/94
2.06
Change in appearance
0.99
2.05
Being a burden to others
1.06
1.96
Susceptibility to other illnesses
1.06
1.82
Change in relationship with spouse
0.87
1.60
Getting medical questions answered
<strong> </strong>
<strong> </strong>
<strong>Discussion</strong>
The present study was conducted to determine the most common stressors in patients undergoing renal transplant. It was found that the main stressors in these patients were fear of graft rejection, financial issues, and uncertainly about future health. This result was not in agreement with study Frey (1990). He stated that the main stressor was fear of hospital readmission (7). The reason for this discrepancy might be the fact that Frey assessed stress during the first six weeks after transplant. Due to patients’ unstable condition, particularly in the first few days after transplant, they were readmitted to hospital for creatinine level and renal function examinations; thus, this stressor will be ruled out after some time.
In line with our study, several other studies demonstrated that fear of graft rejection is one of the most important stressors (3, 5, 8, 13-14). Graft rejection threatens transplant patients’ health and it implies undergoing dialysis and tolerating painful needles again. Renal transplant patients experience multiple stresses during dialysis such as awaiting organ transplant, financial pressure, and difficult process prior to receiving transplant.
According to the present study, a stress-generating factor related to liver transplant was financial pressure. Consistent with this result, Frazier (1995) showed that an important stressor in patients was financial pressure due to giving repeated tests, visits, follow-up issues(8). Despite consensus on financial pressure, the cost of insurance was not one of the stressors in some studies such as Chen (2010).
He stated that financial issues were not a significant concern in Taiwan. The Taiwanese have national health insurance; therefore, patients are only responsible for a small portion of the costs (6). However, since financial problems are one of the important stressors in countries like Iran, where transplant patients are directly responsible for treatment costs and health insurance is responsible for only a small portion of the costs.
In this study, uncertainty about future health was the third highly frequent stressor among the patients. McCormick (2002), quite consistent with our results, stated that uncertainty about future health was a major stressor in transplant patients, which can hinder recovery after renal transplant. Although, patients have learned some coping strategies for the post-transplant period, they are concerned about future health, returning to dialysis (15).
In the present study, fear of graft rejection was not the main stressor, the reason for which might be the religious and spiritual beliefs of Muslim patients. Muslims deem Allah as an omnipotent and all-knowing being, which results in accepting their fate with satisfaction.
According to the results, there was no significant difference between stress score and the length of post-transplant time; thus, passage of time after transplant cannot affect severity of stress.
Chen (2010) proposed that one year after transplant, the patients experienced lower level of stress; however, disregarding post-transplant time, stress continued to some extent (16). Kong (1999) demonstrated that renal transplant patients may experience stress of moderate intensity long after transplant (17). It is possibly reason that the problem related post time transplant is continuing, the stress factor related to transplant is continuing(18).
<strong> </strong>
<strong>Implications for Practice</strong>
Disregarding the outcome of renal transplant, patients experience stress during post-transplant period. There are differences in type and severity of stress-generating factors depending on culture, health care system, insurance support, and religion.
These stressors can deteriorate patients’ physical, psychological, social, and spiritual condition; therefore, identifying and managing these stressors is important. Determination of transplant patients’ perception of stressors can help nurses promote patient outcome. Nursing staff are recommended to employ evidence-based practice to identify vulnerable patients and provide appropriate care for patients.
<strong> </strong>
<strong>Acknowledgments</strong>
This article is part of a PhD dissertation and research project approved and supported by Ahvaz University of Medical Sciences (grant code: 1392.335). The authors would like to thank the Research Board of Ahvaz University of Medical Sciences, as well as the authorities, staff, and transplant patients of Montaserieh Hospital.
<strong>Conflict of interest</strong>
The authors declare that there is no conflict of interest.Mashhad University of Medical SciencesEvidence Based Care2008-24875420160101Prescribing: A Crucial Factor in the Professionalization of Nursing in Iran6566616010.22038/ebcj.2016.6160ENHamidreza HaririanPhD Candidate in Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran0000-0002-5714-8669Journal Article20151027In the past two decades, the number of countries giving the permission of prescribing to nurses has increased. Nowadays, in countries such as Australia, South Africa, Ireland, Finland, Canada, Norway, New Zealand, Sweden, Britain, Spain, and America, nurses have the legal right to prescribe medicine. Nurse prescribing can enhance the quality of care, save patients’ time and money, promote occupational independence in nurses, and provide an opportunity for nurses to use their professional skills more efficiently [1].
In addition, it leads to optimal use of time, elimination of repetitive procedures for nurses, improvement of disease management, reduction in the number of hospital admissions, minimizing the duration of hospital stay, and lowering health costs [2, 3].
In a study done by Courtenay, entitled “Prescription by Nurses: Advantages and Risks”, the results indicated that nurse prescribing can increase communication between different health professionals, decrease physicians’ workload, promote holistic care, and diminish the waiting time for patients to receive a prescription.
In this study, patients expressed the advantages of nurse prescribing to be: accessibility of nurses, receiving detailed information about disease from the nurses, easiness and quickness of nurse prescribing, and nurses’ in-depth knowledge about patient’s condition [4].
Since cost containment is one of the most important policies of worldwide health system, experts believe that one strategy to achieve this goal is to delegate some of the responsibilities of physicians to nurses. It can also help nurses to ensure their occupational development and promote professionalism in nurses [5].
In addition, physicians believe that since nurses have more interpersonal contact with patients, they can have a more efficient role in patient training, especially in terms of the details of prescriptions [2-4].
Nurse prescribing was first introduced in Britain in 1986 by Community health nurses and in a Cambridge report. In 1998, it was performed using a Nurse Prescriber’s Formulary in a limited form. It was eventually made official in 2006 and any Registered Nurse (RN) with three years of experience was allowed to participate in Prescription Writing courses.
Most of nurse prescribers are currently working in health care centers of Britain. Nurse prescribing has been proposed since 2000 with the development of the national health system and the growing emphasis on providing timely health services for patients.
According to the formulary of 2002, independent nurse prescribers in Britain prescribed 180 drugs for about 80 clinical situations, which reached to 240 kinds of drugs for 110 different clinical situations in
1. PhD Candidate in Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
*Corresponding author, Email: houman.haririan@gmail.com
2005. These nurses were able to prescribe all the legal drugs, except for some of the controlled ones such as some narcotics since 2006 [6].
In an African country called Botswana, nurses have been able to write prescriptions in hospitals, public clinics, and different wards since 1992. Nurses in South Africa have achieved the right to independent prescriptions writing since 1997 [7]. The laws of prescription writing in America vary for each state and Advanced Practitioner Nurses (APN) have achieved the privilege of writing prescriptions since 1969, and since 2003 in more than 40 states of America they can prescribe drugs [8].
Darvishpour performed a study in Iran entitled “An Analysis on Prescription by Nurses in Iran and the World: A Comparison”. It showed that even though people do not concept the prescriptions written by nurses, sometimes they are driven by necessity to use nurse prescribing in most hospital wards, especially emergency wards.
Quite the same as other developed countries, the prescribing pattern in Iran is in a range between independent and dependent. But its quality and way of application is extremely different from them, since it is mostly done illegally or even in some cases, secretly [9].
Based on the results of various studies, it has been illustrated that one of the main factors in the professionalization of nurses is having independency in their job [1, 3, 10]. Since nurse prescribing has several advantages for patients, nurses, and even physicians, and because it creates a sense of being useful, independency, and professional identity for nurses [2-4, 11], it can be introduced as a Discipline for the society. Therefore, it seems necessary to develop and design native structures for nurse prescribing in Iran.