Journal of Education and Health Promotion

Abstract BACKGROUND: More than one‑half of people with diabetes need at least one surgery in their
lifespan. Few studies have addressed how to manage the needs of these patients after discharge
from the hospital. The present study is designed to determine the effect of home care on readmission
of Type 2 diabetic patients who underwent surgical procedures.
MATERIALS AND METHODS: The present study was a randomized clinical trial. Sixty‑nine
patients with Type 2 diabetes undergoing surgery were assigned to the intervention and control
groups via blocking order in the selected educational hospitals of Isfahan 2019. Home care
was performed for 3 months with interprofessional team approach. Data collection tools were
re‑admission checklist. Data were entered in SPSS software version 23 and were analyzed by
nonparametric tests.
RESULTS: The background characteristics in the intervention and control groups were not different.
The frequency of readmission in the control and intervention groups from the time of discharge until
3 months later was 25.7% and 18.9%, respectively. Frequency of readmission in the intervention
and control groups was not significant in 3 months from discharge, P > 0.05. The mortality rate was
11.4% and 0% in control and intervention groups, respectively, P < 0.05.
CONCLUSION: It can be argued that continued home care can decrease the rate of readmission
and mortality rate in patients with Type 2 diabetes who will discharge from surgical wards.

Abstract BACKGROUND: Education in vulnerable communities can be a health affordable strategy to
promote patient empowerment. Recognition and understanding the problems of diabetes education
are of significance to overcome the barriers and advance the educational and care services to
control diabetes and promotion of society health. The aim of this study was to explore participants’
perspectives, experiences, and preferences, regarding diabetes education problems.
MATERIALS AND METHODS: This descriptive, qualitative study was conducted from March 2016 to
September 2017. The participants were 23 people including nine patients with diabetes and their family
members and 14 members of diabetes healthcare team (physicians, nurses, and nutritionists). The
data were collected through individual semi‑structured interviews and analyzed through conventional
content analysis approach proposed by Graneheim and Lundman. Some main categories and
subcategories emerged.
RESULTS: Three main categories showed the most prominent problems of diabetes education,
namely, inadequate infrastructure for diabetes education, insufficient defined and de facto position
for the role of diabetes nurse educator, and the failure in patient‑oriented team approach in diabetes
education.
CONCLUSION: This article addresses the most important problems of diabetes education. The
fundamental strategy to overcome these problems seems to be the planning and management of
diabetes education as a high priority in the noncommunicable disease management policies of the
Ministry of Health and Medical Education.

Abstract BACKGROUND: Limited research has been conducted in the field of diabetes educator’s competency.
However, no comprehensive and integrated explanations of educator’s competence requirements
in treatment centers exist in Iran. The aim of this study is to explain the components of diabetes
educator’s competence in diabetes self‑management education in Iran.
MATERIALS AND METHODS: This was a qualitative descriptive‑exploratory study. The data were
collected through semi‑structured and in‑depth interviews and using purposeful sampling method
in Isfahan University of medical science from April to October 2018. Sampling continued until data
saturation. Participants included 20 people who were selected by purposive and snowball sampling
method. The interviews were analyzed using content analysis method of Graneheim, Lundman.
RESULTS: Data analysis resulted in the emergence of three main categories including (1) Patient and
family centered education, (2) process‑based education, and (3) continuous progress in profession
and also seven subcategories (patient and family activation, empower), facilitating educational
process, comprehensive education assessment, development, implementation and evaluation of
educational plans, developing educators’ educational knowledge and skills, development of creativity
and innovation, promote inter‑professional cooperation in education.
CONCLUSION: The evaluation of facilitation factors for participation and empowerment patient and
family along with creativity and interprofessional collaboration for comprehensive evaluation of patients
in designing, implementation of educational programs were mentioned as important competencies
of diabetes educators, which can have a significant impact on patients’ recovery, treatment, and the
promotion of society’s health.

Abstract BACKGROUND: A key step for improving the effectiveness of diabetes self‑management
education (DSME) is to identify its restrictors.
OBJECTIVES: The aim of this study was to explore the restrictors of the effectiveness of DSME.
METHODS: This descriptive qualitative study was conducted in March 2016–2017. Participants
were 16 DSME providers (viz., physicians, nurses, nutritionists, and psychologists) and nine DSME
receivers (viz., patients and their family members) – 25 in total. Semi‑structured interviews were held
for data collection. Interviews were transcribed word by word and analyzed through conventional
content analysis approach proposed by Graneheim and Lundman.
RESULTS: The restrictors of the effectiveness of DSME were categorized into three main categories
and 11 subcategories, namely patients’ limited welcoming of DSME classes (allocating limited time
for participation in DSME classes, inadequate knowledge about diabetes mellitus [DM] importance,
inappropriate educational environment, and financial problems), unfavorable adherence to
treatments: serious challenge (inattention to educations, poor motivation for adherence to medical
recommendations, and inattention to the psychological aspects of DM), and the difficulty of adult
education (the difficulty of changing health‑related attitudes and behaviors, mere information
delivery during education, adults’ physical and perceptual limitations, and diabetes educators’ limited
competence in adult education).
CONCLUSION: The findings of the present study provide an in‑depth understanding about the
restrictors of the effectiveness of DSME. DM management authorities and policymakers can use
these findings to develop strategies for improving the effectiveness of DSME.

Abstract INTRODUCTION: The purpose of this study was to determine the status of observance of structural
standards in rehabilitation centers and nursing homes.
MATERIALS AND METHODS: This cross‑sectional descriptive study was carried out on 12 centers
of the nursing homes of Isfahan city during 2016–2017. The tool was a check. To complete the
checklist, the direct observation of the environment and the review of existing documents were used.
Data were analyzed by descriptive statistics and frequency distribution.
RESULTS:  The findings of this study shows that of 11 standards ofworkforce standards regarding
to health expert presence, nurse presence, therapist and extracurricular instructor presence, have
been observed innone of the centers, and the presence of social worker/psychologist in 50% of the
centers. Of the 21 standards relating to the physical environment, eight standards have not been met
in any of the centers. Of the 25 standards relating to the general conditions of building, 4 standards
have not been met in any of the centers. Of the 10 standard relating to the equipment and supplies
which are needed, 3 were not observed in any of the centers. Of the 10 standards relating to the
required services, except one, standards have been met in all centers. Of the 10 standards relating
to the general provisions, 7 are met in all centers of both types.
CONCLUSION: According to the findings, a significant percentage of standards have not been met
in any of the aging centers or just met in some of these centers. It is hoped that the results of this
study will enable authorities to promote standardization of nursing homes and rehabilitation centers.

Abstract BACKGROUND: Management pain in hospitalized children is challenging for the health-care
professionals. Nurses have the most interactions with children who need to assess and manage for
their pain. Therefore, the aim was to describe nurses’ experiences from pain management among
hospitalized children from Iranian culture in this study.
METHODS: A phenomenological study was conducted in which 23 nurses working in an educational
hospital in Isfahan–Iran. The nurses participated in interviews based on a purposeful sampling method.
RESULTS: Participants’ experiences were categorized into three major themes and twelve subthemes
including the nurses’ ability of detection of the pain nature, reaction to pain management and belief
in pain relief.
CONCLUSIONS: The research showed that the nurses have valuable experiences in pain
management in their workplaces. Their descriptions were based on the use of three domains that
consist of knowledge, belief, and practice. Therefore, it is vital to focus on the subject of pain in
nursing curriculum and guidelines in hospitals. A more extensive research is needed to demonstrate
perceived barriers to pain management.

Abstract BACKGROUND: Clinical education provides a chance to combine theoretical knowledge and clinical
skills. Students are the key elements in the evaluation of clinical education efficacy. The present
study was aimed to define nursing students’ viewpoints concerning conformity to the characteristics
of clinical conference and clinical round.
METHODS: This descriptive analytical study was conducted on the bachelor’s students of the 4th–6th
semester of nursing. Sampling was conducted using census sampling method during the 2nd semester
of 2014–2015 school year. Data collection tool was a three‑section researcher‑made questionnaire
containing demographic, nursing round, and clinical conference characteristics. Descriptive and
inferential statistical tests (independent t‑test, ANOVA, and Spearman and Pearson correlation
coefficients) were used for data analysis.
RESULTS: Participants were 134 bachelor’s students of the 4th–6th semester of nursing. According
to half of the participants, conformity to the characteristics of clinical conference (45.5%, 53%) and
clinical round (44%, 51.5%) were poor and medium, respectively. Paired t‑test showed a significant
difference between students’ viewpoints toward the planning of clinical conference and clinical
nursing round (P = 0.006, t = 2.77).
CONCLUSIONS: According to the results of the present study on students’ viewpoints, clinical
education faces a serious challenge with regard to clinical education methods. Considering the
necessity and importance of clinical education, more investigation should be conducted to detect its
relevant factors and plan for its improvement.

Abstract Background: The need for a correct follow‑up for medical advices of health givers is the
cornerstone for avoiding drug‑related complications in especial period of elderly people life.
There isn’t any data about drug therapy regimens adherence of elderly people of Isfahan. In
this study, we aimed to cover this deficit. Materials and Methods: In this cross‑sectional study
which was carried out in Isfahan (Iran) in 2013 senior citizens (aged 65 or more) who were
taking at least one medication and had no record of residency in nursing homes were included.
We used Morisky medication adherence scale (after validation and reliability assessment for
using this questionnaire in Persian language) to evaluate the level of adherence in the study
population. Results: A total of 200 elderly participants were fully studied (n = 200, 61% females),
and 52% of them had poor medication adherence. 77.5% of participants were suffered from at
least four medical illnesses, and 18.5% of them were taking more than eight medications per
day. We have not found any significant statistical relationship between vision or hearing loss
disorders and the medication adherence of the participants). There was a significant positive
relationship between the level of education and medication adherence (P = 0.001), (2 = 0.29).
Conclusion: Low Medication adherence is a common and important drug issue in the elderly
in Isfahan. This issue can lead to medical complications and huge cost if it is not addressed
appropriately.