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ORIGINAL ARTICLE
J Edu Health Promot 2020,  9:8

Assessment of educational performance of nurses in neonatal intensive care unit from parents' perspective


1 Health Management and Economics Research Center, Iran University of Medical Sciences, Tehran, Iran
2 Ph.D. Candidate. Education and Health Promotion, School of Health, Iran University of Medical Sciences (IUMS), Tehran, Iran
3 NICU, Mofid Hospital, Shahid Beheshri University of Medical Sciences, Tehran, Iran
4 Department of Pediatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
5 Department Public of Health, Abadan Faculty of Medical Sciences, Abadan, Iran
6 Department of Public Health, Ilam University of Medical Sciences, Ilam, Iran
7 Departments of Pediatrics, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
8 Department of Medical Emergencies, School of Paramedical, Kermanshah University of Medical Sciences, Kermanshah, Iran
9 Department of Pediatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz; Neonatal Health Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Date of Submission08-Jul-2019
Date of Acceptance05-Oct-2019
Date of Web Publication30-Jan-2020

Correspondence Address:
Dr. Mohammadreza Mansouri Arani
PhD Candidate, Department of Pediatric Nursing, School of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz; Neonatal Health Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jehp.jehp_371_19

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  Abstract 

INTRODUCTION: One of the key elements in family-centered care is educating parents with hospitalized infant at intensive care unit. Education is a fundamental role of nursing at intensive care units to satisfy parents and accelerate disease progression that eventually reduces hospital re-admission.
MATERIALS AND METHODS: This was a cross-sectional study conducted in 2018, and the study population was admitted infants (n = 90) in the neonatal intensive care unit (NICU) of Shahid Beheshti University of Medical Sciences hospitals. We used a questionnaire including sociodemographic characteristics and performance of nurses in educating parents. Nurses' performance was assessed in five major areas composed of family-centered care, delivering cares according to individualized needs, education on equipment, basic needs of infants, and finally, nutritional education. All statistical analyses were conducted using SPSS version 22. The data were analyzed using t-test, ANOVA, and nonparametric tests.
RESULTS: Findings from the current study indicated that nurses performed their educational role weakly (37% of standard level). We also found that nurses who participated in neonatal educational courses had better performance compared to their counterparts. The results showed that year of experiences working as a clinical nurse was significantly associated (P < 0.05) with performing standard education.
CONCLUSION: Our findings indicated that nurses performed their educational role weakly which might be due to staff shortage, heavy workload, and lack of time for educating parents. Therefore, it is necessary to improve the quality of education among nurses working at the NICUs and provide the necessary standards and indicators to evaluate this important task.

Keywords: Education, neonatal intensive care unit, nursing


How to cite this article:
Mansourian M, Ziapour A, Kazemian M, Damanabad ZH, Rastegarimehr B, Mirzaei A, Safari O, Kalhori RP, Arani MM. Assessment of educational performance of nurses in neonatal intensive care unit from parents' perspective. J Edu Health Promot 2020;9:8

How to cite this URL:
Mansourian M, Ziapour A, Kazemian M, Damanabad ZH, Rastegarimehr B, Mirzaei A, Safari O, Kalhori RP, Arani MM. Assessment of educational performance of nurses in neonatal intensive care unit from parents' perspective. J Edu Health Promot [serial online] 2020 [cited 2020 Feb 19];9:8. Available from: http://www.jehp.net/text.asp?2020/9/1/8/277341


  Introduction Top


Infancy is a vulnerable period in which many of the physiological compatibilities necessary for extrauterine life are formed.[1] Birth of a healthy infant is the best gift given by God which makes the parents blessed, whereas the birth of unhealthy one causes severe mental tensions to parents.[2] Hospitalized infant in a neonatal intensive care unit (NICU) is a very stressful and disturbing experience for parents; they are often confused in such an NICU environment, and they may feel helpless and guilty and get fear about survival or disease lasting effects of their infants.[3] The survival of premature infants with very low birth weight and congenital malformations has been increased due to the advances in technology, new drugs, and the increase in knowledge of neonatal physiology. This means that infants and their parents have to experience long-term hospitalization and stay in hospitals and the infants may be discharged with special health-care needs.[4] With the birth of a premature baby, the family gets a lot of stress due to lack of physical, emotional, and psychological preparation for that event which causes them to face different needs.[5],[6] Preterm birth is a worldwide epidemic with a global incidence of 15 million/year, and nearly 1 in 10 babies is stillborn preterm.[7] Researches showed that mothers who are separated from their babies had high level of anxiety and depression and demonstrated numerous psychological reactions.[8],[9],[10]

Furthermore, studies indicated that the appearance of infants and its behavior and changes in the role of parents are the main causes of increasing their stress in NICU.[11] Families have an important role to determine the specific needs of the baby, and they are an essential role in setting their care program.[12]

Regarding the therapeutic, technical, and technological improvement, NICU mortality rate was decreased, and modern technological advances and medical equipment can be caused to reduce hospitalization time and early discharge.[13] It can increase maternal anxiety.[9]

The role of mothers and their knowledge in dealing with the infant properly and correctly is well known.[14] After discharge, the parents are forced to take care of their baby at home; therefore, it is necessary to identify their abilities, especially the mother as the first caregiver of the baby. Mothers should be taught how to communicate with her baby and should be prepared for its discharging.[15] Mother awareness about how to deal properly with problems of the baby and how to provide essential care during this period may have a major impact on raising the confidence of mothers about the care of her baby and on eliminating many false beliefs and traditions about this matter.[16]

Nursing is an independent disciplinary and a branch of medical science that its graduates work as a member of the team of providing health care in various fields related to health care, training, research, consulting, prevention, management, protection, care, treatment, and rehabilitation.[17],[18]

Education is one of the patients' rights and a means to achieve health promotion, disease prevention, increased patient autonomy, improved self-care, and reduced readmission. Since training is cost-effective on all aspects of patient care, treatment, and recovery, it is important to understand patient education by nurses.[19] Education is a fundamental role of nursing at intensive care units to satisfy parents and accelerate disease progression that eventually reduces hospital re-admission.[20] In general, evaluation of educational performance of nurses by parents can represent the educational role of nurses in the hospital, and necessary activities can be done in order to better playing of this role of the nurse which may reduce bad consequences of neglecting it such as repeated hospitalizations due to lack of proper care at home.[21]

As parent education is one of the important duties of nurses and since nurses spend a lot of time with them, this study aimed to assess the educational performance of nurses in NICU from parents' perspective.


  Materials and Methods Top


This descriptive comparative study was performed on the training process of parents who have infants admitted to the NICU of a selected center affiliated to Shahid Beheshti University of Medical Sciences. All the parents who have infants which were admitted to the NICU 1 (under 1500 g) and NICU 2 (above 1500 g). Inclusion criteria were as follows: 1. lack of congenital malformations. The data related to the educational performance of the nurses were collected using the checklist made based on the standards for the training of parents. The checklist comprised two parts: 1. demographic information of the infants, nurses, and parents and 2. information related to the way of doing standard training and both included the existence of family-centered care approach. Second, specifying a training plan based on needs assessment and providing it to the parents and care providers, 3. training about the equipment, 4. primary care of the infants, and 5. infant nutrition training. Ranking instrument of the checklist items was determined after validation of the checklist because it was researcher-made. The scoring was as follows: “yes” (done correctly [2 points] and done incorrectly [1 point]) or “no” [0 point].



Then, the obtained scores were converted to percentile values and were analyzed. Once the scores of different areas of the checklist were calculated, they were classified under three ranks of low (scores 0–49), middle (scores 50–74), and favorable (scores 75–100). The validity of the checklist for the infant discharge process was determined using content and face validity indexes. To do so, questions of the questionnaire and checklist were formulated using books and articles in this regard, existing protocols and standards, and comments of advising and consulting professors. Then, the questions were judged by 13 specialists and faculty members of nursing. The content validity index was calculated as 94%. The reliability of the checklist was determined using the inter-rater agreement method. The observers agreed with each other by 95%. Based on a review of the related literature, and given that no study was found in this regard, the sample size was obtained as 88 infants using the following equation, where α = 0.5, P = 0.35, and d = 0.1. However, in this study, ninety infants were examined.

The researcher attended in some night shifts and completed the checklist to know the training and continuation of care and the correlation of observations. The assessed indexes included: (1) The existence of family-centered care approach, (2) Specify training plan based on needs assessment and provide it to the parents and care providers, (3) Training about the equipment, (4) Basic care of the infants, and 5. Infant nutrition training. Then, Researcher conducted a structured observation on the process of training which was done during the procedures, and between them, and the results of observations were represented through selecting choices of the checklist, that is, “yes” (done correctly or incorrectly) or “no.”

All statistical analysis was conducted using SPSS 22 (version 22.0, SPSS Inc., Chicago, IL, USA). Normal distribution was shown with Kolmogorov–Smirnov test. Data were analyzed using t-test, ANOVA and nonparametric tests (Mann–Whitney).

Ethics approval and consent to participate

This study was drawn from a research project (No. SBMU.REC.1392.353) sponsored by the Deputy of Research and Technology at Shahid Beheshti University of Medical Sciences (SBUM).


  Results Top


The average age of our participants was 28 years, with an age range of 19–39 years. Most women (66%) had high school diploma, and 62.2% of the mothers were nulliparous. The majority of women (93.3%) in this study had no previous experience of infant admission in the NICU. Among the nurses, 86.7% and 13.3% were married and single, respectively, and 80% of them take specialized training courses for infants. Most nurses (60%) were observed in rotating shifts. The educational level of most nurses (97%) was bachelor's degree The mean age and years of service and experiences of participants was shown in [Table 1]. As shown in [Table 2], minimum and maximum years of service in the NICU were 3 months and 16 years, respectively. The results of the study showed that the implementation rate of educational standards was weak (37%) [Table 2].
Table 1: The statistical indexes of nurses' age, years of service, and experience of working in the neonatal intensive care unit

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Table 2: The implementation rate of educational standards in neonatal intensive care unit

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Parents determined that evening shift nurses had trained better. Furthermore, through studying the relationship between the implementation rate of educational standards and neonatal intensive care specialized training courses showed that the nurses who have completed neonatal training courses have gotten a higher mean score in implementing educational standards. In this regard, the Mann–Whitney test showed that the variables of training about the equipment item and medication item had a significant difference with P < 0.05 [Table 3].
Table 3: The relationship between the implementation of educational standards for nurses' education level

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According to the results, the examination of the correlation between the educational level of nurses and the implementation rate of educational standards, using Kruskal–Wallis test, showed that there was a significant difference with P < 0.05. Having performed Dunn's multiple comparison test, there was a significant difference between nurses with bachelor's degree and nurses with master's degree in terms of implementation rate of discharge standards in the fourth and sixth parts (P = 0.031), as the mean score of the nurses with master's degree was higher than others. However, the difference between nurses with bachelor's degree and patient care technicians and also the difference between nurses with master's degree and patient care technicians were not significant. It must be noted that the number of nurses with master's degree and patient care technicians was very low. Using comparison of multiple range Duncan's test, it was found that there is a significant relationship (P = 0.005) between the clinical experience of neonatal intensive care nurses and the implementation of educational standards so that a higher mean score is obtained when the experience increases. There are significant differences (P = 0.005) between the groups with 0–2-year and >5-year clinical experience in the NICU [Table 4].
Table 4: The relationship between the implementation of educational standards in the neonatal intensive care nurse with clinical experience

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  Discussion Top


The results of the study show that the implementation rate of educational standards in the NICU is in the weak range (37%).

Seyedamini showed that the needs related to sick child was ranked as the most important need from mothers' point of view and the trust needs were ranked as highly met,[22] whereas Mok and Leung reported that mothers experienced the most communication and educational support from nurses.[23] Valizadeh et al. showed that the mothers wanted more supports than they received from nurses.[24]

Research has shown that supporting families and giving information and education make them feel more in control and power over their situations.

Parents like to get correct information about the status of their infants hospitalized. They expect health-care providers inform them about the expected changes that may occur to the baby's physical state and condition.[25] Rasti et al. showed that parents need to receive knowledge and information about current and future problems in premature infants.[26]

Jackson et al. showed that the infant unit gained a high score for the quality of care and information.[27] When parents receive incorrect or incomplete information about their infant, they get stressed.[28] Furthermore, Van Rooyen et al. showed that correct and effective training by nurses is important to overcome the negative emotions of parents.[29]

Implementing clinical supervision system through observation, feedback, discussion, and investigation may develop nurses' knowledge and professional skills in patient education.[30]

The results of Hekmatpoor et al.'s study showed that some factors influenced the structure and process of training patients and in some cases resulted in failure to properly implementing the training in clinical areas. These factors included (1) curriculum and performance of the faculty (routine education and insufficient attention to the needs of students), (2) the inappropriate syllabus of “learning process and principles of training patients” (the course sectionality, superficial emphasis on application of learning theories in clinical areas, and failure to make the students familiar with method of training the patient), (3) paying little attention to the conditions of clinical nurses, (4) paying relative attention to training and cultural needs and habits of patients and their family, (5) training management, and (6) the participants' attitude toward to training patients.[31] Moradi et al. results showed that Considering the low percentage of education in all domains in terms of patients, nurses' performance is not desirable. patient education, the necessary measures should be taken by the direct authorities of this profession. Considering the low percentage of education in all domains in terms of patients, nurses' performance is not desirable.[32]

Klein-Fedyshin et al. showed that nurses did not have enough time to train patients. They emphasized on training patients with videotapes and other audiovisual resources from libraries to save nurses' time, as the confusion and stress of the patients and their family inhibited the training.[33]

Adib-Hajbaghery and Zare explained that barriers to patient education in Iran identified five main areas that were (1) barriers related to nurses: lack of time due to workload of nursing staffing; (2) barriers related to patients: the patients' unfavorable physical and psychic status; (3) management barriers: lack of managers' support; (4) organizational obstacles: the inappropriateness of nurse–patient ratio; and (5) environmental barriers: lack of cooperation of the medical team members to implement educational programs. Most of the barriers to patient education are those related to nurses. To improve the status of patient education, it is essential for managers to encourage nurses in this important task by adopting measures such as increasing in nursing staffing, allocating sufficient funds, and proper supervision.[34]

Training to the parents needs activities of training managers and audiovisual unit, using computer networks, the Internet, and active sessions of face-to-face education. It may include group training sessions, videos, compact discs, booklets, and educational pamphlets and individual training. Other methods are the Internet, newspapers, and magazines. These can be used to take all free times of the family (parents) to empower them.[35]

The relationship between the implementation of discharge standards and nurses' education level shows the mean scores of nurses with a master's degree were more than the others. However, it should be mentioned that the visit number of nurses with master's degree was very low. However, the mean scores of unregistered nurses in the implementation of discharge standards are more than that of nurses.

In Jaloo et al.'s study, it was demonstrated that there is a significant difference between the education levels of nurses with the implementation of nursing care standards in which nurses with master's degree got the highest score (180.2) (P < 0.005). However, it is noteworthy that the number of nurses and unregistered nurses was very low. The mean scores of unregistered nurses (71.5) are lower than registered nurses (96.37).[36]

Studying the relationship between the implementation of educational standards and nurses' clinical experience in the NICU shows that more clinical experience in NICUs leads to higher mean scores in the implementation of discharge standards. The highest mean score was related to nurses with the experience of more than 5 years.

Saadati in his study showed that there was a significant relationship between the implementation of nursing care standards in the intensive care unit of educational hospital and the work experience of nurses in there and there greatest amount was related to the group with the experience of 6–10 years (53.4).[37]

The relationship between the implementation of educational standards and the working shifts shows that the nurses who worked in the evening shift had trained better. However, in Saadati's study, there was not a significant relationship between them.[37] However, in Jaloo et al.'s study, there was a significant relationship between them, and the highest score was related to the nurses who worked in the morning shift (129.93) (P < 0/001).[36]

The relationship between the implementation of educational standards and neonatal intensive care training courses shows that the nurses who had passed these courses get higher mean scores in the implementation of educational standards. Aline with these results, there was shown a significant relationship between the implementation of educational standards and neonatal intensive care specialized training courses, in Mansouri study (P < 0.025).[4]


  Conclusion Top


The results showed that all of the training which was provided in the NICU were at a weak level. According to the survey, it can be concluded that in the inpatient parts, nurses are faced with the lack of time for patient education. The severe shortage of nurses and lack of time to perform nursing interventions are other factors which cause the parents to be trained not properly. They are some other reasons that may lead to bad training including lack of physical space for continued presence of parents in the section and the hospital, low literacy level, sociocultural problems of families in this region, some incompletely training which have been routine, nurses' fears from parents for use of this information against them, and lack of correct systematic attitude in hospital and nursing managers about training to the parents and the correct method of family-centered care. Therefore, it is necessary to improve quality of education among nurses working at the NICUs and provide the necessary standards and indicators to evaluate this important task.

Acknowledgment

The researchers appreciate all the professors, students, nurses, and head nurses who cooperated with them in this study and also the Infant Research Center of Shahid Beheshti Medical Sciences University.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Verklan MT, Walden M. Core Curriculum for Neonatal Intensive Care Nursing-E-Book. 5th edition. English: Elsevier Health Sciences; 2014.  Back to cited text no. 1
    
2.
Henderson J, Carson C, Redshaw M. Impact of preterm birth on maternal well-being and women's perceptions of their baby: A population-based survey. BMJ Open 2016;6:e012676.  Back to cited text no. 2
    
3.
Abuidhail J, Al-Motlaq M, Mrayan L, Salameh T. The lived experience of Jordanian parents in a neonatal intensive care unit: A phenomenological study. J Nurs Res 2017;25:156-62.  Back to cited text no. 3
    
4.
Mansouri Arani M, Alaee Karehroudi F, Manochehri H, Akbarzadeh Baghban A. Audit of neonatal discharge process in neonatal intensive care unit of Mahdieh hospital in Tehran. Iran J Pediatr Nurs 2015;2:28-38.  Back to cited text no. 4
    
5.
Lowe JR, Rieger RE, Moss NC, Yeo RA, Winter S, Patel S, et al. Impact of erythropoiesis-stimulating agents on behavioral measures in children born preterm. J Pediatr 2017;184:75-800.  Back to cited text no. 5
    
6.
Mohammadi M, Ziapoor A, Mahboubi M, Faroukhi A, Amani N, Hydarpour F, et al. Performance evaluation of hospitals under supervision of Kermanshah medical sciences using pabonlasoty diagram of a five-year period (2008-2012). Life Sci J 2014;11:77-81.  Back to cited text no. 6
    
7.
Purisch SE, Gyamfi-Bannerman C. Epidemiology of preterm birth. Semin Perinatol 2017;41:387-91.  Back to cited text no. 7
    
8.
Ong SL, Abdullah KL, Danaee M, Soh KL, Soh KG, Japar S. Stress and anxiety among mothers of premature infants in a Malaysian neonatal intensive care unit. J Reprod Infant Psychol 2019;37:193-205.  Back to cited text no. 8
    
9.
Valizadeh L, Hosseini MB, Heydarpoor Damanabad Z, Rahkar Farshi M, Asgari Jafarabadi M, Ranjbar Kochaksaraie F. Effect of NICU department orientation program on mother's anxiety: A randomized clinical trial. J Caring Sci 2016;5:205-14.  Back to cited text no. 9
    
10.
Azizi-Soleiman F, Motlagh ME, Qorbani M, Heshmat R, Ardalan G, Mansourian M, et al. Dietary habits and health related behaviors in Iranian children and adolescents: The CASPIAN-IV study. Int J Pediatr 2016;4:2087-97.  Back to cited text no. 10
    
11.
Kawafha MM. Parental stress in the neonate intensive care unit and its association with parental and infant characteristics. J Neonatal Nurs 2018;24:266-72.  Back to cited text no. 11
    
12.
Hockenberry MJ, Wilson D. Wong's Nursing Care of Infants and Children-E-Book. 10th edition. English: Elsevier Health Sciences; 2018.  Back to cited text no. 12
    
13.
Te Pas AB. Improving neonatal care with technology. Front Pediatr 2017;5:110.  Back to cited text no. 13
    
14.
Heydarpour S, Keshavarz Z, Bakhtiari M. Factors affecting adaptation to the role of motherhood in mothers of preterm infants admitted to the neonatal intensive care unit: A qualitative study. J Adv Nurs 2017;73:138-48.  Back to cited text no. 14
    
15.
Aydon L, Hauck Y, Murdoch J, Siu D, Sharp M. Transition from hospital to home: Parents' perception of their preparation and readiness for discharge with their preterm infant. J Clin Nurs 2018;27:269-77.  Back to cited text no. 15
    
16.
Vohr B, McGowan E, Keszler L, Alksninis B, O'Donnell M, Hawes K, et al. Impact of a transition home program on rehospitalization rates of preterm infants. J Pediatr 2017;181:86-920.  Back to cited text no. 16
    
17.
Masters K. Role Development In Professional Nursing Practice. 4th edition. American: Jones and Bartlett Learning; 2018.  Back to cited text no. 17
    
18.
Safiri S, Kelishadi R, Qorbani M, Lotfi R, Djalalinia S, Salehifar D, et al. Association of dietary behaviors with physical activity in a nationally representative sample of children and adolescents: The CASPIAN-IV study. Int J Pediatr 2016;4:1505-17.  Back to cited text no. 18
    
19.
El Miedany Y. The Art of Patient Education. In Rheumatology Teaching: Cham:Springer; 2019. p. 155-73.  Back to cited text no. 19
    
20.
Sheldon RE, Bissinger R, Kenner C, Staebler S. The status of us neonatal nurse practitioner education in 2015–2016. NeoReviews 2017;18:e3-21.  Back to cited text no. 20
    
21.
Mohalli F, Wagharseyedin A, Mahmmodirad GH. Nurses' performance review of patients with clinical governance approach. J Nurs Edu 2017;6:1-7.  Back to cited text no. 21
    
22.
Seyedamini B. Fears, needs and nursing support of mothers during their child's hospitalization. Iran J Nurs 2011;24:57-66.  Back to cited text no. 22
    
23.
Mok E, Leung SF. Nurses as providers of support for mothers of premature infants. J Clin Nurs 2006;15:726-34.  Back to cited text no. 23
    
24.
Valizadeh L, Akbarbegloo M, Asadollahi M. Supports provided by nurses for mothers of premature newborns hospitalized in NICU. Iran J Nurs 2009;22:89-98.  Back to cited text no. 24
    
25.
Milan M, Nasimi F. The effect of family-centered care educational program on performance of mothers of premature infants hospitalized in neonatal intensive care unit. Iran J Pediatr Nurs 2019;5:37-43.  Back to cited text no. 25
    
26.
Rasti M, Aliabadi F, Shafarodi N, Rafiee F, Kalani MJ. Specification of the educational needs of parents with premature infants admitted to neonatal intensive care unit. J Modern Rehabil 2014;8:21-9.  Back to cited text no. 26
    
27.
Jackson D, Clare J, Mannix J. Who would want to be a nurse? Violence in the workplace–a factor in recruitment and retention. J nurs manag 2002;10:13-20.  Back to cited text no. 27
    
28.
Hurst I. Vigilant watching over: Mothers' actions to safeguard their premature babies in the newborn intensive care nursery. J Perinatal Neonatal Nurs 2001;15:39-57.  Back to cited text no. 28
    
29.
Van Rooyen D, Nomgqokwana ZL, Kotzé WJ, Carlson SJ. Guidelines to facilitate the nursing accompaniment of mothers with infants in a neonatal intensive care unit. Health SA Gesondheid 2006;11:3-12.  Back to cited text no. 29
    
30.
Heshmati Nabavi F, Memarian R, Vanaki Z. Clinical supervision system: A method for improving educational performance of nursing personnel. Iran J Med Educ 2008;7:257-66.  Back to cited text no. 30
    
31.
Hekmatpoor D, Anoosheh M, Alhani F. The pathology of patient training: A qualitative study. Bim J Iran Nurs 2007;20:50-60.  Back to cited text no. 31
    
32.
Moradi M, Jalali R, Miri A. The point of view of medical and surgical patients in education hospitals of Kermanshah to discharge nurse training performance and compare it with standard in 2014-2015 years. J Nurs Educ 2018;7:21-6.  Back to cited text no. 32
    
33.
Klein-Fedyshin M, Burda ML, Epstein BA, Lawrence B. Collaborating to enhance patient education and recovery. J Med Libr Assoc 2005;93:440-5.  Back to cited text no. 33
    
34.
Adib-Hajbaghery M, Zare M. The barriers to patient education from the viewpoint of nurses in iran: A systematic review. The J Urmia Nurs Mid Fac 2017;15:544-58.  Back to cited text no. 34
    
35.
Kalisch BJ. Missed nursing care: A qualitative study. J Nurs Care Qual 2006;21:306-13.  Back to cited text no. 35
    
36.
Jaloo Z, Pazargadi M, Alaee Karahroudi F. Audit of the Nursing Care Provided to Infants With Respiratory Distress Syndrome Admitted to the Neonatal Intensive Care Units of the Hospitals Affiliated to Shahid Beheshti and Tehran Universities of Medical Sciences and Health Services in Master's Thesis in Nursing. Tehran: Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences and Health Services; 2008.  Back to cited text no. 36
    
37.
Saadati Z. Comparison of Audit in Nursing Care provided to Patients with Coronary Artery Disease in Educational Hospitals With That in Non-Educational Hospitals Affiliated to Mashahd University of Medical Sciences. Master's Thesis in Nursing. Tehran: Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences and Health Services; 2004.  Back to cited text no. 37
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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