( % )! " #,)21(+-./0 +,- * +() ' Downloaded from ijn.iums.ac.ir at 1749 IRDT on Friday March 22nd 2019 & "! #$%%! *!"!%" '(" )*!" #$%& $%,& /0 1 %$)2 3))2 # 45 )$ 6 7#& 82 " ) %., )-&..!%" 47& #$%& >0& ')? 3$7#&!%$ ; <% )=9 2)9 '0$" )( 8 ')? 3$7#& )G& 35D 1.%" 3 C? ) B$ )7,& A& )=9 '( 3$7#&.%'" )",") %&! 3 ')? I)J 3%&K 8H# ')? %$)2 >0& PN'Q 3$7#& )-& )7 3$? %.%$,& #$%& O6 ( )MN,J ) 'G 4 % %" 3 3M D3 D )2 9 4 3$7#& )-& G$ ( #)?!G' 5.2) ) ) #$%&.%"!G' t 3 <)6& ;& S("! TN6 $57 ). ) R7 3$7#& )-&.(13/9±2/2) )2 9 U) V2 ' ;$)W.%& )* CG&,'J %,& C9 R$52.(P<0/05)%".(P<0/05) %"!%# U> Na6 8% 3M % 3$7#& )-& ')? 3$7#&!%$ #$%&." I ')? '" 3$7#& ;$ 3& %I 84/3 3#& #$%& >0&!%# U> ;, 3$7#& )-& ) ; ;b, (P<0/05) " 1 U> ')? '" % `J )2 9 ),& Na6 8% ; ;$!G' K D" 3& CG&,'J %,& > )7 $!"#!! ' %&#$ 90/3/3 2$ c$ 90/6/12 )$K? c$ 0251-7704233 )*+ * (#$% &'*) Email abediny1354@yahoo.com
Downloaded from ijn.iums.ac.ir at 1749 IRDT on Friday March 22nd 2019 O6 O>) " '( ) '2 #$%& 6I n '> ig 1 %( j & (7) T,J )M2 VGN.!%" P$) '0$" ) 2)9 '2 <% D&%' TN6 #$%& <%.%$,& /o) $ )MG J MN 0& )$ J`h % ) p i0&m (9) O6 0 '. &%' &%' TN6 $57 3 )MG 1 VGN $" ) T9! 3 $ &W2 )$,& T,M '"K )7 9 ;$ / ( j.).!), 2)9 $%,& #$%& >q )* '"K (10) l7 ).! 3#& )$ #$%& %$)2 3$7#& B$ / %J ) O ')? %$)2 ;$ )M 3 9 G $ DT,J $)-& %&? D '& )MG $ rj )& N )M$ ",- ( 45&M. i)2 ')? >) >&1, 3 j)' 8W%' "!" ;$ ) $ (11). '2$ R$52 '& )MG j51 /o) " )* " )M i G 3&!%$ (" 3% 3$7#& )-&.0& )$K? 3M 1 " >0& 6 7#& 82 " ) %., %$)2 3))2 # 45 )$ 2)9 '0$" $%,& /0 1 >0& ')? 3$7#& )-& ; <% )=9.!%" 47& #$%& ()!" #$%& )* #$%& N9) e.!%" '(" (2). T,J f DTN6 DPI T"!,& 1) ( N> )7 )2 ;$ g,1 D 1 N2 b& 1 in R&. )? & TN6 $57 J`h (3). / ( j j, ' ;$ #$%& %$)2 NI 51 M$ ( 0.!%" )> M"5? /N 3' 2& )$ NJ D3$7#& G ;$ ) '0& ( 2$ 4%J ;$. %&!) 2) %G ))2 1 5 " )$ )'# 5& )7 ( j 3 k`i ( )MN,J $ )2 M$h. 82 # )$ %$)2 )? )M 45N'0 )$ 3 9 %" (5) D %$,& 2 45N )2 $" )$ )> %$)2 ))2 # 5& #$%& V$)h. 82 )$ DNf0 ) '> )$ )-& $!" 9`I ) '> )$ )7 )$ D2#'!" D%& M"5? ) (6) 1 )2 2 " l06 82.!), 2)9 '0$" %,& 3')? ' #$%& 3)->9I 0!" ;$.%&!)," )* 2)9 SaQ R& '2 O>) $ - (8) /0.!%"!G' 2)9 '2 )$ M"5? 2)9 9`I!, 4 '0$" ) '>. %. 2)9 & %&) )! 6
1390 -* /71 "* /24 $ & Downloaded from ijn.iums.ac.ir at 1749 IRDT on Friday March 22nd 2019. ) R7 (86) 3 (85) ) ) k) $5 5 )M w W B$!),& PQ ` x?!),& V2 ` 8 20 > 9 ) ),& 3$?.%" - 3% c? >0& &)2 ;b,.%$) >6 3&!%$ ; ) V2 ` V2 $5.%" >6 #$%& >0& %'" )" &>Nh h 3$7#&.%$) K( 3#$ & $= T> N9) ) T$, I %"! 3,h 3& %.%&" y( %& %$)2 J`h %" rj 3$7#& '2$ SaQ 3& ;b,.%&, &)6 #)? y% N I Rz? '2$ %"! A`h x$'& DT$, I %" %(! 5 x$'& )p 4 W.2) %( ) 3& '( %Q& '" )$ 3$7#& i, T. TN611/5 Q0& SPSS!G' Rz?! %,`J Na6 8% TJ )* ; ).%" t 3 3$7#&!%$ ) ')? '" )', & N 47&.%"!G'.%$) N 0/05 ;$)W. ' (* 16/73$7#& Na6 8% ;& )2 9 U) 3$7#& )-& ),& ;&.(B$!," 8%1) #0% /",-" )." * #' () 2" % 3" 412"% <)6& ;& )q%9 T%9 13/9±2/2 18/9 4/2 )2 8/9±2/7 15 2 3 13/7±2/9 20 2/5 3M 12/±2/8 17/5 3/7 3 & 3 C? ) B$ )7,& A& )=9 8 3$7#& )G& 35 1.%" I)J 3%&K 8H# ')? )( %&! i M"5? 4NJ!#& 3 ')? ) &,&.%'" )" &>Nh h T$, &))2 N %" 47&,") $= K( %'" )".%'" )!)G& 7 $ 6!) 3$7#&.%&%"!6& <% DJ B$ % 0N1 B$ h ( & Cs.%"! k)" 3$7#& ).%$,& )1 ;$% (, ')? %$)2 %"!G' g 7'01 ;b, 8,J ')? 3 3$7#& )$ )7 &D /) ;$.%& )s 3 k`i ) ( / ')? % )% D`M# D & f DTN6 DPI N9) e >*( aq" &t) e)'2 T,J / ( %& T$6 ) %&) %$)2 k)".%$,& k`i %"! & DN> '0& %$)2 T,M D ')?, >) 3 ) J`h TN6 " %$)2 51 %$%1 J`h j )-& )7 3$? %.%" 47& 'G 4 % #$%& %$)2 >0& PN'Q 3$7#& #)?!G' 5.2) ) ) )2 J`h ) T,'# 3 8 RQ. G$ ( RQ ( ')? '" %,`J T 8% D;) >0& 3$7#&!%$ U) W 9 4 W l' u2 5. #$%& )G& %e 7)-& 3 I >'J O>) G /$)= 5& 5 j$?.%" %j 3)-&/9I 3$7#& )-& #)?.%$) ; 0/83 v>&) 3M D(85) 3 D(87) )2 9 4
Downloaded from ijn.iums.ac.ir at 1749 IRDT on Friday March 22nd 2019 #$%& )$ ) n2 ;$ (%I 25/76)3$7#& )'#. /,& %G C&t RQ )= '.%'0& >0& ( )-& (%I86/9) 3$7#&)q ;$ D3 % #$%& ;$)',.%&!,& 2) )* 3, $= 3 %G U) ;$ (%I 28/5)2! 3 $= ;$.(!," 8%1) )2 % 3$7#& )-& U) '2$ ;$ 3& %I 84/3 3#& #$%& >0& )* CG&,'J %,& C9 R$52 3)? U) 9 ;$ ' ;$)',.%& 62/9) ( P= U& 3$7#& U) 3 % 3$7#& V2 ;$)'#.(%I (%I77/8) J ) 3 / ) 3 / U) V2 ;$)', % )-& ). Ta6 %& %' (%I82) 3$7#& )'# D3M ; < % 2" 3" 412"% #0% 3") 67 ")8 9! 5 #' () %&' ( %&' ) * %+ %+ (,# "# # 23 2 (5/72) 4 (11/44) 0 (0/00) 12 (34/32) 17(48/52) " 7#& CG&,'J %,& w09 rj #$%& -1 16 (45/70) 2 (5/72) 7(20/00) % R$52 2)9 f0 w09 3 )M -2 11 (31/44) 10 (28/60) 1 (2/86) 8(22/81) " V,J )$ rj #$%& ;,= V,J )MG -3 3 (8/45) 10 (28/75) 3 (8/45) 7 (25/60) 10(28/75) % R$52 3M, U> J,'1-4 3 (8/45) 10 (28/60) 3 (8/45) 9 (25/90) 10(28/60) " J`h 3) rj #$%& -5 15 (42/82) 7 (20/00) 6 (17/16) 1 (2/86) 6(17/16) " P= U& 3)? rj #$%& -6 13 (37/18) 10 (28/60) 2 (5/72) 4 (11/34) 6(17/16) %% R$52 3, >) )$!5& #$%& -7, 23 3 (8/45) 3 (8/45) 1 (2/80) 13 (37/48) 15(42/82) #$%& ) > O6 5) -8 4 (11/34) 1 (2/86) 13 (37/18) 12(34/33) %M T0 ;$ )$ ')? B"5? ;aaq'1-9 3 (8/45) 1 (2/86) 4 (11/54) 12 (34/33) 15(42/82) %% R$52 / ( 3M 3, i'0 1-10 10 (28/60) 6 (17/16) 2 (5/62) 12(34/33) " #$%& T0 rj O6 &Q' )' -11 11 (31/44) 11 (31/44) 4 (11/36) 6 (17/29) 3(8/47) 0& %G C&t RQ )= ' #$%& -12,4 23 7 (20/00) 12 (34/29) 10 (28/60) 1(2/86) >0& )$ #$%& &Wh J 1-13 )'> f w` 7 (20/00) 13 (37/18) 8 (22/82) 7 (20/00) 0(0/00) / 8 3$7#& ) ;$ -14 10 (28/64) 12 (34/33) 3(8/45) / I)J 3$7#& ) O2 ;$ -15 13 (37/18) 3 (8/45) 7 (20/04) 7 (20/04) 5(14/29) % R$52 #$%& >q)* -16 3 (8/45) 3 (8/45) 2 (5/92) 12 (34/33) 15(42/85) ( j I)2 " J %G!G' rj #$%& -17 ", 23 1 (2/86) 3 (8/68) 1 (2/86) 15 (42/80) 15(42/80) % R$52 3, $= #$%& -18 13 (37/18) 6 (17/16) 6 (17/16) 7 (20/05) 3(8/45) %% R$52 3 $= ( j #$%& -19 3 (8/45) 6 (17/16) 3 (8/45) 13 (37/28) 10(28/66) % R$52 3'( R& 2)9 %,& #$%& -20 1 (2/86) 13 (37/18) 5 (14/24) 11 (31/48) 5(14/24) %$ R 3, ( j )'0 3 $5-21 8 (22/88) 4 (11/34) 6 (17/16) 4 (11/34) 13(37/18) %$ R$52 ) )$ 3'( R& $= -22 4 (11/34) 6 (17/17) 8 (22/85) 12(34/35) %% 3 >) ;f0 % $= -23
Downloaded from ijn.iums.ac.ir at 1749 IRDT on Friday March 22nd 2019 (14),-(. %&!,&!" )>( )$! n R& /0 T$W 3 k`i 2)9 j& 3 )', ')? 3$7#& D"5& 5& 2)9 %,`J 7&.%!G' %$ R Na6 R$52 3$7#& (12) 8 3$7#& )-& 3%" k) % )-&. U& (" ) #$%& %& }a( )( TJ >, "& ;$ P= %" ')? '" %,`J "5&. '" U> 5& 3& Na6 8% $ Na6 2)#?,-( # (13) ;6 (). '" U> 3$7#& "5&( <)' )MN,J,-( 4%J!,& P$) 2)9 '2 /0 ) ` %&!) 3J Na6 2 ) NJ 3 ) % %,`J!5& >, M$ 1. )$ 2 )* TJ!, 3$7#& (14) 4%J TNJ 1 D! G ;$ D )= 3$7#& 2)9 %,`J!G' T$, ~ (2002) Branch x$'& /0, R& )2 j$? #$%& M'#? ` ;$. -'& )*. & P= U& (" 3$7#& ;$), )'# 1 Nf0 ;$ '" i'0 (13) ) 3$7#&. %$ R$52 J= )MG % 47& )'# ` >q ( 2$. %& )? g 7'01 $%1 z$ % ) 3 / ' #$%&.!%" 3J ;$ >q W, 9 ) PN'Q %$)2 51 ;$)', 7&.) ) NGo 3 6I A&!G' ( j #$%& ( j. $ )* >q x$'& 8a9 ; 3$7#& N ),& ; U> #$%& >0& 3$7#&!%$.%#&!%#.(P<0/05)" 3& Na6 8% 8% ; % ) 3$7#& )-& ) Na6 8% )2 9 ),& ; Na6 1 U> ')? '" %,`J % 3$7#& )-& ; ;b,.(p<0/05)" %"!%# Na6 8% 3M.( 3!," 8%1) (P<0/05) #0% /",-" )." = #' () ) -! ( >? 2" 3" 412"% @ABC A' @DE P t ;& &)2 3$7#&!%$ p=0/01 p=0/01 3/71 11/7±1/5 13/7±1/8-4/05 13/3±2/3 14/4±2/1 9 26 13 22 50 14)$ 8% 14 W 8% 6 78(9 %& ( & +, '2$ CG&,'J %,& ). 3$7#& )-& ) )=9 Rz? 5&D )$K? f0 %,& w09 %J l7 %,'$= )$ %,`J #$%&. %&!),") #$%& ;9 3$7#& 3))2 $%,&) '(" )-&! %& 3, & D'aQ" D`( D )2 %" rj )* 3 51 3J " 09 )*. 3$7#& '2$ w ).!%" k) D( P= U& (" ) #$%& 9 ;$ %'0& P= z$,-( 45&M $ '"K D" ( %&!) 2) #$%& >q %G TJ 3 '&( ( D#$?(
Downloaded from ijn.iums.ac.ir at 1749 IRDT on Friday March 22nd 2019 )$ )* #$%& 7&. %$,& PN'Q ) %" )7 82. %G I)J Ia( O6 #$%& ) 3$7#& )'# )& N >&1, >) )$.%& V2 " )1D$ DJ`h g,1 V$)h z$ O6 S'Q VGN ;b,!%" 2) #$%& V, rj O6 N,J )-& ig 2#' )7 )$!%" Tj0 )'# 09 )-& 3. %#Q ( j c? R)? 3))2 )MG )$ i)2 $)" 8% #$%& ) / 1." T0 >1! )* R$52 R& G$.% $ J,'1 & '>) )MN,J ) > n2 3$7#& )=9. %" 3))2 ;$.%&>& V2 C&t RQ ;$ ) ( j " ~ 3 }a( D 3 % & 9 0&t >) 51!%# 3$7#& I ;$) )MN,J %& R& G$ 0&t 3, #$%& ;$),.%" )* / )* ln x$'& ' tw )-& #$,& %' (2002) Branch. 3, 1 ) 3$7#& 47& ) %$ 3))2 `( >1 ) R&.%",'J $)" ;e % O6 R& G$ ) / 8% 3J 3$7#&!%"! (. i $ >1 %" )MN,J k`i 1 2)I %$ ;$), ) ;$. %" '"%& n ( j 5) 0&t -'& 3% 1 /1 & g g 3& )'# ` 7'& 3$7#& >q (15) >,(2008) %J ). )!%" 3J #$%&!G' g& >,.%& &Q, )=9 x$'&.!%" k) >&1, T ( j ) 3 & #$%& NJ $ (. T9) )$ >0& )'# 3 % Tj0 A& n' G' A& k`i )! (." j i nj M ; MM j51 )G& B$ )MN,J j % 5-10 % ( ;$.) ) )MN,J k`i ) "! 8, }( O$)"!%,J ( / )G& 4-5 2 J= 2)9)o )MN,J k`i )-& `M# % $ w ;$ ). ) 9 )'# 3 <)I & Nj0 ; )% )$. 4 W )'#, 3 k`i ( 3$7#& V$# ' ;$!%" R? " <)I ) O )', 3 (. ;$ M$ )p T )$ '2$ )a6 ;$ ) 3$7#& 3Jp 3 }a( ;$.%'0&,& Ta6 3))2 B, <% ;$)', " O6 ) 2)9 $%,& /0 ) '0$" ) '> )!, %" (7).!%" % )2 1 %( j <% N9) ')? )( 8 3$7#& M$ )-& ( 2)9 O6! Ta6 $& ')? R& )M ;$), D%'0 2)9 3')? % B, 3& O6 (16) %$ ')? 3$7#&. %&" T$%> T,M ( R& j& %&" T'0 I)J
1390 -* /71 "* /24 $ & Downloaded from ijn.iums.ac.ir at 1749 IRDT on Friday March 22nd 2019 k`i ) & T)?!%" 3 Tj0. )= ( j 3& )MN,J R& ;$)'# 3#& 3$7#& )-& ),& N x$'&.%" )2 % U) #$%& $5 D,-( D)MG ) 5& '"K 1. %& '"!" #$%& %$)2 5& Na6 8% 3$7#& >q )-& U> ) ;$!G' DNa6 '" %,`J TJ $!), " 4-& $$? %" 3$7#& $= 7&. 4 W "5& )* TJ O6!6& (19) 3)!%" k) 2)9 %,`J 5& )* 7'01 %I!, %$ ( 3$7#& j& $ (14) %,& R$52 3$7#& /o). %" %$) M$ 3 82 )$!G' 2)9. )= #$%& %& " 4-& )* R& ( #$%& M"5?!) /N 3J ;$ ) 3 ) M9! %!, in " 3b,! %6 ' )$."!G' 6 ))2 # 82 " )M 45N'0, 1. )'# ;$), V, )MG 3$7#& CG&,'J %,& ;. 1 ` '>) inj M, " )>!G', ) 3$1% &.) % #$%&! & ) 47& ')? 3$7#& &,,I M,.) &% %'" )* R& k)h ;$ 3))2 )MN,J k`i 1 3) O / 3 9 '"K." % >0& I)J 3$7#& l)= j& 3&!%#& )', )$ $ M$ %&%& ' T'0 1 4`J 3$7#& 4%J ;$ )* TJ.!%" #$%& )* %' 3$7#& )q D& % g #$%&.%& 3, $= ).!%" 2) )7 82 " )$ #$%& 5& (2008) Epstein (18).!) j" 3$7#& )7 TM" J,'1 # w ) )7 )$ '2) ) % &0& h>, D) O6 )2 T' 3 ;$ 5 B$ a #$%& (6).!%" P$) &`J 2)~ R$52 /1 )$ " 3$1% & ; 1 R& ) 3')? 6 /1 3 8h 5 ;$ ;b,."." >) NI '0 3J 1% 3%" $5 3J ) T )$K? <& '>) )M$ & )M$ ;$.!%" '(" #$%& )=9. ) 1 ))2 1% 3 ) 3$7#& #$%& D3$7#& 'J 9 ;$.!>& %G 3 )* R& )$ }a( '"K M, )$.!%"!" ` i R$52 ')? 3 ')? 3) ; (16) w ;$ )., 5j9 )$ %$) ')? 3 )'# U> ) 3$7#& 1 V$# ;b,. 4 W )' x$'& 8a9 ) O!%" k), )$K? 4%J 3$7#& i 6I )MG 3
Downloaded from ijn.iums.ac.ir at 1749 IRDT on Friday March 22nd 2019 -./* 1- Branch Jr WT, Paranjape A. Feedback and reflection teaching methods for clinical settings. Acad Med. 2002;77(12, Part 1)1185. 2-Medical Education BlogActive Learning-Reflection. Available fromhttp//blogs.usask.ca/ medical_education/archive/2007/10/active_learning_3.html. Accessed 1 Jun 2009. 3- Pee B, Woodman T, Fry H, Davenport ES. Practice-based learning views on the development of a reflective learning tool. Med Educ. 2000 Sep;34(9)754-61. 4- Moattari M, Abedi HA. [Nursing students experiences in reflective thinking a qualitative study. Iranian J Med Edu;2008; 8 101-112.Persian 5- Robottam D.The application of learning style theory in higher education teaching. Available from http//www2.glos.ac.uk/gdn/discuss/kolb2.htm. Accessed 17 Sep 2008. 6- Yousefi A. [Active Learning]. Iranian J Med Edu 2005; 591-2.Persian 7- Yousefi A. [Competency-Based Education (CBE)]. Iranian J Med Edu 2005; 5(2)213-4.Persian 8- Mamede S, Schmidt HG. The structure of reflective practice in medicine. Med Educ. 2004 Dec;38(12)1302-8. 9-Imel S. Reflective practice in adult education. ERIC Digest NO.122. Available fromhttp// www.ericdigests.org/1992-3/adult.htm. Accessed17 Sep 2008. 10- Henderson E, Hogan H, Grant A, Berlin A. Conflict and coping strategies a qualitative study of student attitudes to significant event analysis. Med Educ. 2003 May;37(5)438-46. 11- Moattari M, Abedi HA, Amini A, Fathi Azar A. [The effect of reflection on critical thinking skills of nursing students in tabriz Nursing School].Iranian J Med Edu 2002; 4 58-64.persian 12- Braten I, Olaussen BS. The motivational development of Norwegian nursing student over the college years. Learn Health Soc Care 2007; 6 27-43. 13- Kuiper R.Enhancing metacognition through the reflective use of self-regulated learning strategies. J Contin Educ Nurs 2002;33(2) 78-87. 14- Rahimi A, Ahmadi F.[The obstacles and improving strategies of clinical education from viewpoints of clinical instructors in Tehran Nursing Schools]. Iranian J Med Edu 2005; 5(2) 73-80.Persian 15- Ofori R, Charlton JP. A path model of factors influencing the academic performance of nursing students. J Adv Nurs. 2002 Jun;38(5)507-15. 16- Hartigan-Rogers JA, Cobbett SL, Amirault MA, Muise-Davis ME. Nursing graduates' perceptions of their undergraduate clinical placement. Int J Nurs Edu Scholar. 2007;49. 17- Hassani P, Cheraghi F, Yaghmaie F. [Self-efficacy and self-regulated learning in clinical performance of nursing students a qualitative study]. Iranian J Med Edu 2008; 833-41.Persian 18- Epstein RM. Reflection, perception and the acquisition of wisdom. Med Educ. 2008 Nov;42(11)1048-50. 19- Glossop C. Student nurse attrition from pre-registration courses investigating methodological issues. Nurse Educ Today. 2001 Apr;21(3)170-80.
Iran Journal of Nursing (IJN) Vol. 24, No. 71, Aug 201174-82 Effectiveness of Reflection in Clinical Education Nursing Students Perspective Downloaded from ijn.iums.ac.ir at 1749 IRDT on Friday March 22nd 2019 *Abedini Z. MSc 1 Jafar Begloo E. MSc 2 Raeisi M. MSc 3 Dadkhah Tehrani T. MSc 4 Abstract Background & aim Reflection has been emphasized as an effective educational strategy in clinical settings. Although this educational tool lead to promotion of skills and knowledge in nursing students but is rarely used. The aim of the present study was to determine the viewpoints of nursing students toward reflection in clinical education. Materials & Methods It was a quasi-experimental study with one group, post- test design. The sample consisted of 35 senior nursing students recruited by census. The students were asked to reflect on their performance in clinical settings for four consecutive weeks. A guide for reflective thinking was given to students and they were asked to write their reflections about clinical care in personal journals. Data was collected by a self-constructed questionnaire and analyzed using SPSS-PC (v. 11.5). Result personal domain of reflection was the most prominent subscale from the students perspective (13.9±2.2). Most of students (84.3%) believed that reflection has influenced their sense of empowerment and self-esteem. There was significant relationships between the students perspective in all domains and their age (p<0.05). There were also significant relationships between academic achievement, the score of personal domain and interest in nursing (p<0.05). Conclusion Reflection empowers nursing students and improves their self-esteem from their perspective. Employing this method in nursing clinical education is recommended. Key words Reflection, Nursing, Perspective, Clinical Education Received 24 May 2011 Accepted 3 Sep 2011 1 Senior Lecturer, Nursing Dept. School of Nursing and Midwifery of Qom University of Medical Sciences (*Corresponding Author) Tell 0251-7704233 Email abedini1354@yahoo.com 2 Senior Lecturer, Midwifery Dept. School of Nursing and Midwifery of Qom University of Medical Sciences 3 Senior Lecturer, Midwifery Dept. School of Nursing and Midwifery of Qom University of Medical Sciences 4 Senior Lecturer, Midwifery Dept. School of Nursing and Midwifery of Qom University of Medical Sciences