Abstract

Aim. This study  aimed to explore the effectiveness of storytelling technique on professional communication skills of  nurses in critical care units of ShahidRajaee Heart Center.

Background.  Patient Communication  skill is one of the most important aspects of nursing profession that can improve the overall abilities of  nurses and  health care team. Sharing the tacit knowledge on patient communication skills is one of the issues with which nursing system encountered. Retirement of experienced  nurses causes  a considerable loss of  tacit knowledge. One of the best ways to transfer tacit knowledge is to apply the storytelling  technique in transferring these experiences.

Method.This  was a quasi-experimental study with control group. It was conducted on 130 nurses, working in the ICU, who were randomly divided into groups of  intervention and control. The intervention group was instructed via storytelling on clinical experiences within 6 hours. The effect of the intervention was tested through a self-reflective questionnaire completed by both groups before the intervention and  one month later. To analyze the data, paired and independent T-test, Chi-square, Fisher exact test, Mann-Whitney U test and the analysis of covariance via SPSS version 21 were applied.

Finding. Results showed that the intervention and control groups` pre-test scores were 104.60 with standard deviation of 7.60 and 103.13 with a standard deviation of 9.60, respectively. Furthermore, their post-test scores were estimated  as 117.92  with a standard deviation of  4.37 and 102.25 with standard deviation of  8.66 accordingly. There was a statistically significant difference between the post-test scores of intervention and control groups regarding their professional communication skills (p< 0.001). According to the sample based effect sizes, 71.4% of the variability in the post-test is caused by the intervention.

Conclusion. Based on the findings, it can be concluded that storytelling technique enhances the clinical competency of nurses in terms of professional effective communication with both patients and colleagues. Therefore, this technique can be introduced as an effective way to promote professional communication.

Abstract

Aim. The purpose of this review of article is to assess the reuse of angioplasty devices as a challenge to the health center.

Background. Processing and reuse of disposable medical products began in the United States in 1970.

Method. Nowadays, infection is one of the common post-operative complications which have different severities and types based on social, financial and cultural conditions in different countries. Ignoring the proper disinfection and sterilization of hospital devices and equipment is one of the most important sources for distribution and transmission of nosocomial infections. The papers from 1998 to 2013 were searched for based on the key words "Reuse", "Single Use Only", "Disposable", "Medical Equipment", and "Reuse of Single Used Devices (SUD)" (alone or in combination) in Cumulative Index of Nursing and Allied Health Literature (CINAHL), Scopus, Medline, EMBASE, and PsycINFO.

Findings. The main problems in reusing angiography devices include the failure in cleaning, disinfection and sterilization of equipment due to structure design, lack of knowledge and not providing information  to patients and families regarding to reuse of  disposable devices, unclear  cost for the equipment, ambiguous disinfection and sterilization techniques for disposable medical equipment due to lack of proper staff supervision, lack of informed consent for reusing equipment, contradiction to the principles of clinical governance, patient safety, JCI standardization, and negligence of the ethical issues of patient care.

Conclusion. According to the lack of efficient reprocessing the angiography devices in country, lack of official license and policies issued by Ministry of Health and the Center of Medical Equipment, and the above mentioned risks, the reuse of these devices is not recommended.

Abstract

Aim.The aim of this study was a review on common pain assessment tools which are used in critical care units.

Background. Pain is an unpleasant physiological and psychological feeling and a complex phenomenon which is common among patients in critical care units. Nowadays, the importance of pain is to the extent that the American Pain Association named it as the fifth vital sign. Pain relief is an important issue to improve patient outcomes in the intensive care units. Accordingly, nurses must be sensitive in precise pain assessment.

Method. In this review article, six pain assessment tools were selected based on the keywords "pain", "pain relief", and "pain assessment tools" from the databases Ovid, PubMed, Cochran, CINHAL, Science Direct, Scopus, and Google Scholar. 

Findings.Among articles on pain assessment tools, 40 articles were selected. There are six commonpain assessment toolsused in critical care units includingCritical Pain Observation Tool (CPOT),Behavioral PainScale(BPS), behavioralpain assessmenttool(FLACC), Non-VerbalPainScale)NVPS), Pain Assessment and Intervention Notation (PAIN) algorithm and Nonverbal Pain Assessment Tool (NPAT) which are used in adult and pediatric patients with verbal impairment and for painfulprocedures.

Conclusion. According to the importance of pain management in intensive care units,   nurses must particularly apply valid tools for pain assessment to facilitate healing process and use of pain medications properly.

Abstract

Aim.The aim of this study was to modify and validate FOUR coma scale.

Background.Critically ill patients  admitted to the intensive care unit (ICU) have fluctuating levels of consciousness. It is necessary to have a valid scale to provide an appropriate care of these patients. Presently, the Glasgow coma scale (GCS) is widely used but it has some problems. Recently, the FOUR coma scale proposed to determine the level of consciousness and it is gradually gaining wide acceptance.

Method.This study is a methodological research. After translation and modification of FOUR com scale, the final version used for determining validity. For evaluating convergent construct validity, the original and modified FOUR scale compared with the APACHE II in 15 intensive care unit patients and using 40 critical care nurses by 104 pair-wise ratings.

Findings.Correlation of original and modified FOUR Coma scales with APACHE II was 0.02 and -0.04, respectively. Regression of original and modified FOUR scales with APACHE II was 0.03 and 0.3, respectively.

Conclusion.The FOUR scale doesn't have an item for those intubated patients who are not connected to ventilator. It seems that replacing new item in respiratory section of the scale could increase the validity of FOUR scale.

Abstract

Aim.The aim of this study was to review the physical and social environment monitoring of the intensive care unit and examine how it affects the physiological status of the patient and family needs.

Background.Knowledge and skill in providing nursing care are the main factors affecting the recovery of patients in the intensive care unit (ICU). While a nurse or nursing unit can possess perfect critical care skills and knowledge, those are not the only factors that influence patient recovery. Including nursing skills in ICU is environmental monitoring and creating a pleasant environment with minimal stress. This monitoring includes control of light, sound, color, landscape, music and social support.

Method.This review was conducted by searching electronic databases and hand searching of library resources. Finding articles and research projects was conducted by using keywords on the internet and relevant sites.

Findings.Improvement of the environment in which care is provided not only helps in the healing process for patients, but also increases employee satisfaction and families affected. Environmental monitoring reduces stressful factors from ICU to rectify the effects of these wards for patients and also, reduces staff stress.

Conclusion.The use of research findings is an important part of improving the quality of care for patients in intensive care units and their families. The ICU setting has the potential to afford patients the best possible opportunity to heal if key stress-reducing elements are incorporated into its physical design. Such elements may reduce noise, offer privacy, add full-spectrum lighting, and assimilate color. As well as considering the physical design, a critical program that integrates the family and other healing measures is essential to the milieu of a healing environment.

Aim. This study reviews the various studies conducted about using stem cells in the treatment of peripheral arterial disorders.

Background. Arterial disorders have affected approximately 8 to 12 million individuals in the united states and is associated with significant mortality morbidity and mortality. Critical limb ischemia (CLI) is the end stage of lower extremity peripheral arterial disease. The mainstay of therapy for severe ischemia is endovascular revascularization with the aim of improving blood flow to the affected limb. However, for 20 to 30 percent of patients with CLI that are not considered for endovascular revascularization stem cell therapy may be useful.

Method. In this review, after the searching out databases and electronic resources the latest and most relevant studies about the use of stem cell therapy were considered.

Findings. The studies have shown that stem cell therapy is useful for peripheral arterial disorders, especially for those patients who are not candidate for surgical treatment. It has been found that this method is more effective for patients with Buerger's disease than those with peripheral arterial disorders, and that intramuscular injection method is preferred to intra-arterial injection method. It has been shown that using stem cells derived from bone marrow is more effective and less costly than stem cells derived from peripheral blood. This method is not associated with significant side effects and well tolerated by patient.

Conclusion. Stem cell therapy is an effective and promising treatment strategy, especially in patients who are not candidate for endovascular surgery.

Background. Cardiovascular disease is one of the most common causes of morbidity and mortality around the world. The number of people with cardiovascular disease is increasing. This review article discusses the role of Vitamin D and Vitamin D deficiency complications in cardiovascular system.

Methods. This review article was conducted by searching out electronic databases as Google scholar, Elsevier, PupMed, PMC, and Springer to find articles published between 2007 and 2015. The keywords searched out were: “Cardiovascular disease AND Vit D”, “Vit D AND Hypertension”, “Vit D AND Heart”, “Vit D AND Atherosclerosis”,  and “Vit D deficiency”.

Findings. The response of Vitamin D receptors in all tissues including cardiovascular system (in presence of sufficient amount of Vitamin D) can prevent from uncontrolled growth and proliferation of cells in cardiomyocytes and smooth muscle of vessels wall. This is done by specific gene control through 1/25 Dihydroxyvitamin D (active form of Vitamin D). These genes control proliferation and differentiation of cells resulting in prevention of cardiovascular tissue hypertrophy and vessel thickness. Studies revealed that Vitamin D deficiency can cause inadvertent complications in cardiovascular system but it isn’t completely clear that administration of vitamin D can be beneficial in treatment of cardiovascular disease.

Conclusion. It is essential that adequate levels of Vitamin D is provided and replaced in the body before complications happen.

Aim. This study aimed to examine the effect of intraoperative progress report on anxiety of family members of patients under cardiac catheterization.

Background. Diagnostic and therapeutic procedures for CAD produce considerable anxiety in family members of the patient. Simple and clear explanations about physical and emotional status of the patient may decrease family members’ anxiety.

Method. This quasi-experimental study was conducted on 90 family members (45 in control and 45 in experimental group) of patients referred to angiography department of Imam Khomeini Hospital, Tehran. Intraoperative progress report was implemented for experimental group. Data collection tools were demographic form and Spielberger questionnaire. The data were analyzed in SPSS version 17, using descriptive and inferential statistics.

Findings. Before intervention, there was no statistically significant difference between anxiety scores for experimental (57.64±6.52) and group (50.11±8.32). After intervention, anxiety score in experimental group (46.22±5.18) was significantly lower than that of control group (57.48±7.20) (P<0.0001). Within-group comparisons showed that changes in anxiety score was statistically significant in both groups, it is to be noted that changes in anxiety score in experimental group was decreasing, while for the control group was increasing.

Conclusion. According to the findings, intraoperative progress report during angiography in a simple and clear manner that is understandable for family members may decrease their anxiety. It is suggested to include this supportive intervention as part of nursing care delivered by nurses in angiography departments. 

Aim. This study aimed to evaluate the effect of preoperative cardiac surgery nursing care education on anx-iety, quality of sleep, fasting time and cardiac medication usage in cardiac surgery patients.

Background. Cardiac surgery is one of the most important therapeutic approaches in patients with heart diseases. According to previous studies it is necessary to reduce the anxiety level and improve the quality of sleep the night before surgery, fasting according to standard protocols and continuing usage of cardiac medications.

Method. This study was a quasi-experimental trial in which patients were studied in two groups (before-training group and after-training group). One hundred cardiac surgery patients were selected based on in-clusion criteria as before-training group and evaluated in terms of anxiety level, quality of sleep, fasting time and cardiac medication usage in the night before surgery. Sampling lasted for 42 days. Then, all of the surgical nurses were trained individually for a week, and given pamphlets. Their educational content in-cluded the latest fasting protocols, non-pharmacological methods of reducing anxiety and improving quality of sleep and emphasizing on the importance of cardiac medication usage in the night before surgery. Then, another 100 patients were evaluated as the after-training group. Sampling from this group lasted for 38 days. The tools included demographic sheet and Spielberger anxiety questionnaire. Data were analyzed with SPSS software.

Findings. The findings of this study showed a statistically significant difference in anxiety level between before-training group and after-training group (P<0.0001). Also, there was a significant statistical differ-ence in quality of sleep between two groups (P=0.004). But, there was not a statistically significant differ-ence in fasting hours and cardiac medication usage between two groups.

Conclusion. According to the findings, educating preoperative cardiac surgery nursing care decreased anxi-ety level and improved quality of sleep in after-training group. But this intervention neither decreased fast-ing hours nor increased continuing cardiac medication usage in after-training group.

Aim. This study aimed at examining the effect of nursing care training program on outcomes of mechanically- ventilated infants.

Background. Mechanical ventilation in infants is considered as an invasive procedures with complications such as bronchopulmonary dysplasia, lung bleeding, obstruction or removal of the endotracheal tube, which are almost all preventable. Nurse have responsibility to avoid these complications.

Method. This study was a randomized clinical trial (outcome-based). The study included all infants undergoing mechanical ventilation in the neonatal intensive care unit of Comprehensive Women's hospital in Tehran. Nurses were trained over one month at bedside by the clinical instructor. Data on ventilator complications were collected of 120 cases from patients' medical records, before and after intervention. The data were analyzed by SPSS version 21.

Findings: A statistical significant decrease was seen in most outcomes. The incidence of bronchopulmonary dysplasia declined from 35% to 18%, re-intubation decreased from 57% to 33%, pulmonary hemorrhage declined from 32% to 13%, and pneumothorax changed from 55% to 35%. Duration of mechanical ventilation and length of stay also decreased significantly after intervention. No statistically significant decrease was observed in retinopathy of prematurity and death.

Conclusion. Educational program, especially by the coach, is effective on most outcomes of the infants under mechanical ventilation. Taking into account the workload of nurses and problems with attending in educational classes outside of the ward, it is recommended to hold education at bedside for nurses to improve quality of education.

Aim. This study examined the effect of white noise on depression of patients in the Cardiac Care Unit (CCU).

Background. Many patients with cardiovascular disease are susceptible to experience depression after admission in Cardiac Care Unit (CCU). Depression can influence patients' recovery.

Method. This was a quasi-experimental study conducted in Shaheed Rajaei Cardiovascular Center, Tehran in 2014. Ninety patients admitted to the cardiac care unit were recruited in the study based on convenience sampling and divided into experimental and control group (45 patients in each group). Depression was measured for 3 consecutive days by depression subscale of DASS-21 questionnaire. In the experimental group, white noise with an intensity of 50 to 60 decibels was played for 30 minutes. Data were analyzed by SPSS , version 17, using independent t-test, paired t-test and chi-square test.

Findings. In control group, no statically significant difference was observed between mean scores of depression, before and after intervention (4.12±4.35 and 3.52±3.74, respectively; p=0.05). In the experimental group, the difference between mean scores of depression, before and after intervention was statistically significant (4.81±4.47 and 3.93±4.48, respectively; p=0.02).

Conclusion. According to the findings, white noise can leads to a significant reduction in depression. This intervention can be used as a simple and low-cost non-pharmacological care for these patients.

Aim. This study was aimed to assess the effect of self-care educational program on quality of life in patients with hypertension.

Background. Hypertension is a major health problem due to complications and high mortality rate. It causes problems in the ability of patients for self-care and affect their quality of life.

Method. This clinical trial study with control group was conducted in Mahmud-Abad Hospital affiliated to Mazandaran University of Medical Sciences. In this study, 70 patients who met the inclusion criteria were selected through convenience sampling and to prevent information contamination, they were allocated to groups according to whether they refer to hospital even or odd days. Before and three months after intervention, data were collected by quality of life questionnaire SF-36 in both groups. Patients in control group received routine education. Patients in intervention group participated in three face to face self-care education sessions (each session lasted 20 minutes) and received educational package including instruction booklet and CD. Data were analyzed by using Independent t-test, Paired t test, Chi-square test, and Fisher’s exact test through SPSS version 21.

Findings. The results showed that before intervention, there was not a statistically significant difference between two groups regarding quality of life, but after 3 months there was a statistically significant difference (P<0.0001). Also, in the intervention group, there were statistically significant differences regarding the total score of quality of life and all related dimensions, before and three months after education (P<0.0001).

Conclusion. Self-care education can improve quality of life among patients with hypertension. It is recommended that health care providers, particularly nurses, implement these educational programs for improving the quality of life of patients with hypertension.

Aim. The aim of the study is to investigate the need for hospital infection control and prevention.
Background. Nosocomial infections are among the major health problems which increase mortality and hospital costs, especially in intensive care units. Successful control of nosocomial infections depends on recognition of hospital challenges in this issue.

Method. This study is an overview study. The keywords “hospital infection” and “ICU”, alone or together, with Persian equivalents were searched in websites such as Iranmedex, CINAHL, Scopus, Medline, Embase, SID, PubMed, Magiran and Irandoc.

Findings. Based on the findings, the main causes of nosocomial infections included multiple procedures and invasive diagnostic and therapeutic treatments, especially in ICUs. Compromised immune system, duration of hospitalization, absence of hospital surveillance reporting system, inappropriate disinfection and sterilization of equipment, inappropriate physical structure of ICU, non-cooperative managers and departments, and lack of knowledge of medical staff, especially physicians and nurses.

Conclusion. Identifying causes of hospital infections and the use of especial measures to promote safety and enhance quality of care in the treatment and prevention of these infections are necessary for a comprehensive and integrated controlling program.

Aim. The purpose of this study was to review the effectiveness of new cardiac biomarkers.

Background. Cardiovascular diseases have been a heavy burden on the health system’s shoulders and caused about 30 percent of human's deaths annually. Irreversible myocardial injury occurs within around 15-20 minutes following the coronary artery occlusion. Therefore, early diagnosis of this problem is very important for the health care professionals to save patients’ lives. Nowadays, thanks to recognition of new biomarkers and using their characteristics, evaluating the short-term and long-term prognosis is possible.

Method. In this study, papers published within the time period 1980 to 2014, were considered. The papers  were searched out by the keywords “cardiac biomarker”, “new cardiac markers”, “coronary diseases”, and “cardiovascular diseases” in Elsevier, Google Scholar, JAMA, Science Direct, Wiley, PubMed, and Iran Medex databases.

Findings. The results indicate that characteristic of each biomarker can play an important role to advance the goals of medicine and harm reduction in the cardiovascular patients. However, despite the high efficiency, routine usage of them is still unclear which indicates the need for further research in this field.

Conclusion. New biomarkers provide new insight about recognition of the causes of cardiovascular diseases, also their easy and rapid application with high sensitivity and predictive value will develop a dramatic change in the diagnosis and treatment of patients with cardiovascular diseases.

Aim. This study aimed at investigating the effect of education based on illness perception on self-care behaviors of patients with heart failure.

Background. Heart failure is the final outcome of most cardiovascular diseases, reducing patients’ self-care behaviors as a chronic condition. Changing illness perception of patients with heart failure about the disease is a way to improve the self-care behaviors in these patients.

Method. An experimental design was used to conduct the study. Seventy and six patients with heart failure who admitted to hospitals affiliated to Tehran University of Medical Sciences and were eligible to participate in the study was recruited in 2014 and were randomly divided into intervention and control group. The intervention group attended in three educational sessions and received cell phone follow-up for 8 weeks. The control group received conventional treatment. The self-care behaviors was compared in both groups before, and eight weeks after the intervention. The data were analyzed by SPSS-16 software.

Findings. There was no statistical significant difference between demographic variables of two groups. Self-care behaviors in the intervention group increased after the intervention when compared with the control group (p<0.0001). In the experimental group, the mean score of self-care behaviors after the intervention was significantly higher than mean score before intervention (p<0.0001).

Conclusion. The results showed that education based on illness perception affects self-care behaviors in patients with heart failure. It is suggested as an effective method to promote the self-care behaviors in these patients.

Aim. The purpose of the present study was to investigate the effect of cardiac rehabilitation on quality of life and return to work in patients with Acute coronary syndrome (ACS).

Background. ACS is one of the major cardiovascular diseases that can affects the patients’ quality of life and return to work.

Method. This was a clinical trial study conducted on 50 patients with ACS admitted to the coronary care units of the selected hospital of Isfahan University of Medical Sciences in 2013-2014. The participants were randomly assigned to control (n=25) or experimental  group (n=25). The experimental group received phase 1 and 2 cardiac rehabilitation program, however, the control group received usual care. The data was collected via demographic questionnaire and SF-36 quality of life questionnaire, before and one month after intervention. Return to work  was estimated through questions  and then was compared in both groups.

Findings. There was no statistically significant difference between experimental and control groups in terms of demographic variables and cardiovascular risk factors. After intervention, in the experimental group, the mean scores in all domains of quality of life increased significantly (p<0.0001). In the control group, the mean score of quality of life, before and after the intervention was not significantly different. A statistical significant difference was found between the experimental and control groups in all domains of quality of life, except for general health and social function, in favor of the experimental group. No statistically significant difference was found between the groups in terms of the duration of  return to work.

Conclusion. The results of this study showed that cardiac rehabilitation program can improve the quality of life in patients with ACS.

Aim. This study was conducted to examine the effect of family-centered education on the quality of life patients after coronary artery bypass graft surgery.

Background. Following coronary artery bypass graft surgery, the patients face many physical, mental and social problems, which reduce their quality of life. Teaching the patient's family provides an opportunity for family members to cooperate actively in taking care and supporting patient, thereby, improve patients' quality of life.

Method. This was an experimental study in which 96 patients with their active family members were recruited according to inclusion criteria and randomly allocated to experimental (n=48) and control group (n=48). Before intervention, SF-12 Quality of Life Questionnaire (QOL) was completed by participants in both groups. Then, experimental group received family-centered education in three sessions and control group received only hospital routine educational program. Quality of life was again measured one month later. The data were analyzed by SPSS version 22.

Findings. There were no statistically significant differences between the two groups regarding demographic characteristics. Based on Mann-Whitney test, a statistically significant increase was observed in scores of QOL dimensions after intervention in the experimental group as compared with control group (P<0.0001).

Conclusion: Family-centered education in patients under coronary artery bypass graft can improve quality of life in these patients.

Aim. The aim of this study was to investigate the role of social capital in healthy lifestyle promotion among people with Coronary Artery Disease (CAD).

Background. Social capital, one of the social determinants of health, plays an important role in promoting healthy lifestyle among people. Due to increasing incidence of CAD, research is needed about social capital and its relationship with healthy lifestyle among people with CAD.

Method. This cross-sectional study was conducted on 412 patients with CAD, including 239 men and 173 women, in 4 different wards (i.e. men and women internal wards, Diplomat and VIP wards) in Shahid Rajaie Cardiovascular, Medical and Research Center from January 2015 to June 2015. Data were collected by demographic characteristic form, Miyamoto et al. social capital questionnaire and researcher-made questionnaire of healthy lifestyle. Validity and reliability were confirmed by content analysis and Cronbach's alpha methods. The data were analyzed using SPSS with appropriate statistical tests. 

Findings. There was a statistically significant difference between social capital in terms of gender (p=0.015). A statistically ssignificant correlation was found between social capital and healthy lifestyle (r=0.418, P<0.01). The highest correlation was observed between social capital and “health responsibility” component (r=0.384, P<0.01) and the lowest correlation was observed between social capital and “abstain from tobacco and alcohol’’ (r=0.107, P<0.01). Among social capital components, “social relationships” had the highest correlation with healthy lifestyle (r=0.511, P<0.01).

Conclusion. Social capital and its components have positive and important effects on healthy lifestyle and its subscales. It is necessary to emphasize community-based programs, such as strengthening social capital in the society to prevent and control chronic diseases, especially heart disease.

Aim. The aim of current study was to assess post-traumatic growth in patients with myocardial infarction (MI).

Background. Post-traumatic growth is defined as subjective positive psychological changes following the struggle with highly challenging life events.

Method. This was a descriptive cross-sectional study in which 166 patients with MI, referred to the cardiac clinics in Bonab and Maragheh, were recruited by convenience sampling. Post-traumatic Growth Inventory (PTGI) was used for measuring PTG. Descriptive  and inferential statistics were used by SPSS version 22 to analyze the data.

Results. The mean PTGI score of the participants was 68.39±19.40, and the most acquired score was observed in the dimension "spiritual changes". The results showed that women and patients with a history of MI within the previous 6 months acquired more score of post-traumatic growth than men (p=0.029) and patients with a history of MI before the recent 6 months (p=0.008), respectively.

Conclusion. The occurrence of MI leads to positive psychological changes as named posttraumatic growth. Nurses and care policymakers can use these findings to help patients in coping with stressful conditions.