Abstract

Aim. The aim of this review study is to introduce the cardiac resynchronization therapy through biventricular pacing in treatment of heart failure.

Background. More than 22 million peoples worldwide suffer from congestive heart failure (CHF). As a result of the lack of synchronized contraction, both within and between the ventricles, blood moves through the heart and body at a slower rate. Heart failure impacts on almost all aspects of the quality of life of patients, particularly on mobility. Despite treatment advances such as lifestyle changes, medication and heart surgery, up to %40 of patients with CHF suffer an arrhythmia that further reduces the heart’s ability to beat properly. Cardiac Resynchronization Therapy (CRT) is a new, adjunctive and effective therapy that can relieve CHF symptoms by improving the synchronization of the heart’s contractions.

Findings. According to the studies, after BVP, heart contractility, and left ventricular ejection fraction and stroke volume increase, the incidence of cardiac arrhythmias decreases and some aspects of quality of life such as exercise tolerance improves.

Conclusion. Cardiac resynchronization therapy (CRT) along with other medical options can be safely performed and can relieve CHF symptoms by improving the coordination of the heart’s contractions.

Abstract

Aim. The aim of this review study was to describe psychosocial problems in patients with coronary artery disease and determine strategies to prevent and deal with.

Background. The prevalence of cardiovascular diseases is rising in industrial and developing countries. According to the report of World Health Organization, cardiovascular diseases are accounted for a large percentage of mortalities. The most common cardiovascular disease is coronary artery disease that produces problems for people and worries in community.

Method. A systematic search was conducted on studies published in the last 20 years by using databases such as OVID, PROQUEST, SCIENCE DIRECT, GOOGLE SCHOLAR, EBSCO, SID, MAGIRAN and IRAN MEDEX with keywords such as problems, patients, coronary artery disease and related keywords. Because the aim of this study was describing the psychosocial problems of patients after coronary artery disease, physical problems was excluded.

Findings. About 70 article in English and 20 articles in Persian were found about psychosocial problems after coronary artery disease. Patients' problems were categorized in three categories: educational needs of patients with coronary artery disease, consequences of psychosocial outcomes of coronary artery disease, and different consequences for men and women with coronary artery disease.

Conclusion. Because the heart is a sensitive organ, any heart disease can jeopardize patient identity, and psychosocial effects of heart disease is more prominent than physical effects. So, it is necessary to inform patients about the nature of disease and its causes, and how to implement secondary prevention and rehabilitation to return to work and normal life. Accordingly, continuous care for self-care is of great importance. This can be established by community-based clinics for secondary prevention. Especial attention to issues of women with coronary artery disease is essential.

Abstract

Aim. This paper reviews staff nurses roles in diagnosing and stabilizing neonates with congenital heart disease.

Background. Nowadays, development in managing congenital heart defects has increased survival and quality of life among neonates suffering these defects. Many attempts has been made to detect neonatal congenital heart disease before or immediately after birth, but a large number of neonates with heart problems remain undiagnosed before developing severe signs and symptoms. Although mild forms of the disease may subside spontaneously, severe conditions needs prompt management.

Method. In this literature review, papers published during the last 15 years, were searched out through search engines and data bases: Science Direct, Google Scholar, Ebsco, Pub Med, Ovid, Proquest by the keywords nursing care, congenital heart disease, neonatal, cardiac, and management.

Findings.Twenty three English papers about diagnosis and stabilization of neonatal congenital heart disease and a textbook were selected. The findings are presented within four domains: 1) physical examination, 2) symptoms of disease, 3) management in delivery room and neonatal stabilization, and 4) communication with the parents.

Conclusion. Nurses are the first health care members encounter neonates with congenital heart diseases. Early recognition and stabilization of congenital heart disease is the cornerstone of nursing care of neonates suffering this problem.

Abstract

Aim.The aim of this study is to review the visiting policies, strategies and potential challenges and their different dimensions in ICUs in different societies.

Background. Considering the special needs of patients and their families is one of the essential elements of care in the intensive care units (ICU).

Method.This is a comprehensive review of the studies on different policies about visiting patients in intensive care units, based on  the scientific database. 

Findings.The studies show that despite awareness of the role of family care, visiting hours and related policies in ICUs are still limited due to the medical team concerns. While existing research and evidence do not support these concerns. They show open visiting hours have more benefits for patients and families, however visiting hours   in some societies are still  restricted.

Conclusion. The integration of theory, practice and the use of research findings in improving the quality of care of critically ill patients and their families in intensive care units  is an important part of care. In practice, it is necessary to change the beliefs and attitudes of nurses in intensive care units. Further studies on opening visiting hours in intensive care units and its effect on treatment process is one of the major issues.

Abstract

Aim. The purpose of this paper is to introduce the herbal medicines used for cardiovascular diseases and patient education about these drugs.

Method. This study was a systematic review of herbal medicines used for cardiovascular diseases. Herbal medicines were extracted from databases PubMed, Science Direct, and Highwire (Website of Stanford University) using search keywords Herbal, Hyperlipidemia, Heart failure, Cardiovascular and Hypertension. To describe the effective herbal ingredients, side effects, interactions, and patient education, a nursing book on herbs (Kostka et al, 2005) and the Comprehensive Atlas of Medicinal Plants (Stephen et al, 2004) were used.

Findings. Herbal drugs used for cardiovascular diseases in Iran consist of Antum, Alicom, Diuretic, Olea-crat, Crataegus Microphylla and Cratagus.

Conclusion. Some of cardiovascular diseases can be controlled by herbal drugs. Patient teaching about precaution, interaction and avoidance of arbitrary use of drugs are important.

Abstract

Aim. The purpose of this paper is to describe different types of primary triage methods that are common and applicable in disaster scene in order to familiarize medical team personnel with these methods.

Background. Disaster occurrence is rising all over the world. Primary assessment, treatment and transfer of victims to the medical centers which are away from the disaster scene is important considerations for first responder teams in response phase of disaster management cycle. In this regard, triage is an efficient tool for mass casualty management for which different strategies have been recommended in various countries.

Method. In this review, published articles from 1995 to August 2013 were searched in Ovid, Science Direct, Google Scholar and PubMed data bases by using the keywords Triage, On-scene and Disaster.

Findings. Based on search strategy, 50 English articles were found. Finally, 6 commonly adults triage methods and 2 pediatric triage methods were chosen to be described in this paper.

Conclusion. Regarding the sudden nature of disaster and creating chaos following them, it is necessary for medical team members to apply the appropriate tools for managing mass casualties in attention to limited resources and the large number of victims. In order to perform proper triage method and reduce the amount of error in this procedure, it is necessary to educate correct practices of applicable triage methods to medical team members, Red Crescent workers and volunteers.

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 examine the effect of family presence at the bedside on serum cortisol levels and physiological indexes increasing in stressful situations.

Background.Family has a significant role inrecoveryof patients. Stress andanxiety are perceived reasons for limiting visitation in critical care units.

Method. This was an interventional study performed in intensive care units of three teaching hospitals in Tehran, Iran. Thirty and six blood samples of 18 patients were taken for measuring serum cortisol level and physiological indexes during their admission in the critical care settings with restricted visitation. The samples were taken, before family presence and then, one hour after visitation. Simultaneously, blood pressure and heart rate were recorded. The blood samples were immediately centrifuged and plasma stored at 200C until laboratory measuring. Total serum cortisol level was measured using electrochemiluminescence method. Data were analyzed using SPSS version 21.

Findings.Therewasnostatistically significant difference inserumcortisol levels(P=0.70), systolic blood pressure(P=0.93), diastolic blood pressure (P=0.98), and heart rates(P=0.60), before and after visitation.

Conclusion: Family visitation doesn't cause stress. Unlike some common belief about relationship between family presence and stress in patients, it can be concluded that family visitation can be permitted, if patient desires.

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.

Abstract

Aim.This paper introduces important points on nursing care of dying patients.

Background.Death is part of the human life process. Statistics show that the most common causes of death in America are cardiovascular diseases and cancer. Definition of death, nursing care for dying patients and its importance have been the focus of many studies.

Method.This paper reviews the subject death and dying patients, and introduces nursing care and ethical points to be considered for these patients.

Findings.Dying patients experience different stages from denial to acceptance, and caring these patients in physical and psychological aspects is the responsibility of nurses.

Conclusion.When caring dying patients, palliative care must be considered, because other interventions are no longer effective. This care begins from the time a life-threatening condition is diagnosed and continues to recovery or death and grieving.

Abstract

Aim. This study aimed to assess the domains of patient safety culture issues at Rajaie Cardiovascular, Medical and Research Center in 2012.

Background. Patient safety is a critical component of health care quality. As health care organizations continually strive to improve, there is a growing recognition of the importance of establishing a culture of safety.

Method. This descriptive analytical cross-sectional study was conducted in Rajaie Cardiovascular, Medical and Research Center. Multi-stage random sampling, proportionate to the number of the hospital staff., was used to recruit the participants. The sample consisted of the physicians, nurses, and laboratory personnel. The questionnaire “Hospital Survey on Patient Safety Culture” was used to collect the data.

Findings. The total mean score was 65%. The highest score was achieved by the paraclinical and diagnostic departments in the issue of team-work within organizational units (83%), and the lowest score belonged to the paraclinical and diagnostic departments in the issue of error occurrence (42%) and the intensive care units in the issue of staff affairs (42%).

Abstract

Aim.The aim of this paper is to review studies related to self-care education and quality of life improvement in patients with hypertension.

Background. Hypertension is one of the greatest health problems in the world and also, one of the major risk factors for cardiovascular disease. One of the main aims of health care is improving quality of life. Self-care education can improve the quality of life. Due to the need for recognizing trend of studies related to self-care education and quality of life in patients with hypertension, conducting literature review in this field is necessary.

Method. This article reviews the studies published during the recent 15 years regarding self-care education and quality of life in patients with hypertension that were searched out through scientific databases, including Science Direct, PubMed, Cochrane, Medline, SID, Scopus, CINAHL, OVID, Iran Doc, and Magiranby the keywords “self-care educational program”, “quality of life”, and “hypertensive patients” and their Persian equivalents.

Result. The literature review revealed that few studies have examined the effectiveness of training programs on the quality of life in patients with hypertension. Results showed that patients with hypertension have low quality of life. In some studies, different educational methods were used in an attempt to improve the clinical outcomes of patients and some of these self-care educational programs had positive effects on the quality of life.

Conclusion. The quality of life in patients with hypertension is low. Therefore, because of the importance of quality of life improvement and due to the limitations of the studies, it is essential to conduct further research to investigate the effect of self-care educational program on quality of life in patients with hypertension.

Abstract

Aim.This  review study was done with the purpose of exploring the role of diabetes role in the development of atherosclerosis.

Background.The process of accumulation of fat in the blood vessels is called atherosclerosis. The most important risk factors and aggravating condition of atherosclerosis are the accumulation of carbohydrates and diabetes.

Method.In this study, we reviewed the electronic and manual searches of databases such as Medline, Embase, Springer, Blackwell Synergy, Elsevier, Scopus, Cochran Library and the databases SID, Iran Medex and Magiran within the time period of 2005 -2015.

Findings.The most common cause of death in patients with diabetes is coronary artery disease. Because nitric oxide production is higher in diabetic patients, the process of atherosclerosis occurs more rapidly and coagulation cascade disorder leads to the platelet adhesion, so, diabetic people, especially women, are more prone to atherosclerosis and coronary artery disease.

Conclusion.Nurses can modify several risk factors for atherosclerosis in these patients through education and follow-up, thereby, improving quality of life in these patients.

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 was conducted to evaluate the effect of aromatherapy on ICU nurses' stress.

Background. Nursing, due to its high sensitivity, is known as one of the most stressful professions. ICU nurses experience more stress than other nurses. This stress can reduce the quality of patient care and results in nurses' feelings of inadequacy and depression. Aromatherapy, as a method of complementary medicine may reduce anxiety and warring.

Method: This was a quasi-experimental study in which 70 nurses, working in intensive care unit, were divided into experimental and control groups. Nurses' stress were measured before intervention, then intervention (inhalation of Lavendula using tags for 4 consecutive shifts, each shift for 20 minutes) was was applied for the experimental group (control group received no intervention). At the end of intervention in experimental group, the stress was again measured in both groups. Data were analyzed using the Chi-square and t-test in the SPSS, version 20.

Findings. After intervention, the mean of stress in experimental group (20.57±4.20) was not statistically different when compared with control group (22.43±5/24). But, in the experimental group, the mean of stress score after intervention (20.57±4.20) was significantly lower than the mean of stress score before intervention (22.32±4.61) (P=0/001). Comparing the groups, the changes in mean stress score before and after the intervention was statistically significant (P=0.001).

Conclusion: The findings of this study showed that the Lavender essence can reduce stress in ICU nurses. It is recommended that the aroma of lavender be applied to reduce stress in ICU nurses.