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Abstract

Aim.The aim of this study was to describe and interpret the life experience with heart transplantation. Part of the findings was about spiritual development of heart transplant recipients which is reported in this article.

Background.Heart transplantation is one the recent medical innovations that leads to increase in recipients’ life expectancy and quality of life however, these people will face some problems and need to have supported resources.

Method.This study was a qualitative study with phenomenology approach. Participants were 11 heart transplant recipients in Iran.The data was collected through semi-structured interview and analyzed with Dickelmann, Allen and Tanner method.

Findings.One of the main concepts of this study was approaching to God including "trust to God", "belief in destiny", "further belief in God", and "restricted religious rituals" which indicates the spiritual development.

Conclusion.Heart transplant recipients experience high level of spiritual and religious status which help them to overcome  hopelessness, unpredicted problems and heart transplant consequences by trusting God.

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Abstract

Aim. The purpose of this study was to determine the effect of comprehensive-care program on patient satisfaction in patients with minor and moderate trauma (accident, fall and other types of trauma) in emergency department.

Background. Assessment of patient satisfaction is one of the most important indicators of measuring quality of care. Patient satisfaction of nursing services is declining it can be caused by increased awareness of patients about their rights and health care services which leads to an increase in patient expectations of health care services. Comprehensive care program is one of the ways to increase patient satisfaction.

Method. This clinical trial study was conducted with 104 patients, 52 in each control and experimental groups. The experimental group received comprehensive-care program from the moment of entering emergency department to the discharge of emergency department and the control group received the usual nursing care. After implementing comprehensive-care program and at the end of the patient stay, the patient satisfaction in two groups was measured using a modified form of satisfaction questionnaire. The data analysis was done by SPSS software, version 22 using descriptive and inferential statistics.

Findings. The mean score of the total satisfaction was 32.02 (relatively appropriate) and 45.6 (appropriate) after intervention in control and experimental groups, respectively. There was a statistical significant difference between the mean score of total satisfaction of the groups after intervention (p<0.001).

Conclusion. Implementing comprehensive-care program increases the rate of the patient satisfaction. Therefore, it is recommended to managers and staff of the health care centers and educational centers to apply comprehensive care program.

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Abstract

Aim. This study examines the effect of mindfulness-based cognitive therapy on depression in male patients with coronary artery disease.

Background. After heart events such as acute myocardial infarction, the patient experiences psychological distress. Approximately 65 percent of anxiety symptoms predict poor quality of life reduce return to work and increase risk of mortality.

Method.This is an experimental study with two groups and three stages. Forty male patients with coronary artery disease were randomly allocated to either control or trial group after they had been detected as having a "Beck depression inventory" score of one standard deviation higher than the mean score. The mean score of depression was also evaluated in both groups, immediately and two months after the intervention experimental group. The data were analyzed by SPSS Version 19 and covariance analysis.

Findings.The results showed a statistically significant difference between groups in terms of depression score, immediately and two months after intervention in experimental group (P<0.0001).

Conclusion.Based on the effect of mindfulness-based cognitive therapy on reducing depression in patients with coronary artery disease, it is suggested to implement this method for these patients.

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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.

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Abstract

Aim. The aim of this study was to evaluate nurses' views about visiting in coronary care unit (CCU).

Background. Social support includes emotional and instrumental support provided by family and friends who visit the patient. Visiting is shown to be influential on patients' recovery. On the other hand, visiting time has been an issue of the medical staff, patients and visitors.

Method.In this descriptive cross-sectional study, 140 nurses working in CCU participated in the study. Data were collected by the use of demographic questionnaire and "The Beliefs and Attitudes Toward Visitation in ICU Questionnaire" (BAVIQ). The data were analyzed by descriptive and inferential statistics using SPSS Version 19.

Findings. Most nurses believed that visiting interferes with direct nursing care (65%), and causes nurses to spend more time in providing information to the patients’ families (82.8%). Most nurses (85%) did not desire to liberalize the visiting policy of their unit.

Conclusion. The results of the study showed that CCU nurses have rather negative viewpoints toward visiting and open visiting policy that is in conflict with emotional needs of patients and their families.

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Abstract

Aim.The purpose of this study was to evaluate nursing students’ skills in cardiopulmonary resuscitation (CPR) in their critical care master course.

Background.CPR is a common procedure in intensive care settings and the nurses have an important role in this regard. To consider the aim of training critical care nursing students, and increasing quality of care in intensive care settings, the evaluation of students’ skills in CPR is essential to determine defects and  plan for improvement.

Method. In this descriptive study, nursing students’ performance was evaluated at the end of educational period of their critical care course using objective structured clinical examination (OSCE). The OSCE included five core skills in CPR: airway management, arterial blood gas (ABG) interpretation, basic life support, electrocardiography (ECG) interpretation and assessment of the level of consciousness.

Findings. The study population consisted of 17 nursing students in the 4^th semester of their critical care master course. The results showed the majority of students (64.7%) had moderate performance to do CPR skills. The best performance was related to assessment of the level of consciousness (52.9%). Basic life support (41.2%), airway management (35.3%) and ECG interpretation (11.8%) ranked as the next best skills, respectively. The worse performance was related to ABG interpretation with 0% pass score.

Conclusion. According to the findings, the performance of the nursing students in CPR is moderate, globally and cognitive skills are lower than psychomotor skills. Problem-based educational strategies and encouragement of active thinking are suggested for improving cognitive skills and more practice to improve all competencies up to desirable level.

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Abstract

Aim.The aim of this study is to clarify the perception and experience of life in Iranian patients after angioplasty.

Background.Regarding the high prevalence of coronary artery disease and increasing number of patients in Iran, and widespread use of medical procedures such as angioplasty for the treatment and due to multiple challenges during the post-treatment which affect different dimensions of lives of patients, an in-depth understanding of the experiences of patients plays a significant role in improving the quality of their lives.

Method. Qualitative approach with content analysis method was used to conduct the study. Purposeful sampling was used to recruit 20 patients who had experienced angioplasty. Data were collected through semi-structured interviews. The interviews were analyzed using qualitative content analysis method.

Findings. During the process of data analysis, four themes reflected the experience and dimensions of life in patients after angioplasty, which included “rebirth, another opportunity”, “revising lifestyle”, “deciding to modify lifestyle” and “the use of available social support resources”.

Conclusion.The results of this study will enhance our understanding of patients' experiences and this, in turn, can guide health care system to support patient care and planning to promote care and unique counseling programs along with understanding of the real needs of the patients.

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Abstract

Aim. This study was conducted to examine the effect of supportive nursing program on depression, anxiety and stress of family members of patients during coronary artery bypass graft surgery.

Background. patient’s family members experience high levels of depression, anxiety and stress during coronary artery bypass graft surgery. Informational and emotional support of family members during surgery may have significant effect on reducing their psychological distress and enabling them to better support of the patient.

Method. This semi-experimental study was conducted on 104 relatives of patients. They were recruited in the study with regard to the inclusion criteria and assigned to either experimental (n=52) or control (n=52) group. The experimental group received supportive nursing program including informational and emotional support. The control group only received routine interventions. Data were collected by demographic form and modified Depression Anxiety and Stress Scale (DASS). The data were analyzed by Chi-squire and T-test using SPSS software, version 21.   

Findings. There were no statistically significant differences between control and intervention group regarding the mean scores of depression, anxiety and stress before surgery. After intervention (at the end of surgery) experimental group reported significantly lower levels of depression, anxiety and stress (P<0.0001).

Conclusion. According to the finding, supportive nursing program could reduce depression, anxiety and stress of family members of patients during coronary artery bypass graft surgery so, we suggest this program as an effective intervention to support family members during coronary artery bypass graft surgery.

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Abstract

Aim.The aim of this study was to examine the effect of heart rehabilitation by resistance and endurance training on functional capacity and quality of life in male patients with myocardial infarction.

Background.Half of all people who have a heart attack will survive, but they might end up with a weakened heart and loss of functional capacity. It is necessary for nurses to gain essential knowledge to improve the patient’s quality of life and functional capacity.

Method. In this experimental study, 24 male patients with a history of myocardial infarction were recruited and randomly allocated to the endurance training group (n=8), resistance training group (n=8), and control group (n=8). Exercise training was implemented for 50-60 minutes at three sessions in weeks for eight weeks. Endurance training was implemented at 60-85% maximum heart rate on treadmill, while resistance training was implemented at 40-70% one repetition (RM) in three sets with leg press, calf elevation, and leg cruel exercises. Before and after intervention, functional capacity was assessed with modified Bruce test and quality of life was evaluated with SF-36 questionnaire for all groups under study. 

Findings.The results showed that there was a statistically significant difference in functional capacity of resistance (P=0.002) and endurance (P=0.03) training group with control group. However, there was not significant difference in quality of life between endurance and resistance training groups.

Conclusion.Resistance and endurance training can improve functional capacity in male patients with a history of myocardial infarction. However, resistance training is more effective than endurance training in improving the functional capacity and quality of life.

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Abstract

Aim.The aim of this study was to compare the effect of written, figurative and written-figurative  training package of myocardial perfusion imaging (MPI) on patients’ cooperation in the nuclear medicine department of Rajaie Heart Hospital.

Background.Coronary artery disease (CAD) is one of the most common causes of deathall over the world and MPI is a well-known diagnostic method for CAD. However, not knowing about the procedure makes the patients anxious and reduces their cooperationand causes personnel of the department to experience fatigue and workload.

Method.A quasi-experimental design was used to conduct the study. One hundred patients, referred to the nuclear medicine department of Rajaie Heart Hospital, Tehran, Iran, were randomly assigned in four groups (25 in the control group, 25 in written training group, 25 in figurative training group, and 25 in combined training group). Two questionnaires were provided including demographics, and a researcher-made questionnaire for evaluation of patients’cooperation. Kruskal-Wallis test and Mann-Whitney U post hoc test were used for data analysis.

Findings.A statistically significant difference was seen between cooperation level of the control group and the other three groups. Figurative training package was the most effective training package.

Conclusion.Explaining the procedure to the patients before myocardial perfusion imaging is a significant action to improve their cooperation, leading to less time waste and better results.

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Abstract

Aim. The aim of this study was to determine the effect of training cardiopulmonary cerebral resuscitation management on knowledge of nurses working in maternity wards of Ganjavian Hospital, Dezful, Iran, in 2013.

Background.Cardiaopulmonary cerebral arrest is one of the most dangerous situations that threats the life and requires immediate and appropriate action to survive and protect life and prevent irreparable/irrecoverable complications of the body vital organs.

Method.This is a quasi-experimental pretest-posttest study in which 40 nurses employed in maternal wards of Ganjavian Hospital in Dezful were recruited. The tool used in this study was a researcher-made questionnaire including 20 questions to determine the knowledge of nurses about cardiopulmonary cerebral resuscitation management. After the content validity and reliability of the questionnaire was confirmed, it was distributed among and completed by the participants, before and after intervention. Training workshop was conducted in the form of lecture and practical training on manikin, 8 hours per day for 2 days in both basic and advanced level. The data were analyzed using SPSS 17.

Findings. Maximum and minimum scores of pretest were 13 and 5, respectively, with a mean of 9.90 and standard deviation 7.9. Maximum and minimum scores of post-test were 15 and 8, respectively with a mean of 11.25 and standard deviation 1.6. There was a statistically significant difference between scores of nurses’ knowledge, before and after training (P<0.0001)

Conclusion.The findings provide strong evidence, supporting the important role of holding continuous in-service training courses of cardiopulmonary cerebral resuscitation to improve scientific qualification of the nurses. It is recommended to put more emphasis on resuscitation management process and standardization of the efforts of resuscitation team during emergency events.

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Abstract

Aim. This paper reviews various positions for neonates admitted to Neonatal Intensive Care Unit (NICU), describes benefits and disadvantages of each position and suggests a clinical guideline to improve development.

Background. It has been known that development of active muscle tone begins at 36 weeks gestation, when the baby achieves a postural state known as physiological flexion. Premature babies suffer from low muscle tone because they have missed out on some or all of the substantial stages of muscle tone development in the uterus. Without appropriate intervention these babies may experience head flattening and cranial molding. Without support, gravity causes preterm babies shoulders and hips flatten onto the bed, often called ‘frog leg position’ and ‘W arm position’. This can result in inappropriate or delayed development and mobility challenges including the inability to crawl, stand, walk and problem in fine motor skills such as hand-mouth co-ordination.

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 based on which 16 papers about neonatal positioning during nursing care were selected. Also, three neonatal textbook were used.

Result. One of the earliest neurodevelopmental strategies in the NICU is therapeutic positioning. Positioning of premature infant is an essential neonatal nursing care. These positions are supine, prone, side-lying, and head up tilted position. Many studies have shown that a variety of outcomes can be affected by different body positioning of premature infants. Every position has its own advantages and disadvantages, so each infant should be individually assessed and positioned according to condition, preferences and behavioral cues. Position changes should be slow and steady, so that the infant doesn’t become distressed and dislodgement of invasive and monitoring equipment can be avoided. Whenever possible, an infant should be touched gently and talked to before changing their position.

Conclusion. It is necessary to ensure that preterm and sick neonates receive individualized positioning appropriate for their musculoskeletal development in order to minimize complications. Infants receiving developmentally supportive care have been demonstrated better medical outcomes including shorter duration of mechanical ventilation and supplemental oxygen support, earlier oral feeding, and shorter hospitalization.

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Abstract  

Background. One of the most important aspects of care and follow-up after coronary artery bypass graft surgery is treatment adherence program. As the long term success of the surgery depends on the treatment of adherence plan.

Aim. The purpose of this study was to evaluate the efficacy of phone and SMS follow-up care on patients' treatment adherence after coronary artery bypass graft.

Method. This clinical trial was performed on patients undergoing coronary artery bypass graft surgery in the heart surgery unit in Tehran hospitals in 2014. In this study, 90 patients were selected purposively and allocated into telephone follow-up group (n=30), SMS follow-up group (n=30) and control group (n=30). Demographic and treatment adherence questionnaire were completed twice (before intervention and two months after the intervention). The telephone follow-up and SMS follow-up groups were given training and booklet before discharge. In telephone follow-up intervention, three calls a week was made for two months and the SMS follow-up group received text messages daily for two months. To analyze the data, Chi-square test, Fisher exact test, t-test and ANOVA, ANCOVA, and Bonferroni test were used.

Findings. There was no statistically significant difference between the telephone follow-up and SMS follow-up groups in terms of treatment adherence scores, before and after intervention. A statistically significant difference was seen between telephone follow-up and control groups (p<0.0001), and SMS follow-up and control groups (p<0.0001) in terms of treatment adherence scores, before and after the intervention.  

Conclusion. Both SMS and telephone follow-up are effective to improve treatment adherence in patients after coronary artery bypass graft. It is suggested to use these interventions for patient following coronary artery bypass graft.

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Abstract

Aim.The purpose of this study was to examine the effect of patient education on postoperative pain perception in patient undergoing Coronary Artery Bypass Graft (CABG).

Background.Pain is a common complication after CABG surgery. Non-pharmacological methods are more favorable than pharmacological agents. 

Method.In this quasi-experimental study, 72 patients who were scheduled for elective CABG surgery  were randomized to experimental (n=36) and control group (n=36). Experimental group received educational intervention about pain control, one day before surgery (20-30 minutes duration), while control group received no intervention. Following transferring to the ICU and 2 hours after extubation, patients’ pain intensity wasmeasured by Johnson’s numerical scale. The measurements wererepeated twice withanintervalof threehours. The type and dosage of pain medication administered during ICU stay were recorded. To analyse the data, descriptive(mean and standard deviation, frequency distribution and percentage) and analytical statistics (Chi-square and Mann-Whitneytest) were used.

Findings.There was no statistically significant difference between two groups in terms of demographic characteristics. Two hours after extubation, there were no statistically significant difference between experimental and control group in the intensity of pain (P=0.313). Pain intensity was significantly lower in experimental group than control group, 5 hours (P=0.015) and 8 hours (P=0.006) after surgery. The results also showedthat the amount ofanalgesics used to relieve post-operativepain was significantly lower in experimental group than control group (P=0.046).

Conclusion.Patient education about pain control may have positive effects on postoperative pain in patients undergoing CABG surgery. This intervention could serve as an effective strategy for nurses to improve pain management among these patients. 

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Abstract

Aim.The purpose of this study was to examine the effect of white noise on the anxiety of patients in the Cardiac Care Unit (CCU).

Background. Many patients with cardiovascular disease suffer from some degree of anxiety after admission to CCU. Anxiety adversely affects patients' recovery.

Method.This was a quasi-experimental study conducted in ShaheedRajaei Cardiovascular Center, Tehran in 2014. Ninety patients admittedto 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). Anxiety was measured in both groups for 2 consecutive days by 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, the difference between mean scores of anxiety, before and after intervention was not statistically significant (5.17±3.90 and 4.73±3.77, respectively p=0.08). In the experimental group, the difference between mean scores of anxiety, before and after intervention was statistically significant (5.38±3.87 and 4.58±3.71, respectively p=0.01). 

Conclusion.The white noise can reduce the anxiety of patients admitted to CCU. This method can be used as a simple and low-cost non-pharmacological intervention for these patients.

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Abstract

Aim. This study assessed the knowledge of nurses about arterial blood gases interpretation in intensive care units of selected hospitals in Tehran.

Background. Measurement of arterial blood gases are widely used in intensive care units. The knowledge and mastery in interpretation of arterial blood gases is an essential skill for critical care nurses.

Method. This descriptive-analytical study was conducted on 117 nurses working in intensive care units at selected military hospitals in Tehran in 2013. Data were collected using a questionnaire consisted of 45 questions about personal and professional information, also in the domain of blood gases interpretation based on Bloom's classification of knowledge (judgment and evaluation phase). Data are analyzed by SPSS and descriptive and inferential statistics were presented.

Findings. Knowledge of intensive care unit (ICU) nurses was moderate to poor in arterial blood gas interpretation. A statistically significant difference was seen between the knowledge of the subjects in terms of some variables. Conclusion. Given the importance of arterial blood gases interpretation in ICUs, it is necessary to pay attention to in-service and continuing education programs for nurses.

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Abstract

Aim. The study was conducted to examine the effect of passive range of motion exercises on motor function of patients in acute phase of stroke.

Background. Stroke is one of the most common cerebrovascular disorders. Continuous repetitive exercises in the first six month of stroke may restore significant part of sensory-motor function.

Method. In a randomized controlled trial, the patients with moderate or sever ischemic stroke who experienced hemiparesis or hemiplegia were recruited. Motor function level of defected limb was assessed based on “modified ashworth scale” and motor strength scoring tool. Patients in experimental group (n=37) received passive range of motion exercises, within the 48h of onset of stroke, 6-8 times with 30-45 minutes duration. Patients in control group (n=24) received conventional care. The groups were compared one month after intervention.

Findings. The most recovery was found in upper extremity strength after first month (3.45) relative to basic assessment (2.36). In experimental group, motor strength of upper and lower extremity improved, one month after intervention (P<0.0001). The results showed recovery in motor strength just in upper extremity of control group, after one month (P=0.012). Intervention had no effect on muscle tone.

Conclusion. According to more positive changes in motor function of experimental group after one month, it is suggested to apply the intervention for this group of patients.

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Abstract

Aim. This study aimed to examine the effect of music intervention on anxiety in patients with heart failure.

Background. Anxiety as a psychological problem can increase heart rate, respiration rate and blood pressure all of which have an advert effect on heart in patients with cardiovascular disease, particularly patients with heart failure.

Method. This controlled clinical trial study was conducted in Doctor Shariati Hospital affiliated to Tehran University of Medical Sciences. In this study, in each group (control, and music intervention), 25 hospitalized patients with heart failure were recruited through convenience sampling. Then, patients were allocated to groups by simple randomization. Data were collected by demographic characteristic form and Spiel Berger anxiety assessment questionnaire. In music group, music including two of the three types of classical, gentle and Iranian traditional music was played for 20 minutes after meeting for 3 sequential days by a tape recorder and headphone. Before and 15 minutes after intervention, patients' anxiety was measured and compared. Data was analyzed by using independent t-test, Paired t-test, Fisher’s exact test through SPSS.

Findings. There was a statistically significant difference between control and music intervention groups regarding anxiety score. Also, there was a statistically significant difference, before and after music intervention in anxiety score of patients with heart failure (p<0.0001).

Conclusion. The findings indicated that music intervention significantly reduces anxiety in patients with heart failure. Because of the importance of anxiety reduction in patients with heart failure, it is proposed that music intervention be used in the care of these patients.

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Aim. The aim of this study was to investigate the effect of applying checklist on intra-hospital transport of intensive care patients. Background. Intra-hospital transport of intensive care patients who are at risk of cardiovascular and respiratory instability can lead to physical harm and death. Therefore, prevention through increasing awareness staff about the dangers is a necessity. Method. A quasi-experimental before-after design was used to conduct the study. At first, in a hospital affiliated to Tehran University of Medical Sciences, the quality of 50 cases of intra-hospital transport observed using a checklist during day shifts. Then, intra-hospital transport checklist was given to critical care nurses to be used in cases of patient transport. One month later, the quality of 50 cases of intra-hospital transport observed using a checklist during day shifts. The data were analyzed by SPSS version 21. Findings. The results showed a statistically significant difference between the mean score of the quality of intra-hospital transport, before and after intervention (49.26±9.87 against 54.95±10.27) (P=0.006). Conclusion. Applying checklist improves intra-hospital transport of intensive care patients. It is recommended to use this checklist for intra-hospital transport of intensive care patients to increase patient safety and reduce the complications of in-hospital transport .

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Abstract

Aim. The aim of this study was to determine the prevalence of risk factors of cardiovascular diseases (CVD) in elderly of Kashan.

Background.The Iranian elderly population is rapidly growing. It is estimated that more than 10 percent of country population would be elderly in the forthcoming twenty years. Structural and physiological changes occurring in the elderly’s cardiovascular system are associated with a higher incidence of CVD in the elderly. Coronary heart disease is the most common cause of death in the elderly.

Method.This cross-sectional study was conducted on 500 people over 60 years old in Kashan city, Iran, in 2014. Subjects were randomly selected from10healthcare centers of Kashan. A questionnaire was used to collect data including demographics, underlying diseases and risk factors for CVD. The data analyzed using descriptive statistics through SPSS 11.5.

Findings.The prevalence of risk factors for CVD was high among elderly people.

Conclusion. Teaching individuals, controlling risk factors and screening are suggested. It is also recommended that elderly people  increase physical activities and cease smoking.