The aim of this study was to compare attitude of the last-year nursing and medical students studying at Iran University of Medical Sciences, Tehran, Iran about spiritual care

Background

The spirituality is a complex and multidimensional concepts including cognitive, behavioral and experimental aspects. For promoting spiritual care we have to consider the physical, mental, emotional and spiritual aspects of the human. The studies showed that many patients believe that spirituality plays an important role in their life they believe there is a positive relationship between their recovery and religious and spiritual aspects. Many patients expect health care personnel consider these factors

Method

A descriptive comparative design was used to conduct the study. “Spiritual care perspective scale” (SCPS) was completed by 110 nursing and 220 medical students. Data were analysed by SPSS.

Findings

Based on the findings, 56% of nursing students and 51.8% of medical students have positive attitude on the spiritual care of patients. There was no statistically significant difference between attitudes of the two groups of students. Nursing students had more favorable attitude about existing a superior force or transcendental existence influencing spiritual health. Medical students had more favorable attitudes about considering spiritual care as part of the caring performance.

Conclusion

Aim. The aim of this study was to determine prevalence and causes of fever in hospitalized

patients at intensive care unit (ICU) and its associations with the demographic characteristics .

Background. Fever is a common problem. About 70% of hospitalized patients in the ICU have

fever, which can lead to increased mortality rate in them.

Method. This descriptive analytical study was conducted on 110 patients in the Intensive Care

Units of Sanandaj educational hospitals who had no fever on arrival in the ICU and had a higher

temperature than the 38.3°C, after 24 hours. Data were collected from March to July 2008 by a

standard questionnaire which completed and coded by the researcher. The data were analyzed by

using SPSS software.

Finding. The findings showed that the infectious causes of fever were respectively infections

caused by catheter (38.02%), ventilator associated pneumonia (34.5%) and complications caused

by wounds infections (14.5%) also the majority of non-infectious causes of fever were due to

aspiration pneumonia (29.1%). The Chi-square test showed statistically significant correlations

of age (P<0.01), duration of hospitalization (P<0.05) and the Glasgow Coma Scale (GCS) of

patients (P <0.01) with fever.

Conclusion: Fever incidence in the ICU patients is a relatively common complication. In this

study, the frequency of this complication is similar or even lower than studies done in other areas

and indicates that, despite of lower health care facilities in the study area, the principles of infection

control and patient care has been considered.

Abstract

Aim. This study was conducted with the aim of evaluating mental health status in critical care nurses working in Coronary Care Unit (CCU), Intensive Care Unit (ICU), Emergency Department (ED) and dialysis ward in teaching hospitals of Tehran, Iran.

Background: Nursing is known as a difficult profession which needs an endless patience and tolerance with patients and their families. Furthermore, nurses must update theirs knowledge in all nursing-related topics, but it seems that it is so hard for nurses to update knowledge and at the same time, do their professional tasks such as meeting patients and family needs which occupy nearly all their time. This could run them at risk mentally and physically. Besides, it is much more possible for critical care nurses to be affected because of aggravated work-related stresses.

Method: This is a cross- sectional descriptive study. The sample included 375 critical care nurses with at least one year of nursing experience and six months of working in critical care wards. The convenience sampling method was used. Three valid and reliable questionnaires were used in this

study: "Chalder Fatigue Questionnaire", "Hamilton Anxiety Rating Scale", and "Pittsburgh Sleep Quality Index". Questionnaires were filled by study participants and the data were analyzed by SPSS.

Findings: The findings revealed that %73 of nurses experienced mild levels of anxiety, and %16.5 of them reported mild to moderate levels of anxiety. The remaining had either moderate to severe or severe levels of anxiety. Regarding sleep quality, %89.2 of the samples had bad sleep quality. In terms of fatigue, all participants reported moderate to severe fatig.

Conclusion: Critical care nurses in teaching hospitals of Tehran do not have satisfying mental health status. Most of them are suffering from bad sleep quality, moderate to severe fatigue, and mild or mild to moderate anxiety.

Abstract

Aim. The aim of this study was to evaluate complications of intravenous Streptokinase therapy in acute myocardial infarction patients admitted to the cardiac intensive care unit.

Background. Myocardial infarction is a common disease and the use of thrombolytic agents such as Streptokinase reduces its mortality, but there are some complications associated with streptokinase.

Method. In this descriptive stud y 120, patients treated with streptokinase were evaluated in terms of complications of the drug. A checklist of Streptokinase complications was used to collect the data. The findings were presented in the form of descriptive and inferential statistics.

Findings. According to the finding s, %33.3 of patients had cardiovascular complications, %23.9 developed allergic symptoms, and %17.5 suffered blood complications.

Conclusion. The incidence of cardiac complications was the highest among patients. It is recommended to train nurses to avoid possible complications.

Abstract

Aim. This study examined the effect of using simulation training method on enabling student nurses in advanced pre-hospital care.

Background. Disaster nursing includes especial operational skills to manage disasters victims. These skills mainly include advanced pre-hospital care. To teach these skills, simulation in workshop environment is one of the most valuable and effective methods, one type of which is the use of live models in scenarios of various events that can be implemented and practiced in simulated

environment.

Method. This study was conducted by a quasi-experimental design in which 7 30th semester student nurses were recruited by census sampling and undergone training by simulation method. In this study, three tools (questionnaire, clinical evaluation form, and self-assessment form) were used. The data were managed and analyzed by SPSS, version 16. Findings. At the end of workshop in a simulated environment, %100 of students scored at good level. Also, in terms of pre-hospital skills, %100 of students scored at proficient level. In addition, after the workshop, %100 of students evaluated themselves at completely dominant level.

Conclusion. The results of this study indicate that training by simulation method can teach student nurses the knowledge and necessary skills for pre-hospital emergency care in the best way. Besides, it can improve students' self-assessment on their capabilities.

Abstract

Aim. The aim of this study was to examine the effect of self-care education on quality of life in patients following pacemaker implantation.

Background. One of the most common causes of death after myocardial infarction is arrhythmia resistant to treatment. This type of arrhythmia can be managed by pacemaker. The quality of life after pacemaker implantation is usually low, and self-care education may be a method to address this issue.

Method. In a randomized clinical trial study, 80 patients, candidate for permanent pacemaker implantation at Rajaie Cardiovascular, Medical and Research Center, were recruited to either control or experimental group through the blocked randomization. Data were collected using demographic form and the MacNew health-related quality of life questionnaire. The experimental group patients, in accompany with one first-degree relative, received one session of self-care education on the preimplantation day. The content of this 30 minutes session was "how to use educational footage and pamphlets, and also, a face-to-face education. At the end of the session, the patients were given an "educational package". Following implantation, the experimental group patients were contacted once a week for one-month period. The data were analyzed by SPSS, version 15, using inferential statistics.

Results. There were no statistically significant difference between the experimental and control groups in the mean scores of emotional, physical, and social aspects of quality of life and overall quality of life, before self-care education however, after intervention, a statistically significant difference was found in all these variables between experimental and control groups (P=0.004).

Conclusion. Self-care education could have an effect on the quality of life of patients after permanent pacemaker implantation.

Abstract

Aim. The aim of this study was to determine the current quality of triage in intensive care units for patients admitted to hospital emergency departments in ShahidBeheshti University of Medical Sciences in 2012.

Background. Accurate and rapid patient triage in emergency departments is the key to a successful performance. The study and understanding of the current condition and evaluation  of the  educational needs of triage nurses are highly important.

Method. This study is a retrospective descriptive study in which the data were gathered via in a list of ESI  triage forms. To determine the content validity of data collection tools was used. In this study, the reliability of the test listed under triage nurse was both between observers and reliability with Intraclass Correlation Coefficient (ICC) : 0.857 was specified.

Findings. In this study,23% of the case were undertriage and 11.7% were overtriage.The most of undertriage cases was level 3 based on Emergency Severity Index  (ESI) system. There is a direct correlation between the mortality and hospitalization in the Intensive Care Unit (ICU) and undertriage.

Conclusion. There was no statistically significant difference between proper triage and undertriage cases in  mean length of hospital stay, duration of hospitalization and emergency department waiting time for the first visit of  the emergency physician.

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. This study was conducted with the aim of evaluating the effect of spritual care based on «GHALBE SALIM» model on spritual experiences of the patients who have undergone coronaryartery bypass surgery.

Background. Patients undergoing open heart surgery, experience a crisis in their life. Every crisis is considered as a spiritual crisis and creates a unique experience that is rooted in culture and religion. Spiritual intervention which considers the spiritual mutual experience of the therapist and client is called spiritual care based on «GHALBE SALIM» model.

Method. In this clinical trial, 60 patients, candidated for elective coronary artery bypass graft surgery, were randomly assigned to experimental and control groups. Experimental group received spiritual care based on»GHALBE SALIM» model during hospital stay. The questionnaire Daily Spiritual Experience Scale (DSES) was completed by patients at the time of admission and discharge.

Findings. The level of spritual experiences at the time of hospitalization was not statristically significant between groups. On discharge, after implementing «GHALBE SALIM» model, the level of spritual experiences in experimental group was significantly higher in comparison with control group (P<0.001).

Conclusion. Spiritual care based on «GHALB SALIM» model increases the level of spiritual experiences and could be performed for meeting spiritual needs of patients.

Abstract

Aim. The aim of this study was the assessment of respecting the patient’s privacy in cardiac care units.

Background. Increasing number of people with cardiovascular disease calls for increasing the number of Cardiac Care Units (CCU). The invasive and noninvasive procedures in these units can threaten patient’s privacy.

Method. This descriptive analytic study was conducted on 300 patients admitted to cardiac care units of Tehran›s selected hospitals. The patients were selected by convenient sampling method. Data were collected using a questionnaire consisted of two parts, demographics and privacy questionnaire. The data were analyzed by SPSS software.

Findings. Based on the findings, 50.7% of the sample were Female. Mean age was 61.5=+11.95 year. Mean scores for respecting privacy dimensions ranged from 68.86% for physical privacy to 80.27% for social privacy. There was a statistically significant association of respecting patients privacy with age, sex, marital status, education and history of hospitalization.

Conclusion. Patient s privacy was respected in CCUs, but patient’s privacy is not still respected perfectly. CCU managers should pay more attention to this subject.

Abstract

Aim.The aim of this study was to determine the effect of patient teaching on self-care behaviors with media clips in patients with permanent pacemaker.

Background. One of the most common causes of death after myocardial infarction is arrhythmia. One of the methods to control the arrhythmia resistant to treatment is implantation of pacemaker. The studies that have been done on patients with electrical devices show that most of patients don’t have any information about how to take care of their device and need more education for self-care.

Method. This randomized clinical trial was conducted on 80 patients scheduled to receive permanent pacemakers at Rajaie Cardiovascular, Medical and Research Center in 2012. The patients were recruited to either control or intervention group through block randomization method. Data were collected using demographic checklist. The intervention group patients together with one of their close family members received one session of self-care education on the pre-implantation day. The session was 30 minutes long and contained the use of educational media clip. At the end of the session, the patients were given an “educational package”. Following implantation, the intervention group were contacted weekly for a one-month period. Finally, the variables were compared between the two groups via independent t-test, chi-square test, repeated variance analysis, and using SPSS version 15.

Findings. There were no statistically significant differences between the intervention and control groups (P=0.106) however, after intervention, a meaningful difference was observed in all these variables in the intervention group (P<0.0001).

Conclusion. The results of this study showed that education of self-care behaviors with media clip could have an impact on the self-care of post-pacemaker implantation patients and we recommend this method to improve patient’s knowledge and self-care behaviors and minimize the number of re-hospitalization in these patients.

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.

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.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.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 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.